P5013 - A Rare Case of Metastatic Cervical Cancer Involving the Ileum

Brandon K. Chu, MD, Jennifer Vazzano, DO, MS, Peter P. Stanich, MD
The Ohio State University Wexner Medical Center, Columbus, OH

Introduction: Cervical cancer is the fourth most common cancer in women. Most have localized or locally invasive disease at diagnosis, but 15% have distant metastases. The most frequent metastatic sites include the lungs, bone, and liver. Small bowel involvement of cervical cancer is rare. We present an unusual case of metastatic cervical cancer with ileal involvement in a patient who presented with small bowel obstruction (SBO) and concern for ileitis.

Case Description/Methods: A 62-year-old woman with a history of human papillomavirus-associated squamous cell carcinoma of the cervix (in remission) status post hysterectomy with salpingo-oophorectomy, external beam radiation therapy, and brachytherapy presented with four months of worsening nausea, vomiting, and intermittent right lower quadrant abdominal pain. Initial labs revealed mild hypokalemia and mildly elevated CRP. A CT abdomen and pelvis showed a high-grade SBO with a transition point in the right lower quadrant. She was treated supportively initially, but symptoms persisted. A subsequent CT revealed small bowel wall thickening of the ileum with a transition point at the terminal ileum suspicious for underlying IBD versus radiation enteritis. She was trialed on empiric corticosteroids and referred for further evaluation. A colonoscopy was considered but deferred given her obstruction. She ultimately underwent an exploratory laparotomy with small bowel resection. Pathology from the small bowel resection revealed moderately differentiated squamous cell carcinoma with transmural involvement consistent with metastatic cervical cancer. She was then initiated on systemic chemo-immunotherapy.

Discussion: Our case demonstrates the need for a wide differential as cause of bowel obstruction in the setting of a history of malignancy, even when suspected to be in remission. There are only a few reported cases of cervical cancer with small bowel invasion. Complicating this case was the involvement of the ileum and the history of radiation exposure, which generated an anchoring bias for the initial differential diagnosis. Although corticosteroids may be used in patients with IBD or radiation enteritis, data supporting their use in malignant bowel obstructions is limited. Surgical, cancer-directed, or palliative therapies are the current recommended treatment options. We hope that this case brings awareness to a rare, but important consideration for metastatic cervical cancer.



Disclosures:


Brandon K. Chu, MD, Jennifer Vazzano, DO, MS, Peter P. Stanich, MD. P5013 - A Rare Case of Metastatic Cervical Cancer Involving the Ileum, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.