Recently, a woman in her 60s visited the hospital due to a lump that had formed on her left neck and collarbone, only to be diagnosed with stage 4 colon cancer. This case was published in the medical journal Cureus by doctors at a specialized hospital in Puebla, Mexico. The patient had no typical colon cancer symptoms like bloody stools or changes in bowel habits. Despite this, examinations revealed that the colon cancer had already metastasized to the lymph nodes in her neck and collarbone.

Diverse Symptoms of Colon Cancer

For the past 8 months, the woman had noticed her left neck swelling and had lost approximately 3kg (about 6.6 lbs). A physical examination revealed a cluster of swollen lymph nodes in her left neck. Lymph nodes are part of the immune system, filtering out foreign substances like bacteria and viruses and triggering immune responses. Infections can cause lymph nodes to swell, and when cancer cells spread through the lymphatic system, lymph node enlargement can occur.

Tests for Accurate Diagnosis

Blood tests showed a high level of the tumor marker CEA at 360.7 ng/mL. After a needle biopsy of the enlarged lymph nodes in her neck, the medical team confirmed the presence of adenocarcinoma cells, indicating they had spread from another organ. Subsequent CT scans of her chest, abdomen, and pelvis were performed to assess the extent of cancer metastasis. Enlarged lymph nodes were found in multiple areas, not just the neck, and a section of her colon appeared thickened.

Rare Metastasis

While colon cancer commonly metastasizes to the liver, lungs, peritoneum, and nearby lymph nodes, it is very rare for the initial symptom to be swelling of lymph nodes in the neck or collarbone. In fact, the rate of neck lymph node metastasis from colon cancer is reported to be less than 1%. The lymph nodes above the left collarbone are known as 'Virchow's nodes' and are connected to the pathway where lymphatic fluid from the abdomen ascends through the thoracic duct before entering the bloodstream.

Effective Treatment Methods

Given that the cancer had spread to multiple sites, the medical team decided to proceed with chemotherapy first, rather than surgery. The patient received a combination of oral capecitabine and intravenous oxaliplatin, along with bevacizumab, a targeted therapy that inhibits blood vessel formation for cancer cells. Following treatment, her blood markers significantly improved, and no visible signs of cancer activity were detected in colonoscopy and CT scans. This was evaluated as a 'clinical complete response'.

The medical team emphasized, "Even without gastrointestinal symptoms, unexplained swelling of neck lymph nodes should prompt investigation not only for head and neck cancers or lymphoma but also for gastrointestinal cancers." This case provides a crucial reminder for early cancer detection and treatment.