Tuesday, April 29, 2014

Floor-of-the-mouth metastasis of colorectal cancer

Occasionally, a primary cancer in another part of the body will metastasize to the mouth region - either to the soft tissues or to the jawbones. The most common sources of such oral metastases are cancers in the breast, lung or kidney. Colorectal cancer usually metastasizes to the liver and lungs; metastases to the oral region are uncommon and have a poor prognosis. Singh et al. have reported an unusual case from Bangalore, India, where a colorectal tumor metastasized to the floor of the mouth.  

Colorectal cancer metastasis to the floor of the mouth. Patients with metastatic spread to the oral cavity usually fare poorly; despite treatment, this woman died after less than a month. Image from: Singh et al. (2011)

A 42-year-old woman was admitted to hospital in December 2003 with a 10-day history of blood and mucus in the stool. It turned out that she had a large tumor that began 4 cm above the anal verge and caused an obstruction. A biopsy was performed, and histologic examination revealed an adenocarcinoma. The patient underwent surgery and the entire tumor was excised. Histological examination revealed a mucinous adenocarcinoma of the rectum extending through the whole muscular layer with invasion of the serosa. There was nodal involvement (two lymph nodes), and the cancer was staged T3N1M0. Postoperatively, she received a course of radiotherapy to the whole pelvis, and afterwards, 6 cycles of chemotherapy (5-fluorouracil/leucovorin). 

She remained symptom free until January 2007, when she was readmitted to the hospital because of persistent lower abdominal pain. A CT scan of the abdomen revealed a lesion, which turned out to be a recurrence of adenocarcinoma. The patient was treated with 6 cycles of FOLFOX4 (oxaliplatin, folinic acid and 5-fluorouracil), and a CT scan of the abdomen subsequently showed that the lesion had disappeared.

Within 2 months, however the patient was readmitted with a growth in the floor of the mouth. A punch biopsy was performed. Histopathological examination revealed a well-differentiated adenocarcinoma, and the original primary and floor-of-mouth metastases were morphologically similar. She was treated with chemotherapy, but two cycles of chemotherapy elicited no response, and the growth was progressively increasing in size. Chemotherapy was stopped and she was treated with radiotherapy. She did not respond to this treatment either and succumbed to the disease after 20 days.

Singh T, Amirtham U, Satheesh CT, Lakshmaiah KC, Suresh TM, Govind Babu K, Ramachandra C. (2011) Floor-of-mouth metastasis in colorectal cancer. Ann Saudi Med. 31(1): 87-89.


  1. I was looking for articles on dentist in India and I came across yours inspiring read.
    Great post! Thanks!

  2. Omg this is shocking! read some great dental care tips here to prevent such diseases.