BERKELEY, CA (UroToday.com) - Distant metastasis from colorectal carcinoma most often occurs in the liver and lungs.
Metastasis to bones, adrenals, lymph nodes, brain, and skin has also been reported. Metastatic colon cancer to the testes is very uncommon. Even more uncommon is testicular metastasis from rectal carcinoma. We searched the English medical literature using the MEDLINE/PUBMED database from 1950 through January 2010. Our search yielded 33 cases of testicular metastasis from colonic or rectal carcinoma. Clinical information was not available on 2 cases. Only one of the reported cases of metastatic testicular tumors was from the rectum and two were from the rectosigmoid. According to the reviewed cases, the median age at presentation was 52 years (range 18-87). These patients were older than those who present with primary testicular tumors. The most frequent site of the colorectal region to metastasize to the testis was the sigmoid, followed by the cecum, rectum then other parts of the colon. This can help physicians make the best estimation of the risk of testicular metastasis from a primary colorectal carcinoma according to the site of the primary tumor.
Various routes of spread of metastatic tumors to the testes have been suggested. These include arterial embolization, retrograde venous spread, retrograde lymphatic spread, direct spread along the vas deferens to the epididymis, as well as transperitoneal seeding through a patent tunica vaginalis. Differentiating primary from secondary carcinoma of the testes depends mainly on the microscopic examination of the testes; suggestive evidence can be pursued from the age of the patient at the onset of symptoms and signs indicating involvement of other organs. Compared to patients with primary testicular tumors, those with secondary testicular tumors present at an older age. Therefore, in older patients who present with a testicular mass, the differential diagnosis must include, in addition to primary testicular tumors, lymphoma, rete testis, melanotic hamartomas and secondary neoplasm among which colorectal metastatic carcinoma should be concluded.
Therapeutic strategies to any metastatic tumour include palliative chemotherapy, radiation and sometimes surgery. In general the role of surgery in metastatic colorectal cancer would aim at palliation of symptoms, control of tumor growth, and nowadays improving survival. Among all aims, quality of life remains the most important. Nowadays resection of metastases to other organs including the lungs is being practiced, and we suggest a similar approach with metastasis to the testes from colorectal cancer. Since there are no randomized clinical trials on resection of testicular metastasis from colorectal cancer, we suggest that surgery be done for palliative intent whether the metastasis was single or multiple, synchronous or metachronous. Pre- or post-operative chemotherapy and targeted therapy remain of clear benefit in improving survival and should be considered.
We recommend that physicians be aware of the risk of metastasis from the colorectal region to the testes in their evaluation of patients with testicular symptoms in the setting of colorectal carcinoma.
Hassan A. Hatoum, MD,1 George S. Abi Saad, MD,2 Zaher K. Otrock, MD,3 Kassem A. Barada, MD,1, and Ali I. Shamseddine, MD,1 as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
1Department of Internal Medicine, 2Department of Surgery, 3Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon