A rare metastasis of cervical cancer to the sigmoid colon: a case report and review of the literature
Case Report

A rare metastasis of cervical cancer to the sigmoid colon: a case report and review of the literature

Yu Liu1,2, Xiaoting Zhou1,2, Hongling Peng1,2, Fang Fang1,2, Xiang He1,2

1Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China; 2Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China

Contributions: (I) Conception and design: F Fang, X He; (II) Administrative support: X He; (III) Provision of study materials or patients: F Fang, X He; (IV) Collection and assembly of data: Y Liu, X Zhou; (V) Data analysis and interpretation: Y Liu, H Peng; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

Correspondence to: Dr. Xiang He. 20 South Renmin Road, Block 3, Chengdu 610041, China. Email: popxiang@163.com.

Background: Cervical cancer is a malignant tumor of the female reproductive system with a high incidence. The main ways of metastasis are direct local extension and lymphatic dissemination. Sigmoid colon metastasis as the first site recurrence of cervical cancer is rare. Only a few cases are reported in the literature.

Case Description: We reported a 49-year-old woman diagnosed with cervical squamous cell carcinoma through biopsy. The clinical staging was IB2 and the patient underwent radical hysterectomy, salpingo-ovariectomy, bilateral pelvic lymphadenectomy and para-aortic lymph node sampling through the laparoscope. No lymph node metastasis was found. She did not receive radiotherapy or chemotherapy. The patient had an irregular follow-up. Six months later, gynecological examination and cytology of the vaginal cuff revealed no evidence of recurrence. One and a half years later, the patient had acute intestinal obstruction because of sigmoid lesions. She underwent radical resection, and the postoperative pathological diagnosis was squamous-cell carcinoma of the sigmoid. The patient’s medical history and the pathological type of the tumor suggested that it was a sigmoid metastasis from cervical cancer. However, the patient had no recurrent signs in the vaginal cuff and the pelvic cavity by examination, including physical and auxiliary examinations.

Conclusions: Cervical cancer had multiple metastasis routes. The patient may have distant metastasis without infiltrating adjacent tissues. Regular follow-up is essential. Clinicians should pay more attention to the metastatic locations of cervical cancer, especially some rare sites.

Keywords: Cervical cancer; metastasis; recurrence; sigmoid colon; case report

Received: 11 March 2022; Accepted: 26 October 2022; Published: 25 December 2022.

doi: 10.21037/gpm-22-13

Introduction

Despite the efforts of human papillomavirus (HPV) vaccination, cervical cancer is a common malignant tumor, and the incidence rate is still the fourth worldwide among female tumors. There are estimated 604,127 new cases and 341,831 deaths in 2020 (1), accounting for a large proportion of cancer deaths worldwide (2,3). Although significant advancement in early screening has provided a reliable reference for the early diagnosis and treatment of cervical cancer, up to 20% of early-stage cancer relapse in 5 years, with a poor prognosis and significantly high mortality rates (4). Direct local extension and lymphatic dissemination are the main ways of metastasis. The lung and paraaortic nodes are the most prevalent sites of distant metastases (5). The brain, skin, spleen, muscle, and gastrointestinal tract are rare sites that have only been described in a few cases (6-10).

We reported a case of sigmoid colon metastasis as the first site of recurrence cervical cancer, arising one and a half years after primary surgical therapy, which was successfully treated by surgery. This case provides several lessons for the choice of surgical treatment on adjuvant treatment in patients with early-stage cervical cancer. Additionally, based on current literature, we provide information about the management of cervical cancer patients, hoping to shed light on potential therapy options. We present the following case in accordance with the CARE reporting checklist (available at https://gpm.amegroups.com/article/view/10.21037/gpm-22-13/rc).

Case presentation

We reported a 49-year-old woman admitted to our hospital with a complaint of vaginal bleeding for 4 months in November 2018. All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee(s) and with the Helsinki Declaration (as revised in 2013). Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the editorial office of this journal. One month ago, the patient went to a local hospital and received gynecological physical examinations. There was a mass on her cervix. The HPV detection showed HPV16 was positive. A biopsy was done under colposcopy, and the pathological diagnosis was cervical squamous cell carcinoma. The patient sent the pathological tissue to our hospital for consultation. The pathological results were consistent with the local hospital.

The menstrual cycles of the patient were regular in the past. Four months ago, she had abnormal vaginal bleeding without abdominal pain, abdominal distension, lower limb edema, flank pain, and sciatica. The medical and surgical history was not special except for asthma controlled well. The reproductive history was gravida 2 para 1 (G2P1).

There were no pathological signs of metastasis before surgery. The patient did not have the symptoms of pelvic sidewall invasion (limb edema, flank pain, and sciatica), bladder invasion (vesicovaginal fistula), and rectum invasion (rectovaginal fistula). On gynecological physical examination of bimanual examination and rectovaginal examination, she was found to have a mass less than 4 cm confined to the cervix with contact bleeding. The uterus and parametria were flexible, and vaginal fornix was not involved. Besides, there was also no metastasis evidence on imaging evaluation. The chest X-ray showed normal. The abdominal and pelvic enhanced computed tomography (CT) scanning showed the inferior muscle layer and cervix of the uterus were heterogeneous enhanced. No significant thickness of the parametrial tissue was observed. In addition to the uterus, there was no evidence of other lesions and enlarged lymph nodes. The patient was clinically diagnosed with stage IB2 cervical cancer according to the International Federation of Gynecology and Obstetrics (FIGO 2018). The patient chose radical hysterectomy, salpingo-ovariectomy, bilateral pelvic lymphadenectomy, and para-aortic lymph node sampling through the laparoscope. During the operation, we carefully examine the abdomen and pelvis, including the small intestine, omentum, peritoneum, colon, sigmoid colon, and other organs. The peritoneal surfaces were noted to be smooth, and no visible lesions were found in other tissue. The operation went smoothly, and the uterus with the lesion was completely taken out through the vagina. The lesion residual was R0.

The postoperative pathological diagnosis is cervical moderately differentiated squamous cell carcinoma with one-third cervical stromal invasion. The tumor size was 3.5 cm. The operation margins, including parametrial extension, ligaments and vagina were all negative. There was no lymphovascular invasion. No lymph node metastasis was found in the bilateral pelvic and para-aortic lymph nodes. Immunohistochemistry showed CK5/6+++, P16++, P63++, P40++, and Ki67 was 90% positive. After the operation, she did not receive radiotherapy or chemotherapy. The patient was discharged in a week and relatively good health. The patient had poor compliance and an irregular follow-up. Six months later, gynecological examination and cytology of the vaginal cuff revealed no evidence of recurrence.

One and a half years later, the patient was admitted to a local hospital with repeated abdominal pain and vomiting for about one month. An emergent CT scan revealed acute intestinal obstruction and sigmoid lesions. A sigmoid tumor was suspected to be the cause of the obstruction. She underwent radical resection of the sigmoid tumor. The postoperative pathological diagnosis was squamous-cell carcinoma of the sigmoid. Considering the patient history and the tumor pathologic type, it was thought to be a sigmoid metastasis from cervical cancer. However, the patient came to our hospital again, and no recurrent signs were found in the vaginal cuff and the pelvic cavity by our examination, including HPV DNA test, ThinPrep cytology test (TCT) test and pelvic CT scan. The timeline of disease progression was shown in Figure 1.

Figure 1 Timeline of disease progression. HPV, human papillomavirus.

Discussion

Cervical cancer is one of the most common gynecological cancers, with higher incident rates and mortality in developing countries. Implementing HPV vaccines and early detection including Pap smear, liquid-based cytology and HPV test have markedly reduced the incidence and mortality of cervical cancer in part of the world (11). However, recurrence or distant metastasis poses a considerable challenge due to limited therapeutic options and poor prognosis. Pelvic is the most common site of recurrence (12). Distant metastasis of recurrences involves the lungs (69%), bone (21%), gastrointestinal tract (14%), liver (13%), brain, and other sites (5). Unusual metastases have been reported in the skin (6), thumb (13), spleen (14), kidney (9), and skeletal muscle (15). Colonic metastases, especially isolated sigmoid colon metastasis of cervical cancers, are exceedingly rare (16), probably due to relatively short intestinal segment. To date, only 6 cases of sigmoid colon metastasis are reported in the literature, and three are isolated (16-21). Table 1 provides a simple review of the published cases of rare metastases from cervical cancer in the English literature, including the 6 cases of sigmoid colon metastasis (6,8,9,13-27).

Table 1

Clinical features of reported patients with recurrence from cervical cancer

No. Age (years) Histology FIGO stage [date of diagnosis] Approach of surgery Non-operative therapy Metastasis sites Time of recurrence Treatment Outcome Reference Year
1 29 SCC IB1 [2017] Fertility sparing total LRT None Sigmoid and rectum 8 months Surgery, adjuvant chemotherapy and radiation therapy In remission (3 months) Shen et al. (17) 2019
2 47 SCC SCC in situ [2014] NA NA Sigmoid colon 4 years Surgery and debulking NA Lelchuk et al. (18) 2018
3 45 SCC IB1 [2013] NA None Small intestine and sigmoid colon 3 years Segmental intestine resection and chemotherapy During chemotherapy Yu et al. (16) 2016
4 57 Cervical adenocarcinoma NA NA NA Sigmoid colon 5 years Sigmoid resection NA Damin et al. (19) 2014
5 37 Adenosquamous carcinoma IB [2010] Robotic-assisted laparoscopic radical hysterectomy None Sigmoid colon 2 years Partial sigmoid resection and chemotherapy In remission (2 months) Barlin et al. (20) 2013
6 57 SCC IB [2006] NA None Sigmoid colon (colovesical fistula) 4 years NA NA Chen et al. (21) 2010
7 63 SCC NA Laparotomy Postoperative chemoradiotherapy Jejunal 8 months Surgical resection In remission (30 months) Onal et al. (22) 2015
8 46 SCC IB1 [NA] Laparoscopic radical hysterectomy None Abdominal wall invading the small bowel and the bladder 2 years Neoadjuvant chemotherapy followed by surgical debulking and adjuvant chemotherapy In remission (18 months) Chou et al. (23) 2020
9 46 SCC IB1 [NA] NA Chemotherapy and radiotherapy Spleen, ileal 17 months Resection of a segment of ileum lesion laparoscopically and splenectomy, chemotherapy During chemotherapy Dixit et al. (14) 2016
10 31 SCC IIB [NA] NA Neoadjuvant chemotherapy and radiation therapy Spleen 18 months Splenectomy and adjuvant chemotherapy In remission (1 year) Bacalbasa et al. (24) 2017
11 60 Adenosquamous carcinoma IIA [2011] NA Radiation therapy Left abdomen skin 38 months Chemotherapy Death (4 years) Katiyar et al. (6) 2019
12 35 SCC IIA [1998] Laparotomy Postoperative radiotherapy Incisional skin 3.5 years Salvage chemotherapy Death Srivastava et al. (25) 2005
13 75 Adenocarcinoma IB2 [NA] NA Adjuvant chemotherapy Skeletal muscle 5 years Salvage surgery In remission (10 months) Omokawa et al. (15) 2020
14 34 SCC IIIB [2015] None Chemotherapy and radiation Kidney and paraspinal muscle 21 months Right nephrectomy and radiotherapy Death (5 months) Rodriguez et al. (9) 2019
15 52 SCC IIIB [2012] None Cisplatin and concurrent radiation Skeletal muscle 2 years Local radiation with concurrent chemotherapy In remission (2 years) Varadarajan et al. (8) 2017
16 58 Adenocarcinoma IIB [NA] None Chemoradiation and
radiotherapy		 Right thumb 6 months None Death (4 months) Gallardo-Alvarado et al. (13) 2020
17 48 Adenocarcinoma IB1 [2017] Robotic-assisted radical hysterectomy Chemoradiotherapy Liver and pancreatic lymph node, right adrenal gland, and bones 3 months Chemotherapy Death (6 months) Tong et al. (26) 2019
18 68 Adenocarcinoma IB [NA] NA Radiation therapy Appendix 16 years Laparoscopic appendectomy NA Fukai et al. (27) 2021

FIGO, the International Federation of Gynecology and Obstetrics; SCC, squamous cell carcinoma; LRT, laparoscopicradical trachelect; NA, not available from original literature.

Retrospective data suggest that minimally invasive surgery (MIS) techniques (standard laparoscopy or robotic-assisted laparoscopy) cause less blood loss, shorter hospital stay, and lower postoperative complications (28,29). Hence, this patient chose to be treated with laparoscopic radical hysterectomy, salpingo-ovariectomy, bilateral pelvic lymphadenectomy and para-aortic lymph node sampling. However, the perceived oncologic safety of MIS has been challenged by the LACC trial. The large phase 3 randomized trial involved 631 patients with stage IA1 (lymphovascular invasion), IA2, or IB1 cervical cancer during the 2008–2017 period, comparing the recurrence and overall survival of MIS and open surgery. The results showed that minimally invasive radical hysterectomy had shorter overall survival and lower rates of disease-free survival than open surgery (30). Similar findings were reported in a retrospective study conducted by Melamed et al. published on The New England Journal of Medicine (NEJM) (31). Moreover, Uppal et al. confirmed that early-stage cervical cancer patients undergoing minimally invasive radical hysterectomy had inferior recurrence-free survival (32). Another single-institution, retrospective study including 582 early-stage patients suggested a high risk of peritoneal recurrence in the MIS group compared with the abdominal radical hysterectomy group (33). Regardless of the limitations of the trial design, these unexcepted results could be attributed to several potential factors, such as a less extent of operative field exposure than open surgery, the use of uterine manipulator and CO2 gas insufflation causing the propensity for tumor spillage, and incorrect manipulation (32,34). In the present case, the reasons for sigmoid colon metastases are not clear. The hypothesis that MIS caused tumor spreading could not be ruled out. Considering that laparoscopic surgery is currently controversial, surgeons performing MIS should have great proficiency and be meticulous during the surgery. Importantly, the tumor-free principle should be insisted on. The experienced surgeons should evaluate the patient thoroughly and resect all lesions as possible.

Furthermore, routine post-treatment follow-up visits are advised every 3–4 months for the first 2–3 years, then at 6-month to 5-year intervals, and annually for life (12). History taking, physical examinations and auxiliary examinations should be performed carefully to check the treatment complications at each visit. Hence, in addition to detecting the vaginal stump regularly by HPV testing and cervical cytology, CT or magnetic resonance imaging (MRI) are also recommended to evaluate the distant region relapse in some special circumstances such as involved high pelvic lymph nodes (12). Once the rectal extension is suspected, proctoscopy may be considered. However, this patient had poor compliance and an irregular follow-up.

Cervical cancer had multiple metastasis routes, including direct extension, lymphatic channels and hematogenous route (35). The patient may have distant metastasis without infiltrating adjacent tissues. We reported an unusual case of a patient presenting with sigmoid obstruction caused by tumor metastasis from cervical cancer. Clinicians should pay more attention to the metastatic sites of cervical cancer, especially some rare sites.

Acknowledgments

Funding: This work was supported by Department of Science and Technology of Sichuan Province (funding number: 2018JY0609).

Footnote

Reporting Checklist: The authors have completed the CARE reporting checklist. Available at https://gpm.amegroups.com/article/view/10.21037/gpm-22-13/rc

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://gpm.amegroups.com/article/view/10.21037/gpm-22-13/coif). FF and XH serve as unpaid editorial board members of Gynecology and Pelvic Medicine from June 2022 to May 2024. The other authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee(s) and with the Helsinki Declaration (as revised in 2013). Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the editorial office of this journal.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

  1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68:394-424. [Crossref] [PubMed]
  2. Cohen PA, Jhingran A, Oaknin A, et al. Cervical cancer. Lancet 2019;393:169-82. [Crossref] [PubMed]
  3. Enokida T, Moreira A, Bhardwaj N. Vaccines for immunoprevention of cancer. J Clin Invest 2021;131:146956. [Crossref] [PubMed]
  4. Salani R, Khanna N, Frimer M, et al. An update on post-treatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncology (SGO) recommendations. Gynecol Oncol 2017;146:3-10. [Crossref] [PubMed]
  5. Fagundes H, Perez CA, Grigsby PW, et al. Distant metastases after irradiation alone in carcinoma of the uterine cervix. Int J Radiat Oncol Biol Phys 1992;24:197-204. [Crossref] [PubMed]
  6. Katiyar V, Araujo T, Majeed N, et al. Multiple recurrences from cervical cancer presenting as skin metastasis of different morphologies. Gynecol Oncol Rep 2019;28:61-4. [Crossref] [PubMed]
  7. Taga S, Sawada M, Nagai A, et al. Splenic metastasis of squamous cell carcinoma of the uterine cervix: a case report and review of the literature. Case Rep Obstet Gynecol 2014;2014:798948. [Crossref] [PubMed]
  8. Varadarajan I, Basu A, Besmer S, et al. Solitary Skeletal Muscle Metastasis as First Site of Recurrence of Cervical Cancer: A Case Report. Case Rep Oncol 2017;10:694-8. [Crossref] [PubMed]
  9. Rodriguez J, Castro JC, Beltran M, et al. Simultaneous Metastasis from Cervical Cancer to the Kidney and Paraspinal Muscle: A Case Report. Cureus 2019;11:e4148. [Crossref] [PubMed]
  10. Pyeon SY, Park JY, Ulak R, et al. Isolated brain metastasis from uterine cervical cancer: a case report and review of literature. Eur J Gynaecol Oncol 2015;36:602-4. [PubMed]
  11. Chrysostomou AC, Stylianou DC, Constantinidou A, et al. Cervical Cancer Screening Programs in Europe: The Transition Towards HPV Vaccination and Population-Based HPV Testing. Viruses 2018;10:729. [Crossref] [PubMed]
  12. Bhatla N, Aoki D, Sharma DN, et al. Cancer of the cervix uteri: 2021 update. Int J Gynaecol Obstet 2021;155:28-44. [Crossref] [PubMed]
  13. Gallardo-Alvarado L, Ramos AA, Perez-Montiel D, et al. Hand metastasis in a patient with cervical cancer: A case report. Medicine (Baltimore) 2020;99:e20897. [Crossref] [PubMed]
  14. Dixit J, Mohammed N, Shetty P. Splenic Metastasis from Cancer of Uterine Cervix-a Rare Case. Indian J Surg Oncol 2016;7:479-83. [Crossref] [PubMed]
  15. Omokawa N, Mabuchi S, Iwai K, et al. Skeletal muscle metastasis as a first site of recurrence of cervical cancer: A case report and review of the literature. Medicine (Baltimore) 2020;99:e20056. [Crossref] [PubMed]
  16. Yu X, Wang Z, Zhang Z, et al. Postoperation of cervical cancer with intestine metastasis: a case report and literature review. World J Surg Oncol 2016;14:2. [Crossref] [PubMed]
  17. Shen W, Huang Y, Zhou Y, et al. Intestinal metastasis after total laparoscopic radical trachelectomy for stage IB1 cervical cancer: A case report. Gynecol Oncol Rep 2019;28:37-40. [Crossref] [PubMed]
  18. Lelchuk A, Morin N, Bain K. Squamous cell carcinoma of cervix origin with rare metastasis to the colon. AME Case Rep 2018;2:23. [Crossref] [PubMed]
  19. Damin AP, Agnes G, Tarta C, et al. Human papillomavirus detected in a colonic metastasis of cervical adenocarcinoma. Tech Coloproctol 2014;18:515-6. [Crossref] [PubMed]
  20. Barlin JN, Kim JS, Barakat RR. Recurrent cervical cancer isolated to the sigmoid colon: A case report. Gynecol Oncol Case Rep 2013;6:28-30. [Crossref] [PubMed]
  21. Chen KY, Hsu CH, Kao CH, et al. Colovesical fistula in a patient with recurrent cervical cancer detected by FDG PET/CT. Clin Nucl Med 2010;35:808-10. [Crossref] [PubMed]
  22. Onal C, Nursal GN, Torer N, et al. Isolated jejunal metastasis in a patient with cervical cancer: A case report. Rep Pract Oncol Radiother 2015;20:239-42. [Crossref] [PubMed]
  23. Chou J, Strzyzewski L, Timmers C, et al. Cervical cancer recurrence presenting as abdominal wall mass and accompanying cellulitis. Gynecol Oncol Rep 2020;33:100619. [Crossref] [PubMed]
  24. Bacalbasa N, Balescu I, Marcu M, et al. Solitary Splenic Metastasis After Surgically-treated Cervical Cancer - A Case Report and Literature Review. Anticancer Res 2017;37:2615-8. [Crossref] [PubMed]
  25. Srivastava K, Singh S, Srivastava M, et al. Incisional skin metastasis of a squamous cell cervical carcinoma 3.5 years after radical treatment--a case report. Int J Gynecol Cancer 2005;15:1183-6. [Crossref] [PubMed]
  26. Tong J, Yu H, Li J, et al. Short-term recurrence and distant metastasis following robotic-assisted radical hysterectomy with pelvic lymphadenectomy and chemoradiotherapy for a stage IB1 cervical adenocarcinoma: A case report and literature review. Medicine (Baltimore) 2019;98:e15387. [Crossref] [PubMed]
  27. Fukai S, Lefor AK, Mizokami K. Laparoscopic appendectomy for metastatic cervical cancer presenting as appendicitis. Surg Case Rep 2021;7:114. [Crossref] [PubMed]
  28. Hill EK. Updates in Cervical Cancer Treatment. Clin Obstet Gynecol 2020;63:3-11. [Crossref] [PubMed]
  29. Shazly SA, Murad MH, Dowdy SC, et al. Robotic radical hysterectomy in early stage cervical cancer: A systematic review and meta-analysis. Gynecol Oncol 2015;138:457-71. [Crossref] [PubMed]
  30. Ramirez PT, Frumovitz M, Pareja R, et al. Minimally Invasive versus Abdominal Radical Hysterectomy for Cervical Cancer. N Engl J Med 2018;379:1895-904. [Crossref] [PubMed]
  31. Melamed A, Margul DJ, Chen L, et al. Survival after Minimally Invasive Radical Hysterectomy for Early-Stage Cervical Cancer. N Engl J Med 2018;379:1905-14. [Crossref] [PubMed]
  32. Uppal S, Gehrig PA, Peng K, et al. Recurrence Rates in Patients With Cervical Cancer Treated With Abdominal Versus Minimally Invasive Radical Hysterectomy: A Multi-Institutional Retrospective Review Study. J Clin Oncol 2020;38:1030-40. [Crossref] [PubMed]
  33. Sert BM, Kristensen GB, Kleppe A, et al. Long-term oncological outcomes and recurrence patterns in early-stage cervical cancer treated with minimally invasive versus abdominal radical hysterectomy: The Norwegian Radium Hospital experience. Gynecol Oncol 2021;162:284-91. [Crossref] [PubMed]
  34. Bogani G, Ghezzi F, Chiva L, et al. Patterns of recurrence after laparoscopic versus open abdominal radical hysterectomy in patients with cervical cancer: a propensity-matched analysis. Int J Gynecol Cancer 2020;30:987-92. [Crossref] [PubMed]
  35. Zhou Y, Rassy E, Coutte A, et al. Current Standards in the Management of Early and Locally Advanced Cervical Cancer: Update on the Benefit of Neoadjuvant/Adjuvant Strategies. Cancers (Basel) 2022;14:2449. [Crossref] [PubMed]
doi: 10.21037/gpm-22-13
Cite this article as: Liu Y, Zhou X, Peng H, Fang F, He X. A rare metastasis of cervical cancer to the sigmoid colon: a case report and review of the literature. Gynecol Pelvic Med 2022;5:35.

Article Options

Download Citation

Share