Metastasis to Bone from Carcinoma of the Gastro-intestinal Tract

A STUDY of bone metastasis from primary carcinoma situated in the gastro-intestinal tract reveals the incidence to be much higher than is generally thought. In Table I are shown the statistics based upon the findings in 1,005 cases of carcinoma of the gastro-intestinal tract which were admitted to Hines Hospital between Jan. 1, 1931, and Jan. 1, 1939. It is believed that the number would have been much higher if specific studies of bone metastasis in these cases had been made during hospitalization. Special roentgenologic study was made only in the cases in which there were complaints referable to the osseous system. Esophagus.—In Midler's (1) series of 101 cases of carcinoma of the esophagus, metastasis to bone occurred in seven instances, or 6.93 per cent. Limacher (2) reported five from 119 cases of esophageal carcinoma; Clayton (3), two cases in a series of 41, and Willis (4), one in 12 cases. Stomach.—Willis (4) stated that the incidence of skeletal metastasis from carcinoma of the stomach was approximately 5 per cent. In 1935, Kerr and Berger (5) reviewed the literature and found 143 cases of primary gastric carcinoma with metastasis to bone; they reported five additional cases. In a series of 309 cases of gastric carcinoma reported by Nisn-jewitsch (6), bone metastasis occurred in eight instances (2.3 per cent). In Müller's (1) series of 309 cases of gastric carcinoma, bone metastasis occurred in eight cases, or 2.58 per cent. This figure corresponds very closely to the writer's series of 340 cases. Warwick (7) found metastasis to bone in four out of 176 cases of gastric carcinoma, or 2.2 per cent. Her findings were based on postmortem examination. Copeland (8) reported seven instances of bone metastasis in a series of 537 cases of gastric carcinoma. Sutherland, Decker, and Cilley (9) found 1.9 per cent bone metastasis from gastric carcinoma in a series of 1,032 cases of malignant bone metastasis. An incidence of 2.5 per cent is given by Matthews (10) and 5.7 per cent by Warren (11). Lawton (12) reviewed 606 cases of gastric carcinoma and found bone metastasis in only three. In a series of 903 cases reported by Winiwarter (13), bone metastasis was not present. Because of the blood changes found in some cases of carcinoma of the stomach with bone metastasis, the illness may simulate pernicious anemia. Myeloblasts, myelocytes, erythroblasts, marked anemia, and a high color index occur in some patients following bone metastasis. There are many references to this blood picture in the literature. Large and Small Intestine.—There are not enough cases of primary carcinoma of the small bowel in the literature to determine the real incidence of bone metastasis. In my series of 12 cases, bony involvement was present in only one. One case with bone metastasis has been reported by Ghormley and Vails (14); also one by Fort (15).