Lower extremity pain as initial presentation of cervical cancer☆

The diagnosis of bone metastases in cervical cancer defines advanced disease with a median overall survival of b1 year (Matsuyama et al., 1989; Abdul-Karimet al., 1990). Themost common bones affected are the lumbar spine and pelvis; distal extremity metastases are rare, accounting for b5% of bone metastases (Ratanatharathorn et al., 1994; Rangarajan et al., 2010). High-dose palliative radiotherapy provides significant symptomatic relief in approximately 67% of cervical cancer patients (Matsuyama et al., 1989). The overall clinical and personal impact of osseous fractures for patients highlights the importance of clearly defining the management plan for osseous metastases in gynecological cancers. We report a woman who presented with back and lower extremity pain, ultimately found to have cervical cancer. Despite multimodal therapy, the patient passed away 3 months after her initial presentation. This case report also reviews the biology of bone metastases and presents some emerging therapeutic options for these scenarios.