Krukenberg tumors of colorectal origin: a dismal outcome-experience of a tertiary center

Krukenberg tumor (KT) is described as metastases of the ovary usually from a tumor of gastric origin. As colorectal cancer (CRC) is now the most common cancer in Singapore, we are seeing more KT with colorectal origin. To determine the pattern of presentation of KT from CRC origin in terms of patient demographics, time of onset related to the diagnosis of CRC, presence of elevated serum tumor markers, carcinomatosis peritoneii, and survival of patients. A retrospective database review of all patients diagnosed with KT from CRC treated in a specialized colorectal surgery department between August 1992 and March 2004. Twenty-five patients' records were available for analysis. Median age at diagnosis was 53 years old (range: 38-79). Sixteen patients (64%) had ovarian metastasis at the time of diagnosis of the CRC. Eleven patients (44%) had unilateral ovarian involvement. Nineteen patients (76%) had carcinomatosis peritoneii. Serum Carcinoembryonic antigen (CEA) was available for 21 patients, 18 (86%) were raised; serum cancer antigen-125 (CA-125) was available for seven patients, five (71%) were raised. There were 11 mortalities (44%) and all died of the disease. Median time between diagnosis of KT and death was 19 months. The rest of the patients were alive with existence of disease at last follow-up. KT is associated with a dismal outcome and poor prognosis. There was 0% disease-free survival. Serum CEA and CA-125 tend to rise in patients with KT. Patients investigated for elevated CA-125 and unilateral ovarian mass should have the diagnosis of colorectal cancer excluded before treatment of ovarian mass.