A 64 y.o. woman presents with pain in the L heel.
What is the differential
This patient had cervical carcinoma metastatic to the calcaneus.
Only 1% of cervical cancer metastasizes to bone. The most common site is the spine and it is usually found at a median of 16 months after diagnosis. There are two types of metastases in cervical cancer; lymphatic and hematogenous. The hematogenous metastases, as in our patient with a distant bone met, are associated with a higher risk of death.
Over the last 40 years the number of cases of cervical cancer has decreasedby 50%. This is directly related to Pap smear testing which detects cervical cancer in the early stages. However cervical cancer still accounts for 10% of all cancers diagnosed in women. The incidence is highest in African Americans, followed by Asians and Pacific Islanders and then Caucasians. American Indians and native Alaskans have the lowest incidence of cervical cancer. 80% of the cases are in the developing world; with Malawi and Mozambique being the two countries with the highest incidence. In addition to screening programs, cytological examinations must be accurate to decrease the incidence of cervical cancer.. In Mexico for example, screening programs exist but the cytological evaluation is so poor that an estimated 54% of those screened are false negative.
Currently 15% of cervical cancer is diagnosed in women over 65. This is thought to be due to a long latency period of human papilloma virus.
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