Left Cervical Lymphadenopathy Presentation of Metastatic Colorectal Adenocarcinoma

Background: Colorectal adenocarcinoma, the third most diagnosed cancer in males and the second most diagnosed in females, commonly presents with changes in bowel habits, rectal bleeding, weight loss, fatigue, and abdominal pain. We report the case of a patient with colorectal cancer who had an unusual initial presentation.

Case Report: The patient reported dizziness, and physical examination revealed cervical lymphadenopathy. Fine needle aspiration of the lymph node supported a diagnosis of adenocarcinoma, and colonoscopy found a mass in the hepatic flexure that was biopsied and identified as adenocarcinoma. The patient was treated with 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX) and bevacizumab. Imaging and physical examination 4 months later confirmed resolution of the mass and lymphadenopathy.

Conclusion: The patient is regularly followed by hematology/oncology and his primary care physician. He has shown no evidence of recurrence to date. This case supports the necessity of a complete workup and imaging when any solid lymphadenopathy is present.