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Does colon cancer ever metastasize to bone first? a temporal analysis of colorectal cancer progression

Eira S Roth1, David T Fetzer1, Bruce J Barron2, Usha A Joseph3, Isis W Gayed3 and David Q Wan3*

Author affiliations

1 Medical Students, The University of Texas Medical School, Houston, USA

2 Visiting Professor, University of Texas Medical School, Houston, USA: Emory University hospital Midtown, 550 peachtree street, NE Atlanta Georgia 30308, USA

3 Department of Diagnostic and Interventional Imaging, The University of Texas Medical School, Houston, MSB 2.130B, 6431 Fannin Street, Houston, Texas 77030, USA

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Citation and License

BMC Cancer 2009, 9:274  doi:10.1186/1471-2407-9-274

Published: 7 August 2009



It is well recognized that colorectal cancer does not frequently metastasize to bone. The aim of this retrospective study was to establish whether colorectal cancer ever bypasses other organs and metastasizes directly to bone and whether the presence of lung lesions is superior to liver as a better predictor of the likelihood and timing of bone metastasis.


We performed a retrospective analysis on patients with a clinical diagnosis of colon cancer referred for staging using whole-body 18F-FDG PET and CT or PET/CT. We combined PET and CT reports from 252 individuals with information concerning patient history, other imaging modalities, and treatments to analyze disease progression.


No patient had isolated osseous metastasis at the time of diagnosis, and none developed isolated bone metastasis without other organ involvement during our survey period. It took significantly longer for colorectal cancer patients to develop metastasis to the lungs (23.3 months) or to bone (21.2 months) than to the liver (9.8 months). Conclusion: Metastasis only to bone without other organ involvement in colorectal cancer patients is extremely rare, perhaps more rare than we previously thought. Our findings suggest that resistant metastasis to the lungs predicts potential disease progression to bone in the colorectal cancer population better than liver metastasis does.