[Seetal]

hi guys
Goljan says (n he repeats this) that primary mets cancer to liver is from lung n secondary from colon. but FA says primary from colon n lastly by lung. who is right?

albeit goljan emphasized that he knows better.
because when i did FA QnA there was a question so i answered lung, but the answer was colon... sigh...

 

[dazzles]

Look at the patient's situation. You have to see if the patient is a smoker or nonsmoker. If the patient is a smoker then he/she probably has lung cancer metastasizing to the liver. If the patient is a non-smoker then he/she probably has colon cancer metastasizing to the liver.

 

[ashishkabir]

Well this is confusing - medscape has completely different info:

http://emedicine.medscape.com/article/369936-overview

Pathophysiology

Common primary sites
Metastasis is the most common neoplasm in an adult liver; the liver is the second most common site for metastatic spread, after the lymph nodes. Analyzing the data from 9700 consecutive autopsies in patients with 10,736 primary cancers, Pickren et al found that liver metastases were present in 41%.4,5 They found that the primary sites most commonly metastasizing to the liver are the eye (77.8%), pancreas (75.1%), breast (60.6%), gallbladder and extrahepatic bile ducts (60.5%), colon or rectum (56.8%), and stomach (48.9%). Gilbert et al reported that the liver is a primary target organ of gastrointestinal (GI) cancers, some urologic cancers, neuroblastomas, some melanomas, and lung cancers.6 In breast cancer, the liver is less often the primary target organ. The liver may be the only organ involved in colorectal primaries, HCCs, and neuroendocrine tumors.

I'd say stick with colon as the right answer because it seems that both papers found more GI metastasis than lung but I definitely remember Goljan saying lung

 

[Seetal]

yeah i think first we look at the question n examine the sign n symptoms, but if the symptoms are vague, like fatigue, then go with colon.

 

[Sabio]

The exact discussion a year ago

This exact question was posted almost a year ago here
http://www.usmle-forums.com/usmle-step-1-forum/1085-most-common-metastasis-liver.html