Late pheo metastasis

Some people with pheo will unfortunately develop metastasis. The most common organs that pheo metastasize to are the bones, liver, and lungs. There are a few predictors of pheo metastasis risk such as certain pheo-predisposing gene mutations (e.g. SDHB), primary tumor size, and histological findings (e.g. the PASS score). In clinical practice, the metastasis risk of an individual patient is pretty hard to predict. Some patients are followed for years after pheo resection. Shall we continue following them?

Once in a while, pheo metastasis is found many years after pheo resection. The record is 53 years. I have a patient who was found to have metastasis 52 years after pheo resection. It is not to say that the metastasis happens only after these many years. Based on studies of other cancers, metastasis likely happens before the pheo resection. The metastatic lesions remain microscopic and dormant. Years later, due to unclear reasons, the tiny lesions awaken and begin to grow, kind of like what happened in those dormant spy movies. Thus I favor continued pheo surveillance even in patients with a remote pheo history. I have diagnosed pheo metastasis in a couple of such patients.

Dr. Pheo