Loyola University Medical Center Maywood, IL, United States
Eliza Lewine, MD, Judy Trieu, MD, Abdul Haseeb, MD, MPH Loyola University Medical Center, Maywood, IL
Introduction: In the United States, breast cancer is the second leading cause of cancer death in women. Breast cancer rarely metastasizes to the gastrointestinal tract. With significant strides in breast cancer survivorship, gastrointestinal manifestations of recurrent disease are now being recognized on routine/diagnostic endoscopic evaluation.
Case Description/Methods: A 65 year old female with stage IV ER+, HER2+ lobular breast cancer, presented to GI clinic with early satiety, post-prandial vomiting, and a 20-lb weight loss. Cross-sectional imaging demonstrated gastric distension with antral wall thickening. EGD demonstrated severe stenosis at the pylorus requiring neonatal scope passage over a wire to traverse the stricture (Figure 1A, 1B). Biopsies of the stricture were consistent with metastatic breast cancer. Palliative radiation to the pylorus was performed. However, the patient returned with altered bowel habits and given personal history of tubular adenomas, she underwent a colonoscopy. A 2 mm polyp was incidentally found in the transverse colon (Figure 1C). Histology was consistent with metastatic adenocarcinoma with tumor markers (GATA3+, CK7+) supportive of breast cancer primary. She continues ongoing oncologic treatment.
Discussion: Approximately 3-12% of patients with breast cancer will develop GI metastases. Invasive lobular carcinoma is more likely to metastasize to the GI tract than ductal carcinoma. Colonoscopy reveals polyps with biopsies positive for CK7 and mammaglobin and negative for CK20; primary colon cancer is typically CK20-positive. This case illustrates the risk of gastrointestinal metastasis among patients with breast cancer especially lobular carcinoma. Studies demonstrate a timeframe of 1 to 10 years for development of metastasis. With improving breast cancer survivorship, future guidelines should consider earlier colorectal cancer screening, rather than more frequent, for patients with breast cancer diagnosed under 45.
Figure: Figure 1: EGD revealed severe pyloric stenosis (A) that was traversed with an ultra-thin scope over a wire (B). Colonoscopy showed a 2mm polyp (C) in the transverse colon
Disclosures: Eliza Lewine indicated no relevant financial relationships. Judy Trieu indicated no relevant financial relationships. Abdul Haseeb indicated no relevant financial relationships.
Eliza Lewine, MD, Judy Trieu, MD, Abdul Haseeb, MD, MPH. P0221 - Breast Cancer Metastases to the GI Tract in the Era of Improved Breast Cancer Survivorship, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.