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10.1245/ASO.2005.03.030
Annals of Surgical Oncology 12:886-894 (2005)
© 2005 Society of Surgical Oncology
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Original Article

Breast Cancer: Presentation and Intervention in Women With Gastrointestinal Metastasis and Carcinomatosis

Elisabeth C. McLemore, MD1, Barbara A. Pockaj, MD1, Carol Reynolds, MD2, Richard J. Gray, MD1, Jose L. Hernandez, BA3, Clive S. Grant, MD4 and John H. Donohue, MD4

1 Division of General Surgery, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, Arizona 85259
2 Division of Anatomic Pathology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905
3 Division of Biostatistics, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, Arizona 85259
4 Division of Gastroenterologic and General Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905

Correspondence: Address correspondence and reprint requests to: Barbara A. Pockaj, MD; E-mail: pockaj.barbara{at}mayo.edu.

Background: Breast cancer metastatic to the gastrointestinal tract or peritoneum is rare. We reviewed the natural history of ductal and lobular carcinoma in women with breast cancer metastatic to the gastrointestinal tract, peritoneum, or both.

Methods: We performed a retrospective review of all patients (1985–2000) with a pathologic diagnosis of breast cancer metastatic to the gastrointestinal tract or peritoneum. Patients were categorized into three groups: those with gastrointestinal metastasis, carcinomatosis, or both.

Results: Of 73 patients, 23 (32%) had gastrointestinal metastasis only, 32 (44%) had carcinomatosis only, and 18 (25%) had both. The median age at initial breast cancer diagnosis was 55 years. The mean interval between the primary diagnosis and metastatic presentation was 7 years. Sites of gastrointestinal metastases included the esophagus (8%), stomach (28%), small intestine (19%), and colon and rectum (45%). Infiltrating lobular carcinoma represented 34 (64%) of the 53 gastrointestinal metastases. The median overall survival after diagnosis was 28 months. Palliative surgical intervention in 47 patients (64%) did not affect overall survival. Some survival benefit may have accrued to select patients with gastrointestinal metastasis who underwent surgical palliation (44 vs. 9 months). Advanced age at diagnosis and gastric metastases had a negative effect on survival, whereas treatment with systemic chemotherapy or tamoxifen had a positive effect on survival.

Conclusions: Gastrointestinal metastasis occurred more often in patients with invasive lobular carcinoma. Surgical intervention did not significantly extend overall survival but may be considered in a select group of patients.

Key Words: Gastrointestinal metastasis • Carcinomatosis • Breast cancer • Palliative surgery • Survival






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