Gastric and Colon Metastasis From Breast Cancer: Case Report, Review of the Literature, and Possible Underlying Mechanisms

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the ONA take:

The most frequently reported sites of breast cancer distant metastases are the bone, liver, lung, and brain; metastases in the gastrointestinal tract are less common. In lobular carcinoma, the incidence of extrahepatic gastrointestinal tract metastases is estimated between 4% and 18% from autopsy studies, with the stomach being the organ most often affected, followed by the colon and rectum. 

In a case study published in Breast Cancer: Targets and Therapy, the authors describe a 58 year old women with hormone receptor (HR)-positive, HER2-negative invasive lobular carcinoma and 20 to 25 affected axillary nodes who ultimately relapsed 3 years after surgery and adjuvant chemotherapy. Upon relapse, the patients presented with simultaneous gastric and colonic mucosal metastases, as well as gastritis by Helicobacter pylori (H. pylori).

After 6 courses of capecitabine, a PET scan revealed a hypermetabolic lesion in the second lumbar vertebra, the patient developed pancytopenia, and a biopsy showed metastasis in the bone marrow. The patient then received multiple chemotherapy regimens and hormonal therapies, including bevacizumab plus carboplatin and paclitaxel with zoledronic acid, cisplatin plus gemcitabine, vinorelbine, liposomal doxorubicin, and other aromatase inhibitors, but she eventually developed brain metastases and passed away.

The authors hypothesized that a combination of H. pylori, inflammatory cells, and chemokines may have created a favorable environment for tumor cells to spread. Further studies are necessary to determine the true role of these factors in the progression of breast cancer to the gastrointestinal tract.

Breast Cancer: Targets and Therapy journal
Breast Cancer: Targets and Therapy journal

Abstract: Gastrointestinal metastases from breast cancer are not common. We present a 58-year-old female diagnosed with lobular breast cancer some years before whose relapses were gastric and colonic mucosal. Simultaneous metastases are extremely rare. To our knowledge, no cases of initial dual affectation have been reported. The patient also showed gastritis by Helicobacter pylori. Invasive lobular breast carcinoma is the most frequent special type of breast cancer and carries some specific molecular alterations such as loss of expression of E-cadherin. Although underlying mechanisms of metastasization are not entirely known, chemokines as well as inflammatory events seem to be implicated in this process. Interaction between chemokines and their receptors frequently induces cell migration. We hypothesize that Hpylori, inflammatory cells, and chemokines may create a favorable environment attracting tumor cells.


Keywords: chemokines, gastrointestinal metastases, Hpylori, lobular carcinoma 

INTRODUCTION

Breast cancer is the most frequent malignancy among women. Approximately 16,000 new cases are diagnosed each year in Spain. The 5-year survival rate is constantly increasing, which implies a growing prevalence in almost all developed countries. Modern adjuvant treatment regimens have yielded a reduction in relapses and higher cure rates.

Relapses have been reported in 30%–80% of patients in spite of surgery, chemotherapy, and radiotherapy, but are rare in early-stage breast cancer.1 The most common sites of distant metastases are in bone, liver, lung, and brain.

Lobular carcinoma is less likely to involve the gastrointestinal tract. The incidence of extrahepatic gastrointestinal tract metastases observed in autopsy studies varies from 4% to 18%, with the most commonly affected organ being the stomach, followed by colon and rectum.2,3 Nevertheless, coexisting solitary metastases to both stomach and colon are extremely rare.  

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