YO3 - Metastatic Breast cancer to esophagus: A case report and review of literature

Case summary

METASTATIC BREAST CANCER TO ESOPHAGUS: A CASE REPORT AND REVIEW OF THE LITERATURE

Secondary esophageal carcinoma from a breast primary is an infrequent phenomenon occurring in around 0.4% of patients. It is pertinent to rule out esophageal metastasis when a patient of breast carcinoma present with dysphagia after a long DFS. Most esophageal metastasis are usually submucosal deposition, requiring EUS-FNB for diagnosis. Given the rarity of this presentation and failure of diagnosis by simple mucosal biopsy during patient’s lifetime, there is a general lack of consensus on management guidelines in these patients.

Herein we report a case of 65 year old female presented with dysphagia who was subsequently diagnosed with esophageal metastases, 14years post surgery for breast cancer. She was treated with a combination of systemic Chemotherapy, hormonal therapy and local radiotherapy comprising both external beam radiotherapy(EBRT) and Intraluminal radiotherapy(ILRT). We also performed a comprehensive review of literature on esophageal metastases from breast primary, aiming to improve the diagnostic accuracy and treatment efficacy in this rare presentation. Our patient tolerated the treatment well and achieved a significant symptomatic improvement post Radiotherapy. Reviewing various literature, we observed 83% patients presented with complaints of dysphagia after a median of 13 years post breast surgery, with 72% metastases involving mid thoracic esophagus while majority were hormonally receptive.

We conclude that patients presenting with dysphagia post breast cancer treatment, should undergo EUS-FNB to rule out esophageal metastasis. While surgical interventions were effective treatment in some cases, we suggest systemic Chemotherapy with Hormonal therapy, and radiotherapy for local control as the management of choice in these patients. Even though prognosis is difficult to predict , this combined modality of treatment seems to achieve a better overall survival.

Clinical trial identification

Editorial acknowledgement