Abdominal carcinomatosis in women with a history of breast cancer
Introduction
Breast cancer is the most common malignancy among women in the United States. The current 5-year relative survival rates of 97% and 78% for localized and regional disease, respectively, indicate that a significant proportion of breast cancer patients will experience prolonged survival [1]. Although the risk of breast cancer recurrence diminishes over time, late recurrences well into the second decade of surveillance can occur. Among patients with metastatic breast cancer, extra-hepatic and extra-skeletal abdominal locales account for 10% of cases. Ascites and carcinomatosis may be present in as many as 5.4% and 2.6% of cases, respectively [2].
The female genital system is a common site of second primary non-mammary malignancies. Specifically, a personal history of breast cancer is associated with a two to four-fold increase in the risk of ovarian cancer [3]. In breast cancer patients, the clinical distinction between recurrent metastatic breast cancer and a new, second primary malignancy of the ovary or peritoneum can be difficult. The clinical relevance of this distinction is predicated on the disparate management strategies for ovarian/peritoneal cancer (cytoreductive surgery followed by platinum-based combination chemotherapy) compared to metastatic breast cancer (hormonal therapy versus chemotherapy). Consequently, the goals of this study were to: (1) characterize the etiology of abdominal carcinomatosis in women with a history of breast cancer, (2) identify clinical features predictive of primary ovarian/peritoneal cancer, and (3) evaluate the survival impact of cytoreductive surgery among patients with advanced ovarian/peritoneal cancer subsequent to a diagnosis of breast cancer.
Section snippets
Methods
Approval to conduct this study was obtained from the Johns Hopkins Medical Institutions (JHMI) Clinical Research Committee and Joint Committee on Clinical Investigation. All patients with a personal history of primary breast cancer who subsequently underwent clinical management for a diagnosis of abdominal carcinomatosis at the JHMI between 1/1/88 and 12/31/02 were identified through the JHMI Tumor Registry, the Kelly Gynecologic Oncology Service clinical database, and the Department of
Patient characteristics
A total of 1501 patients with a history of recurrent breast cancer (n = 1274) or breast cancer with another primary site of malignancy (n = 227) were identified through the JHMI databases during the study interval. Of these, 79 patients were documented as presenting with abdominal carcinomatosis ≥30 days subsequent to the diagnosis of primary breast cancer. The demographic characteristics of patients with breast cancer diagnosis are shown in Table 1.
The median patient age at breast cancer
Predictors of primary ovarian/peritoneal cancer
Multivariate logistic regression analysis of demographic and clinical variables revealed that only AJCC Stage I breast cancer (odds ratio [OR] = 10.73, 95% confidence interval [95%CI] = 2.6–43.7, P = 0.001) and the absence of a prior breast cancer recurrence (OR = 10.60, 95%CI = 2.5–45.2, P = 0.001) were independently and statistically significantly associated with a diagnosis of primary ovarian/peritoneal cancer versus recurrent breast cancer (Table 2).
Although not statistically significant,
Surgical outcome and survival analysis
All patients underwent a minimum of exploratory laparotomy or diagnostic laparoscopy with tissue biopsy, which was the only procedure performed in 9 cases. Additional procedures were performed with the following frequencies: unilateral or bilateral salpingo-oophorectomy (n = 68), omentectomy or omental biopsy (n = 59), total or supracervical hysterectomy (n = 54), tumor cytoreduction (n = 43), retroperitoneal lymph node sampling (n = 39), small bowel resection (n = 11), large bowl resection (n
Discussion
Breast cancer and ovarian cancer rank as the second and fifth leading causes of cancer-related death, respectively, among United States women [1]. One in eight women will have breast cancer during their lifetimes and one in 70 will be diagnosed with ovarian cancer [3]. Currently, about half of all patients with a diagnosis of breast cancer will experience a recurrence and one third will die of their disease [11].
Several factors may predispose a patient to develop both breast cancer and ovarian
References (19)
- et al.
Distribution of metastases in breast carcinoma: CT evaluation of abdomen
Clin. Imaging
(1991) - et al.
Selecting a patient characteristics index for prediction of medical outcomes using administrative claims data
J. Clin. Epidemiol.
(1995) - et al.
Nongenital cancers metastatic to the ovary
Gynecol. Oncol.
(1992) - et al.
Metastatic breast carcinoma to the abdomen and pelvis
Gynecol. Oncol.
(1997) - et al.
Breast cancer metastatic to abdomen and pelvis: role of surgical resection
Gynecol. Oncol.
(2003) Cancer facts and figures: American Cancer Society, Inc.
(2003)- et al.
Genetics of breast and ovarian cancer
(2004) - et al.
Nonparametric estimation from incomplete observations
J. Am. Stat. Assoc.
(1958)
Cited by (20)
Peritoneal metastases from extra-abdominal cancer – A population-based study
2018, European Journal of Surgical OncologyCitation Excerpt :The clinical distinction between recurrent metastatic breast cancer and primary peritoneal malignancy or peritoneal metastases of ovarian origin is not clear. In patients with a history of breast cancer, peritoneal carcinomatosis is more likely to result from ovarian or primary peritoneal malignancy than from recurrence of primary breast cancer in patients with AJCC stage 1 breast cancer and patients with no previous history of recurrence [37]. Pathological differentiation between primary peritoneal papillary serous carcinoma, an uncommon epithelial tumour, and ovarian papillary serous carcinoma is difficult and criteria to differentiate between the two requires examination of the ovaries [38].
Ovarian cancer presenting as an axillary mass: Case series and literature review
2016, Current Research in Translational MedicineCitation Excerpt :Imaging should be performed if tumor suspicion results from these immunohistochemical methods. Ovarian carcinoma and metastases to the axillary area are clinically relevant because they bring with them a different prognosis and a likely requirement for alternative treatment strategies [9,10]. The fundamental aim for these patients is to decrease the tumor burden through cytoreductive surgery.
Outcome and clinical-biological characteristics of patients with advanced breast cancer undergoing removal of ovarian/pelvic metastases
2012, Annals of OncologyCitation Excerpt :These data are likely to confirm the positive role of surgery, although this is not a randomized trial. There are at least four retrospective studies reporting a trend toward a significant improvement in survival when patients are treated with radical surgery for pelvic metastases rather than with a debulking [8, 9, 14, 17]. A similar trend was evident in our series of patients who had a median OS of 81 months after radical pelvic surgery versus 39 months after a no radical surgery, although it was not statistically significant (log-rank P = 0.27).
Investigating women with suspected ovarian cancer
2008, Gynecologic OncologyPeritoneal Metastases from Extraperitoneal Primary Tumors: Incidence, Treatment, and Survival from a Nationwide Database
2023, Indian Journal of Surgical Oncology