What happened, in summary

A 65-year-old woman had previously been treated for Stage I left breast cancer that was estrogen-receptor positive, progesterone-receptor positive, and HER2-negative. She underwent left mastectomy with sentinel lymph-node biopsy in 2014 and completed 5 years of anastrozole in 2019. She declined chemotherapy. Her last breast-cancer follow-up showed no evidence of disease, documenting at least 5 years of breast-cancer follow-up without recurrence.

Years later, she was hospitalized with chest and abdominal pain, major weight loss, lung abnormalities, numerous liver lesions, and painful visual symptoms. Examination showed metastatic lesions in both retinas. Although her prior breast cancer was an important part of the differential diagnosis, biopsy findings argued against both breast and pulmonary origin and instead favored a gastrointestinal or pancreaticobiliary primary.

After several goals-of-care discussions, she and her family chose comfort-focused care and home hospice. She died within 2 weeks of discharge. The later widespread illness was treated as a separate cancer rather than a recurrence of her earlier breast cancer, and she died shortly after entering hospice.