Invasive lobular breast cancer with colonic metastases treated with colectomy and capecitabine

What happened, in summary

This 57-year-old woman was diagnosed in 2018 with invasive lobular carcinoma of the left breast. Her initial breast cancer was pT1cN1a, estrogen receptor positive, progesterone receptor positive, and HER2/neu negative. She underwent quadrantectomy of the left breast and left axillary lymph-node dissection after a positive sentinel node biopsy, then received radiotherapy and started anastrozole in October 2018. For several years, regular follow-up showed no evidence of recurrence. In November 2023, she came to the emergency department with intermittent abdominal pain. CT showed a small bowel obstruction, initially managed without surgery. Recurrent sub-occlusive episodes led to colonoscopy in December 2023, which found 3 narrowing masses in the descending and sigmoid colon. Biopsy confirmed metastases from invasive lobular breast cancer. PET/CT confirmed colonic metastases without further disease dissemination, and her team began systemic therapy with fulvestrant plus palbociclib. A follow-up PET/CT initially showed stable disease, so treatment continued. In December 2024, PET/CT showed progression, with stronger uptake and new metabolically active areas. Colonoscopy showed 2 cancer-related sub-stenoses that prevented completion of the exam. In February 2025, she underwent laparoscopic left colectomy. Recovery was complicated by delayed ileus from an internal hernia requiring surgical reintervention, but she was discharged 7 days after the initial surgery. Pathology confirmed multiple colonic metastases from breast cancer with perivisceral lymph-node involvement, again showing hormone receptor-positive and HER2-negative disease. She then started oral capecitabine and remained under regular oncology surveillance, with no clinical or radiological recurrence or progression at 8-month postoperative follow-up to date.