This document discusses gastrointestinal (GI) tract metastases from various primary cancers. It notes that melanoma, lung cancer, and breast cancer most commonly metastasize to the GI tract. The presentation of GI metastases can be variable and nonspecific, with gastrointestinal bleeding or abdominal pain being most common. Endoscopically, metastases may appear as solitary or multiple nodules, ulcers, or subepithelial masses. Diagnosis can be difficult due to the often prolonged time between primary tumor and metastasis, as well as benign-appearing lesions that can mimic primary GI cancers. Advanced imaging like CT and EUS-guided biopsy help confirm diagnoses. Familiarity with metastatic patterns from common primary cancers aids in detection and prevents misdiag

1. Kurdistan Board GEH J Club:
Supervised by:
Dr. Mohamed Alshekhani
Professor in Medicine
MBChB-CABM-FRCP-EBGH 2016
1

2. Introduction:
• The three cancers commonly reported to be associated with
• metastasis to GIT include melanoma, lung cancer& breast cancer.
• In Taiwan HCC was the leading primary lesion.
• The primary cancer most commonly metastasizing to GIT may differ
from country to country or ethnicity to ethnicity.
• The incidence of GIT metastasis is rare,1/3847 in OGD ,1/1871 IN
colonoscopies.
• Incidence of metastasis in eso 0.3- 6.1%& stomach 0.2-5.4%.
• In melanoma, the incidence 43.5% in one autopsy series.
• Another review, metastasis from melanoma in liver 68%, colon
22%, stomach 20%, duodenum 12%, rectum 5%, eso 4%, anus 1%.
• Most have metastatic lesions in the gastrointestinal tract have also
had other sites of metastasis.

3. Introduction:
• Autopsy series record an incidence as high as 8–16% of breast
cancer metastasis to GIT with latency between the diagnosis of &
GIT metastasis few months -to years.
• Lobular BC represents a minor group of the histological subtype in
BC(10–15%), but it is the most common metastatic histological type
from BC to GIT.
• The autopsy data on GIT metastases from LC 14% incidence with
esophagus being the most common site,then SI & colon.

4. Introduction:
• Bloodborne mets to GIT are commonly observed in all malignancies.
• Most lesions are from malignant melanoma & BC or lung, most
commonly involve stomach & SI because of their rich blood supply.
• The radiologic appearance mainly depends on the histologic
characteristics of the lesion, including the degree of vascularity
relative to the growth rate&the desmoplastic capability.
• Although most GIT metastases are encountered in patients with
widespread metastases & known primary lesions, they may
occasionally present as the initial manifestation of an occult
primary lesion, leading to diagnostic difficulty.
• Familiarity with CT findings of blood-borne metastases to GIT &
understanding disease spread pattern in common primary cancers
will help in detecting metastatic disease & minimizing misdiagnosis
for another metachronous malignancy.

5. Clinical features:
• Can be quite variable so a high index of suspicion needed even with
nonspecific symptoms in patients who have current, recent or
remote history of above-mentioned tumors.
• The presenting symptoms may be nonspecific, but the symptoms of
GIB or abd pain are the 2 most common symptoms.
• Occasionally, wt loss, dysphagia,dyspepsia ,SIO may be presenting.
• The GIB can be gross, occult, acute or chronic.
• Small bowel palpable mass from metastatic melanoma&
obstructive jaundice from metastasis to the ampulla reported.
• The mets to eso can result in dysphagia& mets to stomach can
produce dyspepsia.
• Rarely malabsorption reported due to SI mets from melanoma.
• Asymptomatic in 3–22% with SI mets from melanoma.
• LC mets to GIT involve usually SI &appear clinically more frequently
as intestinal perforation due to the to necrotic tendency .

6. Endoscopic features:
• Can be variable &can present as solitary or multiple nodular lesions.
• The appearance of these tumors as subtle mucosal changes,
multiple nodules, bull’s eye lesions, extrinsic mass lesions,
ulcerations,subepithelial growths or polypoid tumor masses
reported.
• In the stomach, solitary metastasis appears more common than
multiple.
• In one endoscopy series more frequently solitary (61.9%) rather
than multiple (38.1%)&most tumors were primary (mucosa-origin)
carcinoma-like (90.5%).
• Previous report, a submucosal tumor-like appearance of metastases
(51%) being more common than primary (mucosa-origin)
carcinoma-like lesions (39%).
• In cases of melanoma, all histologic subtypes may metastasize to
but the superficial spreading melanoma is the most common

7. Endoscopic features:
• Metastatic gastric &duodenal melanomas classically appear as small
submucosal nodules that may have central ulceration well-known
“target or bull’s-eye lesions” on endoscopy.
• These lesions may be either pigmented or amelanotic.
• The SI involvement with metastatic tumors is more common in
melanoma than upper or lower GIT due to its rich blood supply&
appear as intraluminal masses or serosal implants, usually
diagnosed on imaging studies.
• Metastatic breast cancer with GIT involvement represents evidence
of a systemic disease,with great variability, including lesions with a
benign appearance but also diffusely infiltrative lesions&localized
tumor formation with nodules/or ulceration.

12. Diagnosis:
• Can be difficult due to an often prolonged tumor-free interval &
benign appearance of the lesions &gastric metastasis may
occasionally mimic a gastric primary.
• Stomach is the most frequent GIT site for metastatic breast cancer.
• The most characteristic endoscopic finding of metastatic lobular
breast carcinoma is a linitis-plastica-like appearance,showing tumor
infiltration along the stomach wall with mural thickening of the
involved segment & submucosal infiltration,makes the diagnosis
difficult on endoscopic & imaging exams.
• Advances in imaging techniques like CT scan &EUS with guided
biopsy have aided confirmation of the diagnosis.
• The HCC with GIT metastasis is rare,only in 4–12% in autopsy,
usually present with GIB with OGD features included ulcerative
tumors mimicking advanced GC(43%) & submucosal tumors (29%)
mostly in stomach,duodenum, colon, duodenum&colon with
extremely poor prognosis.

13. Diagnosis:
• The GIT metastasis in RCC is very rare, duodenal,gastric metastasis
with endoscopic appearance of solitary or multiple nodules.
• The other tumors develop metastasis to GIT include malignant
pleural mesothelioma,hepatic angiosarcoma, primary
leiomyosarcoma,testicular seminoma& head / neck tumors.