Management of endobronchial metastasis of colorectal carcinoma

Although the exact incidence of nonbronchogenic endobronchial metastatic (EBM) disease is unknown, it appears a rare cause of central airway obstruction. It is likely that nonpulmonary endobronchial metastases are underdiagnosed, as many patients with known or suspected lung parenchymal metastases do not undergo bronchoscopy as part of their clinical evaluation. Colorectal carcinoma, the third most common cancer, remains a predominant cause of nonlung EBM. Other gastrointestinal tumors (gastric, pancreatic, hepatocellular, ampullary, and esophageal carcinoma) are also known to metastasize to the central airways. A high index of suspicion must be maintained for the possibility of EBM in patients with known metastatic disease elsewhere, as the symptoms may be subtle. Bronchoscopy offers the best method to evaluate the airway for EBM and evaluate therapeutic options. Currently, the standard of care for EBM is interventional bronchoscopy with endoluminal ablation and adjunctive techniques to provide rapid, effective, and safe restoration of the central airway lumen and maintain patency of the airway lumen. Most patients require multimodality approaches. Referral should be made to a center of excellence with the experience and availability of technology that allow multiple modalities to be used.