How do you manage metastatic breast cancer to the uterus/ovaries that is symptomatic?  

Management would be based on overall disease status, performance status, systemic treatment options, and expected survival. It tends to be seen more so in lobular carcinoma. Options could be from surgical debunking to quad shot based on the above.

I would generally recommend an attempt at palliative radiation first as feasible rather than jumping straight to a hysterectomy, especially in the setting of a non-radioresistant histology such as breast cancer. However, if the patient with multiple systemic lines and limited disease status wanted ...