About 4 weeks ago my wife was diagnosed with moderately differentiated metaplastic spindle cell carcinoma with focal squamous differentiation in the left breast. A tumor mass (2.7 x 2.1 x 1.6 cm) was removed surgically at Mayo Clinic ~2 weeks ago. 5 lymph nodes were biopsied and were negative for cancer cells. All tissues were negative for ER, PR, and Her2. My research indicates that when this type of cancer metastasizes, it rarely utilizes the lymph system and therfore the node finding does not offer assurance of no metastases.
There is some literature suggesting that the presence of EGFR is common for this cancer type, but this was not evaluated at Mayo. If present, does this receptor indicate the use of a particular drug or hormone therapy. I have found little to suggest that a well-defined post-surgery strategy exists for treating metaplastic carcinoma of the breast. Is this indeed the case? Are there accurate diagnostics that would show the presence of metastases now that the tumor has been removed? Is the lung the most common site for metastases? What should be monitored most closely in the future to detect metastases?
Any information or recommendations would be greatly appreciated.
Dear the.tysons: There is evidence in the literature that EGFR may be expressed in some metaplastic breast cancers. Based on work in lung cancer treatment with EGFR inhibitors, the likelihood for effectiveness is not related to expression of EGFR but rather genetic mutations in EGFR. The significance of EGFR for breast cancer prognosis and treatment is unknown. There are some medications that target EGFR but the data to support their use in breast cancer is unknown. Whether or not any of these compounds would offer any benefit, particularly in the adjuvant setting, in metaplastic breast cancer is also unknown. Radiologic studies such as CT scans and nuclear medicine bone scans can be used to detect metastatic disease but do not detect disease at the microscopic level. There are no diagnostic tests that are useful for detecting microscopic metastatic disease . The lung is one common area of metastases. Other common areas include the liver and bone. The important aspect for future monitoring is regular clinical visits every 3-6months for the next 5 years, with radiologic evaluations of areas of concern based on the appearance or persistence of new symptoms of discomfort.
Dear the.tysons: I was diagnosed with metaplastic carcinoma on 1/9/06, following surgical removal of a 1.8 cm tumor. All tissues were negative for ER, PR and Her2-neu. With lymph nodes being "clear" I too am concerned about metastases through bloodstream. I meet with an oncologist on 1/19/06 to discuss this concern, proposed diagnostic tests and treatments. I would be interested in sharing notes with you on a regular basis.
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