Does this sound right

[jenhc]

I have a friend who was diagnosed with breast cancer.  Between the time she was diagnosed and had a lumpectomy the tumors had doubled in size.  She had positivee and negative nodes.  A couple of weeks later she had a port put in then soon after started chemo once every 3 weeks for a several months.  She was suppose to have a month off before she started radiation.  3 weeks after her last chemo the NP at the surgeons office diagnosed her with shingles at her surgical site so she didn't start radiation.  10 days later she started having severe headaches, nausea and vomiting.  She went to the ER and had a MRI which shold numerous brain metastases and the oncologist said that it wasn't shimgles but cancer at her original site.  She had an LP which showed cancer in her spinal fluid.  I have never heard of breast cancer spreading this fast especially while on chemo.  Can and does this happen?  Would a mastectomy have helped?  All of her original scans were normal. It has only been7 months since original diagnosis and the doctors say she has a month or less left.

[Fernando Roque, MD]

Hi. The additional information you have given all confirm my suspicion that your friend has an aggressive tumor subtype. In particular, she has a less common subtype called a "triple negative" tumor, owing to the fact that the ER, PR and HER-2 assays are all negative.  This tumor is resistant to some of the usual cancer treatment like Herceptin or hormonal therapy, but may be responsive to chemotherapy which contains anthracyclines (e.g. Epirubicin), taxanes (e.g. Docetaxel), or platinum (e.g. Cisplatin) drugs.  There is a foundation, the Triple Negative Breast Cancer Foundation, which may be able to provide you with additional information and help regarding your friend's condition (link: http://www.tnbcfoundation.org/index.html).

[jenhc]

To Dr Rogue,
She is 41.  Her assays were all negative.  I do not know what chemo she wa on.  One relative an aunt died of breast cancer but she lived awhile with it.

[Fernando Roque, MD]

Hi.  I'm sorry to hear about what your friend is going through.  All the things you've said about your friend's condition - the rapid doubling of the tumor's size, the development of skin and brain metastases soon after chemotherapy -  all point to an aggressive type of breast cancer.  It is very possible for aggressive tumor types to develop resistance to the initial chemotherapy regimen and spread rapidly.  

My impression of your friend's case is that the doctors were not able to pick up the various hints that the tumor they're dealing with is aggressive.  Maybe if they did, they could have  managed the case more aggressively (e.g. performed a mastectomy instead of a lumpectomy).  However, it may also be unfair to judge the doctors' decision because we already have the benefit of hindsight.  We know how your friend turned out, while those doctors did not at the time they made their management decisions.  

I do think that the skin metastases which were misdiagnosed as shingles was clearly an error on the part of the doctor and could have delayed the administration of proper treatment (radiation and chemotherapy). But even with the correct diagnosis, I don't think the brain metastases could have been prevented.

Your friend's case has piqued my interest.  I would appreciate it if you can provide additional information about her case.  How old is she? Did she have any relatives who had breast cancer? Were assays for estrogen receptor (ER), progesterone receptor (PR), and HER-2 done? What were the results? What drugs were used for her initial chemotherapy?  I hope to hear more from you soon.