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Breast Cancer: Stage 3 & 4 Community
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Avatar universal

Recurrent Breast Cancer

My mother was diagnosed with breast cancer in the left breast in October 2006, the tumor was surgically removed (Lupectomy), and the final histopathology report showed, “An irregular scirrhous infiltrating grayish white tumor 2.4 by 2.2 by 2.0 cm with another tumor 0.1 to 0.2 cms away from the main tumor. On microscopy, it is infiltrating duct carcinoma (grade III) associated with multiple foci of high grade intraductal carcinoma with comedonecrosis. The resected margins are free. Two out of ten lymph node were positive for micro metastases. The tumor is negative for Estrogen, Progesterone and HER – 2 neu receptor. TNM – T2N1M0.”

She developed a seroma after removal of the suction drains and subsequently a fulminant pseudomonas infection of the seroma. This took nearly two months to resolve with treatment.

The doctor gave my mother a choice of complete mastectomy followed by chemo-radiotherapy or to go directly for chemo-radiotherapy, my mother opted for the latter.

She started her chemo therapy in December 2006, she received 3 cycles of FEC and 3 cycles of Docetexal (from 6th Dec 2006-19th Mar 2007). From 12th April 2007-30th May 2007 she did the radiation therapy.

After the treatment the she was normal and her review check up with chest x-ray and USG of abdomen and pelvis was alright in April 2008 as reviewed by the doctor.

In mid-July 2008 she felt pain in the left breast with a swelling the pain was intolerable of for the first few days and it gradually subsided, but was not completely gone. The doctor when consulted in August first week asked to get the PET scan done, the scan showed presence of cancer.

She was again operated on 6th august 2008 – Mastectomy and reconstruction. The histopathology report says:
Paraffin section :- Infiltrating duct carcinoma (GradeIII) left breast, III – circumscribed tumor, invasive cords and nests of cuboidal cells, moderate to marked nuclear anaplasia, foci of necrosis, tumor emboli in dermal lymphatics.
Residual tumor in left breast:- multiple tumor nodules in skeletal muscle and fat abutting base, several tumor emboli in dermal lymphatics, tumor abuts epidermis at places Metastasis in all fifteen axillary lymph nodes with peri-nodal spread. T4N2MX stage IIIB.
Estrogren receptor – negative
Progesterone receptor – negative
Herceptin Test (HER2/NEU/C-ERB B2 – INTERNAL DOMAIN) - negative

My mother is recovering well from the surgery.

The questions now are:
a) What are the treatment options available to her to avoid any further recurrence of the cancer?
b) If chemotherapy - then what combination of drugs should be used and in what cycles?
c) Are there any chances that the tumor spreads before the treatment starts or during the treatment?
d) What she should do after the chemotherapy treatment ends, so as to control the disease?
e) Is a complete cure possible after this stage?
f) Was the earlier treatment correct?
g) Was the decision to not go for Mastectomy earlier incorrect?
2 Responses
Avatar universal
Hi there.

If there are no other sites of recurrence other than the operated breast, then she may still receive additional chemotherapy to decrease the chance of future recurrence and still increase likelihood of cure.  Other chemotherapy drugs may be given (the ones she has not yet used before) such as Capecitabine, but there is no standard duration and number of cycles.   She is not a good candidate for additional radiation since she has already received radiation therapy before.

The earlier treatment was correct (lumpectomy- chemo- radiation), and I don't think doing a mastectomy earlier would have made such an impact.

The decision to give chemotherapy after this will depend on the discussion between the patient and the oncologist.  some oncologists would opt not to give additional treatment but some would pursue additional chemotherapy (since again, there are no standard protocols for her situation).

Regards.

Avatar universal
Thank you very much for your time,
Our Oncologist here has suggested, Gemcitabine and Carboplatinum, for chemotherpy treatment, are these drugs right for this situation?

The other concern that we are facing is that my mother has already spent 3 weeks post surgery, and the doctor is recomending 2 more weeks of healing before the chemo starts - is this safe considering her situation and the spread of cancer?

Thank you once again for your time and guidance.
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