would like to brief a case below and i would kindly request you to advice
your openion with regards to the same,
My mother 52 year old lady 2 and half years back she had a lump in the right
breast noticed during self breast examination. No associated pain or fever.
No history of any trauma. No history of any nipple discharge or increase in
size. Two FTND, First delivery at the age of 19, first child birth 24 years
back, both children breast fed. Menarche at the age of 14 years .Attained
menopause 3.5 years back. No history of any OCP usage. She is known
hypertensive and is on Amlodipine BD. H/o dyslipidemia and she is on tablet
Atorvastatin 5mg. No family history of breast malignancy or colorectal
Mammogram: poorly define isodense lesion in upper outer quadrant of right
breast. No evidence of micro calcification .BIRADS IV
Later due to the suspicion of malignancy, she was planned for wide local
excision followed by frozen section. Wide local excision and frozen was done
and was reported as infiltrating ductal carcinoma and posterior margin was
involved. So modified radical mastectomy was done. The post operative period
was uneventful. The patient recovered well. The wound was healthy The drain
was removed on the 6th post operative day. At discharge, the patient was
stable and the wound healthy.
Carcinoma Right Breast = Infiltrating Duct carcinoma Systemic Hypertension
Procedure Done: Modified radical mastectomy. Right Side
Stage: T1 N1M0, IDC, ER and PR neg, Her 2 Neu score 1 Bone Scan : N
Her2 Neu. Score 1
Wide local excision with right mastectomy Infiltrating duct carcinoma NOS(
Grade II BRS Modified) measuring 1.4X1.3X1 cm wit tumor metastasis to one of
seven axillaries lymph node with tumor size 1.4 cm size.
Nipple areola, Deep margin , Free of tumor.
Chemo Cycle: 6 cycle given
Inj. Ondansetron 8mg+Inj.Dexona 8mg in 100ml NS Inj.Adriamycin 80 mg slow IV
push Inj. Cyclophophamide 800 mg in 100 ml
Adv. Tab Tamoxifen 20 mg OD
She used to have regular follow up every three months. Last one and half
year she was only talking Tamoxifen 20 mg. No radiation treatment was done
after or prior to the mastectomy. Mammogram and ultra performed during this
period. No other test done.
After completing the last follow up with doctor two weeks later she started
having cough with scanty expectation breathlessness and left sided chest
pain it last for another two weeks. She went to a doctor and he did some
clinical testing like CT scan and chest examination and confirmed the
metastasis spread to lung and small lesion in the liver. Lung almost right
full and left 3 forth was affected. She went her regular doctor oncologist
and they did some pulmonary medical support for 10 days during their
investigation later she was given Inj.Docetoxel one dos. Later discharged
from the hospital and after within ten days she passed away.
1)I would like to know what was the reason for spreading the cancer cells to
other part of the body.
2) Was it necessary radiation treatment should be given after mastectomy?
3) why the treatment cannot prolong the life of the patient even she was a
safer zone in the beginning.
I would appreciate your kind advice and support with regards to this case
and please let me know any fault and mistake associated with the treatment
given to the patient.
Thanks and regards