currect treatement ?

spacebmt

currect treatement ?

spacebmt

 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
cancer.

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.

Diagnosis:
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

Immunohistochemical Studies:
ER.<5% Positive
PR.<5%
Her2 Neu. Score 1

Impression:
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.
pTNM .pT1N1Mx

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

Fidelia

I am very sorry to learn about your mother's passing.Vey sad that she was so young and although she did get treatment - clearly the treatment failed her. The first point you ask - what did the cancer spread - this is something no-one can currently answer - despite a lot of research and some recent breakthroughs in understanding cellular behaviour - the researchers don't know and clinicians know even less and untl the researchers know - the drugs just don't get developed - so far there is no drug to specifically target metastasis - chemo targets fast growing cells - which is not always the same thing.

It seems your mother's disease had very little hormonal sensitivity - so she would not have had much use out of any of the hormonal preparations including tamoxifen - but it is often used just in case. From your description it could be that the disease had already spread by the time of surgery.

In your position I would make an appointment with the oncologist who treated your mother why they think the treatment failed - it is your right as your mother's child to get as much information as you can to help you come to terms with this terrible loss. Sadly, there are sometimes no real answers apart from the fact that we just don't know enough yet about how cancer works - so often treatments work or fail and no-one really knows why.

Fidelia