Query on post surgical treatment for Breast Cancer

[Agarwalg]

Hi my mother is 59 years old and was diagnosed with Lump on her left breast a month back during mammography and post FNAC and PET Scan, it was confirmed that she was having a tumour of about 3 cm and possible uptake on auxially node.

She went through MRM and aux lymph node clearance on 29 August 2016 (dissected 10 lymph nodes were removed, largest is a matted node measuring 6*3*3 CMs)

The Histopathalogy reports have come a couple of days back and they state as follows:

1. Left left modified radical mastectomy shows features of infiltrating duct carcinoma. Modified RB score : 3+ 2+2=7, Grade II

2. Tumor cells are arranged in lobules trabecular and singles in a desmoplastic stroma

3. Lymphovascular invasion is seen

4. No In situ ductal component is seen

5. Base is free of tumour

6. No perineural invasion is seen

7. Only one of the auxially nodes shows metastatic tumour deposits with peri nodal extension (1/10)

8. Tumour occupying outer quadrants of breast measuring 4*3*3 CMs. It is present 2cms away from base and 3cms away from overlying skin.

9. Nipple and areole are unremarkable.

IHC:

1. ER: Positive - Allred score - 4+ 1= 5/8, 30 to 40% of tumour cells show nuclear positivity of weak intensity

2. PR : Positive - Allred score - 4+ 1 = 5/8, 30 to 40% of tumour cells show nuclear positivity of weak intensity

3. HER 2 Neu : Negative

She has borderline diabetes(H1BAC: 6.3%) , blood pressure, severe osteo arthritis on both knees and is obese (BMi: 35) and takes thronorme 50 mcg

She takes the following medication for

1. Rosutec- 10 mg

2. Glucosamine (joint pain)

3. A ten -D and Telvas AM ( blood pressure)

4. Zyloric (Uric acid)

5. Thyronorm (50 mcg)

6. Calcium

7. Volix 0.2 mg

8. Uprise and metroneurobion for vitamins

Her uterus and overies were removed 20 years back for some stones found in them.

Considering her body factors, we have been suggested to provide her with hormone therapy and AVOID chemotherapy

Please suggest considering the her Histopathalogy reports and body factors mentioned above , if this is the correct way ahead.

Thanks I advance

[sumeet_shah Administrator]

I am sorry this forum is not for any form of medical opinions. Not because we do not wish to help. We wish to, that's the reason we started this forum. But opinions in Oncology need a detailed assessment of a patient Simply because each patient is different and just one report cannot dictate further treatment. It needs to be seen in totality. We request you that you talk to your Oncologist in This regard. if you wish you can always take a second opinion.

[roxboxfox RadiationOncologist]

Your Oncologist will be the best person to assess and take a Call and individualise the risk Vs Benefit of chemo... And as rightly explained to yourself... The risks far outweigh the benefits.. Hence Adj Hormone Therapy will suffice.

May I add that Adjuvant Radiotherapy is also ideally indicated as per current evidence based practice and if she weights less than 180 kg... You may wish to seek opinion from Radiation Oncologist whether Adjuvant Radiotherapy will be feasible or not.

Regards

Dr Rohit Malde MD, DNB, FRCR(UK)

Consultant Radiation Oncoligist

Nanavati Hosp

[Agarwalg in reply to roxboxfox]

Thank you Sir. We have begun with radiatio therapy - IGRT