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What Causes A 5 Cm Mass In Breast?

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Posted on Mon, 3 Aug 2015
Question: After waiting 2 months to have a mammogram, this womans mammogram has confirmed a 5 cm mass. She then had an ultrasound guided biopsy. This biopsy confirmed the presence of cancer cells. An additional biopsy confirmed the presence of cancer cells in 3 of her lymph nodes most proximal to the tumor.

What are the the primary concerns for her right now?
What is the rationale of the concerns?
What are some of the expected medical surgical interventions?
What is the worst possible complication to anticipate?
What further assessment will be needed if complications develop?
doctor
Answered by Dr. Grzegorz Stanko (29 minutes later)
Brief Answer:
Breast cancer stage III.

Detailed Answer:
Hello!

Thank you for the query.

Here is what we know right now. The woman is stage III breast cancer.The tumor is quite large and there are multiply metastases in lymph nodes. We do not know anything else about the tumor nature (grade, ER receptor status, PR receptor status, HER2 receptor status). We also do not know if there are already distant metastases. This seems to be the most concerning at this point.

It should be diagnosed with large core needle biopsy (tissue sample should be checked, not just aspirated single cells). She should also has BRCA1 and BRCA2 mutation check.

From this results it depends what type of chemotherapy she should receive. She will need surgical intervention for sure. In her case total mastectomy and total axillary lymph nodes removal seems the only reasonable option. This surgery she may have limb swelling for a long time (like few months) and limb mobility problems as well. This is the most common complication.

Her oncologist should discuss with her if she will get chemotherapy before or after the surgery.

Radiotherapy will be also necessary after both chemo and surgery treatment.

She should also be checked with chest x-ray and abdominal ultrasound (or better CT) to seek for possible metastases. Ca 15-3 marker should be checked before the treatment start.

In conclusion she should not be afraid of surgery complications. This is really not an important thing at this point. She will have to fight for her life and this is the most important thing.

I hope this will help. Feel free to ask further questions.
Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Grzegorz Stanko (17 minutes later)
What is BRCA1 and BRCA2 mutation check? How is it performed?
What type of chemo is ususually given to these women with stage III breast cancer and how long will she be in treatment?
Describe radiotherapy?
How did you determine it was stage III?
What is life expectency for a woman with stage III cancer?
Can you please tell me more about the CA 15-3 marker?
Can you discus further grade, ER receptor status, PR receptor status, HER2 receptor status?
This woman has 4 children and she is divorced, is there any teaching I can do with her or any support groups to get her in touch with?
doctor
Answered by Dr. Grzegorz Stanko (8 minutes later)
Brief Answer:
Detailed below.

Detailed Answer:
BRCA1 and BRCA2 are the genes responsible for breast cancer. In case of this mutation, the chemotherapy contains different medicines.
Type of chemo depends of the mentioned receptors status, distant metastases, receptor status. So its too early to say. Chemotherapy is given in 4 or 6 cycles. This is an infusion given every 3 weeks for 4 or 6 times.

Radiotherapy is a radiation (similar to x-rays, just much higher dosage).

Stage III is because she has tumor larger than 5 cm and metastases in at least 3 lymph nodes. It can be also stage IV if any distant metastases will be found.

5 year survival for stage III is about 70%.

Ca 15-3 marker is just a protein which can be checked during the blood work. It gets higher in case of breast cancer and can be used to monitor the response to the treatment.

Grade - how fast the cells multiply it can be G1 (slowly), G2 and G3 (very fast)
ER determines if the cancer cells contains estrogen receptor on the cells surfaces. If it does, the cells can be blocked with antiestrogen medicines. Same with PR (progesterone) receptor.

HER2 is a receptor for herceptine. Too much of this receptor indicates higher aggressiveness, however we have a medicine to block it as well.

She should get the treatment as soon as possible. There are breast cancer support groups for sure. But first she needs to start the treatment as soon as possible.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Grzegorz Stanko (39 minutes later)
HER2 is a receptor for herceptine. Too much of this receptor indicates higher aggressiveness, however we have a medicine to block it as well. What medicne do you use to block this receptor and how is it given?

I had an Aunt who passed recently with Stage IV, her death came so quickly.

Do you have specific websites I can go to for further reading about Stage III-IV breast cancer, treatment and follow-up?

Thank you so much for your time, you have been very helpful
doctor
Answered by Dr. Grzegorz Stanko (13 hours later)
Brief Answer:
Herceptin can be given for HER2 positive tumors.

Detailed Answer:
Herceptine is a medicine which can be given to block this receptor. It is usually given 6 weeks after the surgery and chemotherapy or along with chemotherapy.

You may try cancer.gov website. It is very informative for the patients.
Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Grzegorz Stanko

General Surgeon

Practicing since :2008

Answered : 5795 Questions

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What Causes A 5 Cm Mass In Breast?

Brief Answer: Breast cancer stage III. Detailed Answer: Hello! Thank you for the query. Here is what we know right now. The woman is stage III breast cancer.The tumor is quite large and there are multiply metastases in lymph nodes. We do not know anything else about the tumor nature (grade, ER receptor status, PR receptor status, HER2 receptor status). We also do not know if there are already distant metastases. This seems to be the most concerning at this point. It should be diagnosed with large core needle biopsy (tissue sample should be checked, not just aspirated single cells). She should also has BRCA1 and BRCA2 mutation check. From this results it depends what type of chemotherapy she should receive. She will need surgical intervention for sure. In her case total mastectomy and total axillary lymph nodes removal seems the only reasonable option. This surgery she may have limb swelling for a long time (like few months) and limb mobility problems as well. This is the most common complication. Her oncologist should discuss with her if she will get chemotherapy before or after the surgery. Radiotherapy will be also necessary after both chemo and surgery treatment. She should also be checked with chest x-ray and abdominal ultrasound (or better CT) to seek for possible metastases. Ca 15-3 marker should be checked before the treatment start. In conclusion she should not be afraid of surgery complications. This is really not an important thing at this point. She will have to fight for her life and this is the most important thing. I hope this will help. Feel free to ask further questions. Regards.