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    Breast cancer, lumpectomy, mastectomy, hormonal treatment, chances of recurrence

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Posted on Sat, 6 Oct 2012 in Breast Cancer
Question: Respected Doctor:

I am a gynaecologist doctor and my younger sister( aged 53 yrs- having only one I.V.F child ) is suffering from breast cancer and has undergone surgery (lumpectomy) about 2 weeks ago. I am enclosing her reports and request you to kindly go through these reports and suggest me on the following points :-
1) Whether she should now go for mastectomy surgery ?

2) Whether hormonal treatment (Tamoxifen) will be useful. If yes, will there be chances of uterine cancer ?

3) Whether she should undergo radiotherapy or chemotherapy or both ?

4) What are the chances of reccurrence after above treatment?

5) Will you advice any other investigation or treatment ?

I shall be very much thankful to you for your kind cooperation and advice. Reports will be sent if required.

Yours Truly,
XXXXXXX

Mobile : 0000
doctor
Answered by Dr. Raju A.T 3 hours later
Hi XXXXXXX

Thanks for your query,

I do consider it to be helpful if you can send me the reports.I could be more accurate and specific in my answers once I have those reports to understand the condition better.

Kindly send them to YYYY@YYYY .

Will wit for the same.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Raju A.T 33 hours later
Dear Doctor,


I have attached my reports and sent it to YYYY@YYYY


Yours Truly,

XXXXXXX
doctor
Answered by Dr. Raju A.T 4 hours later
Hi XXXXXXX ,

Thanks for the reports , they were helpful in arriving at my answers below,

Let me go in sequence ,

1) Whether she should now go for mastectomy surgery ?
Since It has micropappilary presentation along with some biopsy site changes
I would consider Mastectomy to be the best choice here.Specifically Mastectomy
with breast reconstruction.This will ensure maximum prevention from recurrences.

2) Whether hormonal treatment (Tamoxifen) will be useful. If yes, will there be
chances of uterine cancer ?
Since the tumor is XXXXXXX in ER and PR, I would consider going for hormone receptor
antagoist treatment can be encouraged but I am afraid to say it may not be of
much help as the tumor is of gradeIII.Also the succes of the same will depend
on lymph node clearence.The response in good in cases like IIb OR IIIB with
N0 and N1(nodal involvement).

Even though it is an antagonist in breast tissue it acts as partial agonist on
the endometrium and has been the cause for endometrial cancer in some.Well here
in case of GradeIII DCIS the treatment with Tamoxifen duration may be long which
may increase the risk of endometrial cancers.

3)Whether she should undergo radiotherapy or chemotherapy or both ?
Post surgery radiotherapy and chemotherapy combination is what always recomended
in DCIS Grade III.

4)What are the chances of reccurrence after above treatment?
Well its a Grade III tumor , the chances of recurrence are very high.Radical Lymph
node dissection along with mastectomy followed by Radio+chemo may reduce the chances
of recurrence.

5)Will you advice any other investigation or treatment ?
Additional interventions like getting the 'erbB2'(oncogene) status checked which will
predict the efficacy and the succes of newer treatments like Trastuzumab.Treating with
the same(provided there is no pre existing heart disease) has shown reduction in the
recurrence by 50%.


I hope and consider that i have answered your query competely.Kindly come with folow up
queries if any.

Wish her Good Health.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Raju A.T 2 days later
1. Is breast reconstruction compulsory ?
2. As nodes are not removed during lumpectomy - should it be removed during mastectomy and histology done ?
3. What you mean by chemotherapy ? Is it tamoxifen or something else ?
4. Could histectomy be suggested before tamoxifen therapy ?
5. What do you mean by Radical lymph node dissection ?
doctor
Answered by Dr. Raju A.T 39 minutes later
Hi XXXXXXX

Thanks for following me up ,

My answers to your questions,

1)Is breast reconstruction compulsory ?

Breast reconstruction is always a patient's choice, well its purpose is purely cosmetic and not a part in management of the cancer.

2)As nodes are not removed during lumpectomy - should it be removed during mastectomy and histology done ?

Yes, after removal nodes have to be studied for confirmation of the stage in which the cancer is.

3)What you mean by chemotherapy ? Is it tamoxifen or something else ?

No , its not only about Tamoxifen.By chemotherapy i meant treatment to kill the remaining cancer cells kill and the prevent recurrences by anticancer
medications like Paclitaxel, Docetaxel, Doxorubicin, Cyclophosphamide or Methotrexate with or without Tamoxifen etc

4)Could histectomy be suggested before tamoxifen therapy ?

At age 53 and if there are plans with tamoxifen, Hysterectomy could be a good choice.

5. What do you mean by Radical lymph node dissection ?

Radical lymph node dissection is a surgical procedure to remove most or all of the lymph nodes that drain lymph from the area around a tumor. The lymph nodes are then subjected to HPE to confirm the stage.

I hope, I answered you well.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Raju A.T

General & Family Physician

Practicing since :2008

Answered : 4038 Questions

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