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Dr. Andrew Rynne

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Exp 50 years

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Operated for breast cancer and had chemo. PET scan showed lungs cancer. Treatment?

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Dr. Gyanshankar Mishra

Pulmonologist

Practicing since :2003

Answered : 600 Questions

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Posted on Thu, 27 Dec 2012 in Lung Cancer
Question: Hi My Name is XXXXXXX from india and this question is about my mother. she was operated for breast cancer three years back followed with 8 session of chemo and raditation. her ER / PR was negative and her2neu was 3+ . now after three years her pet scan and CT chest scan are showing metastics cancer in lungs. a CT guided biopsy is also done but could not get the right answer. now another biposy can not be done because it was the best possible area to do biopsy. now the doctor saying lung cancer is not curable but the treatment can increase the life span. now following is the treatment option given by our doctor. :

1st Option: Lapatinib + Capecitabine
2nd option: Docetaxel (Chemo) + Capecitabine
3rd Option: Capecitabine

now doctor saying there is no gurantee of the complete cure by any of the treatment.
Please suggest as i am really very confused and want to take another opinion
Also to add that she suffered for high fever couple of months last year and all the blood reports were normal. she has lost 10 kg weight last year and now at 42 KG.
Attached: recent CT scan, biopsy, pet scan, tb test, cheast pa, summary of radiation, chemo, and other reports
doctor
Answered by Dr. Gyanshankar Mishra 3 hours later
Hi,
Thanks for posting the query on XXXXXXX
After going through the query, I would like to comment the following:

1. Your mother seems to have been diagnosed with metastatic lung cancer. This is stage 4 clung cancer with a poor outcome once diagnosed.

2. The aim is to give palliative chemotherapy once this stage is diagnosed. The options given by your doctor are correct.

3. I am not able to see any accompanying reports. Please upload them if possible.

4. However a pulmonologist opinion should be sought for histopathological typing of the cancer. Either a CT guided fnac or bronchoscopic biopsy can be done for typing of the cancer. Also gene mutation studies (eg. EGFR mutation) can be done on the biopsied samples in cases of non small cell lung malignancies which have somewhat favourable outcomes if positive.

5. Clinical assessment of all her lymph nodes should be done. It would be better if you could let me know all the reports mentioned in the query by uploading them.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Gyanshankar Mishra 18 hours later
Hi Doctor,

Thanks for the response. i have sent the reports on YYYY@YYYY the moment i asked the question because it was not uploading that time and custmer care guy asked me to do that. please check the same.

a ct guided fnac is already done but didnt get the desired outcome and another fnac or bronchoscopy can not be done because it was not the best possible area to do that. now yesterday i met with another doctor to take an opinion and he said herceptine or lapatinib might not work on your mother because 3 years back report on the her2neu was based on >10% of the tumer cell. now it is atleast >30% of the tumor cell than only they consider it positive.

now the only optin left with me is chemo +Capecitabine

please see the reports and let me know if this is the best altenative and also do let me know the transparent feedback on how long does this kind of patient survive generally.

thanks.
doctor
Answered by Dr. Gyanshankar Mishra 1 hour later
Hi,
Thanks for the follow up.
Went through the reports. After going through the reports and your follow up info, I would like to comment the following:

1. In absence of any histopathological confirmation of the lung metastasis, the lesion will have to be treated as lung metastasis with breast primary.

2. chemo + Capecitabine is an acceptable palliative therapy in such cases. The disease has progressed beyond surgical resection.

3. The five-year survival rate of a patient diagnosed with stage IV breast cancer is nearly 20%.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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