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What does the MRI report when suffering from metastatic breast cancer indicate?

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Posted on Tue, 26 May 2015
Question: Dear Doctors


Mangla Mathur's metastatic breast cancer was detected nearly three years ago in Apr 2012.

Radiation doctor asked for MRI and MRS spectroscopy to be done for Mangla. We got it done on 1.5.15 and the reports are attached herewith. Also attached is an excel summary of three sheets made by me 1) all MRIs till now 2) MRS 3) Seizures, radiation brain ( SRS) and medication connected with brain .

The reports seem to be alarming.

A) MRI summary would show increasing sizes of lesion from even before SRS that was done on 1.10.14 as per MRI dated 28.09.14, 10.12.14, 02.02.15 and 01.05.15
a) left high frontal size increasing 16 X 15 mm, 19 X 15 mm, 27 X 16 mm and now 3.4 X 1.6 cm respectively
b) left occipital lobe along left tentorium cerebelli fluctuating 19 X 21 X 12 mm, , 12(TR) X 21(AP) X 11(CC) MM, no size shown to now 4.3 X 2.9 cm
Surprisingly MRI report is showing such a major increase from mm to cm as only a mild increase.
These details are given in my MRI summary in excel sheet.

It seems that the Oct 14 SRS did not finish these two lesions at all and MRI spectroscopy confirms their being consistent with metastasis, ie malignant in nature, as also areas with Radiation necrosis exist.

If it so then is it that it was required to stop their growth at initial stages itself ? What now ?

B) Moreover now MRI is also showing Mass Effect, effacement as also shift of midline septum , all of them further worsening the situation with increasing edema bringing on and off effect on limb movement , memory mood understanding and ability to do activities.
What can be done about it now ?

D) Details of Seizures, Radiation and brain medicines viz. Dexona, Levepil and Frisium are given in my excel sheet on it along with dates, nature, doses and duration.
Are these not sufficient to be able to control the deteriorating mental state and well being ?

E ) Lately from 24.02.15 to 17.03.15 Radiation of primary location being left breast was done, the only other place showing last though started with liver, lymph nodes etc also in 3.5.12 , the first PET CT. Latest PET CT report dated 12.02.15 is attached herewith. .
Could this be a cause of such rapid changes in the brain leading to increased growth of metastatic disease ?
.Rest of the body position yet to be known after PET CT when it is done later on after the last one done on 12.02.15.

F ) Medicines taken till now sequentially,for other than brain prescribed by medical onco are as follows:
Under systematic treatment - Andryamycin, Cytoxan, Taxol, Taxotere, Arimidex (Horm), Zeloda, Navelbine, Femara (Horm), Aromasin (Horm) and now continuing Nolvadex (Tamoxifen)(Horm).

Under Targeted Therapy - Herclon, Canmab, Tykerb and Canmab still continuing as on date starting from as long back as 22.08.12 totalling to nearly 40 viles other than Tykerb.

she is er/pr and her-2 positive

Your valuable advice is required to see the things down the line and proceed.
doctor
Answered by Dr. Monish De (10 hours later)
Brief Answer:
Pertuzumab therapy along with increase of frisium dosage

Detailed Answer:
Hi

I have gone through the reports.

Her metastatic breast cancer has now progressed further as per the MRI report.

As radiation of primary location of left breast was done only this could be cause of progression of her disease.

Since she has also tried multiple lines of therapy but still the disease has progressed and as she is er/pr and her 2 positive she has to change her present targeted therapy to pertuzumab along with continuation of tamoxifen.

She has to increase her dose of frisium to atleast 40 mg daily to decrease her symptoms.

She also has to continue radiation to brain.

Regards

Dr De
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Answered by
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Dr. Monish De

Oncologist

Practicing since :2004

Answered : 2233 Questions

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What does the MRI report when suffering from metastatic breast cancer indicate?

Brief Answer: Pertuzumab therapy along with increase of frisium dosage Detailed Answer: Hi I have gone through the reports. Her metastatic breast cancer has now progressed further as per the MRI report. As radiation of primary location of left breast was done only this could be cause of progression of her disease. Since she has also tried multiple lines of therapy but still the disease has progressed and as she is er/pr and her 2 positive she has to change her present targeted therapy to pertuzumab along with continuation of tamoxifen. She has to increase her dose of frisium to atleast 40 mg daily to decrease her symptoms. She also has to continue radiation to brain. Regards Dr De