Left Operable Breast Cancer on Follow-Up
PATIENT DETAILS
Age: 56 years
Gender: Female
Allergies: No Known Allergy
Menarche: Started menstruating at age 13
Parity: Nulliparous (has not given birth) and has undergone In Vitro Fertilization (IVF) twice
Menopausal Status: Postmenopausal (Menopause at 52 years)
Oral Contraceptive Pills (OCP) / Hormone Replacement Therapy (HRT): None
Medical History:
- Known case of Diabetes Mellitus (DM)
- Hypertension (HTN)
- Hypothyroidism
- Under treatment for cervical dystonia and possible early Parkinson’s disease
- Recently started on Tab Ecosprin (aspirin) for the last 2-3 months
TESTS PERFORMED
Bilateral Mammography (B/L MMG): It showed:
- An irregular lesion in the lower inner part of the left breast.
- Another smaller, mobile lesion in the lower outer part.
Post-Surgical Pathology: The examination of tissues removed during surgery showed that cancer had invaded some blood vessels but not the nerves. One out of 16 lymph nodes tested was affected by cancer.
Biopsy and Histopathology: Tissue samples were taken from the lesions to determine if they were cancerous. This confirmed the presence of invasive ductal carcinoma (IDC) Grade III with a tumor size of 2.5x2x2 cm.
TREATMENT
Chemotherapy: Received 4 cycles of EC (Epirubicin and Cyclophosphamide) followed by 4 cycles of Docetaxel. The first cycle was administered on 01/06/2023.
Radiation Therapy: Completed External Beam Radiation Therapy (EBRT) on 09/01/2024.
Medications: Started on LETROZ 2.5 mg, planned to start Abemaciclib after diabetes management.
DIAGNOSIS
The patient was diagnosed with Invasive Ductal Carcinoma (IDC) Grade III, indicating the presence of breast cancer that originated in the milk ducts and spread into surrounding breast tissue.
SYMPTOMS
Initial Symptoms: The presence of irregular and mobile lumps in the left breast, was detected during a routine mammogram.
Current Symptoms: No new symptoms were reported during the follow-up visit.
CASE PRESENTATION
A 56-year-old postmenopausal woman, following treatment for left operable breast cancer, came for a follow-up visit with Dr. Garvit Chitkara, a breast cancer surgeon in Mumbai.
She was diagnosed with invasive ductal carcinoma (IDC) in the left breast. Initially, she presented with irregular and mobile lumps in her left breast, detected through a mammogram. Due to high blood sugar levels (300 mg/dl), a PET scan could not be performed at that time.
The patient has a complex medical history including diabetes mellitus, hypertension, hypothyroidism, cervical dystonia, and possible early Parkinson’s disease. Since 2 to 3 months she has started with Tab Ecosprin.
DETAILED DESCRIPTION OF TREATMENT
Surgical Intervention: The patient underwent surgery to remove the cancerous tumor from her left breast while preserving as much breast tissue as possible. The surgery also included bilateral reduction (to reduce the size of both breasts for symmetry) and axillary clearance (removal of lymph nodes in the armpit to check for cancer spread).
Chemotherapy Regimen: Chemotherapy was administered in two phases: four cycles of EC, a combination of Epirubicin and Cyclophosphamide, which work together to kill cancer cells, followed by four cycles of Docetaxel, a drug that prevents cancer cells from dividing and growing.
Radiation Therapy: After chemotherapy, the patient underwent EBRT, where precise beams of radiation were directed at the breast to destroy any residual cancer cells, reducing the risk of local recurrence.
Hormone Therapy: During follow-up, no new symptoms were detected. Dr. Chitkara started hormone therapy. He prescribed LETROZ 2.5 mg to lower estrogen levels in the body since estrogen can promote the growth of certain types of breast cancers. Abemaciclib will be added to the treatment plan to further inhibit cancer cell growth once the patient’s blood sugar levels are better controlled.
POST-OPERATIVE ASSESSMENT
Physical Examination: The patient showed post-radiation changes, which are normal after completing EBRT. No new abnormalities were detected.
Lab Results: Pathology reports confirmed that the surgical margins were free of cancer, meaning the tumor was completely removed.
Follow-Up: Garvit Chitkara, an experienced breast cancer surgeon in Mumbai, advised the patient to have her chemoport (a device used to administer chemotherapy) flushed.