Breast cancer and follow up - Forum

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Breast cancer and follow up - Ärzteforum

Post#1 »

I would like your opinion on a 45 year old lady mother of five who presented with a lump of her right breast for one year no other symptoms O/E she had 3+4 cm. firm rt.breast mass at 11 oclock position with multiple firm right axillary lymph nodes

mammogram and F.N.A.C.showed breast ca.

no other lesions of the other breast

She had right mastectomy and axillary clearance histopathology showed infiltrating ductal carcinoma, 4 positive lymph nodes and lobular carcinoma in situ

I would like to know what sort of management or advice you would offer this lady regarding

* follow up for the other breast(mammography, how often)
* would you offer this lady mastectomy of the other breast.

John Dissector

Re: Breast cancer and follow up - Ärzteforum

Post#2 »

The other breast should be followed up yearly--there is no benefit to doing it more often--the risk of cancer in this other breast is about 0.8% per year, so her cumulative lifetime risk of contralateral cancer is less than 50%--i.e. chances are she never will develop it. Now concomitant LCIS has been reported to increase that risk, but those are old studies with unreliable data--I'd inform the woman and indicate I'd work with her to do whatever she is most comfortable with--mastectomy or followup each has its own small risks and uncertainties.

Also, chest wall irradiation and chemotherapy are both indicated. I would also add Tamoxifen.


Re: Breast cancer and follow up - Ärzteforum

Post#3 »

I would have considered neo-adjuvant chemotherapy for this patient, with the expectation that her primary would shrink and thus be more amenable to breast-conserving therapy. Given the initial mastectomy that she had, I would follow her as I would any other breast ca pt-- annual mammograms, semi-annual breast exams. She is a candidate for chemotherapy and tamoxifen. She is at very high risk for recurrence, based primarily on the size of the primary and the number of + nodes. If the tumor is high grade, that adds to the recurrence risk.


Re: Breast cancer and follow up - Ärzteforum

Post#4 »

what are your feelings on irradiating the axilla after an axillary clearance

John Dissector

Re: Breast cancer and follow up - Ärzteforum

Post#5 »

There is no rationale and a big downside to irradiating the axilla after a surgical axillary dissection--one or the other is acceptable, but never both UNLESS there is grossly enlarged nodes still left behind after an axillary dissection--and I have had that happen to me once in the last 15 years! I know of no data to support doing both routinely, yet inexplicably radiation therapists continue to do this morbid procedure.


Re: Breast cancer and follow up - Ärzteforum

Post#6 »

This is the case in the Midwest as well. A boost is given to the axilla, whether it has been dissected or not. Consequently, there is an increasing incidence of arm edema, for which the surgeon is often blamed (at least locally).

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