CASE DISCUSSIONS IN

BREAST CANCER
DR. KUMAR SAURABH
MD,DM
CONSULTANT MEDICAL ONCOLOGIST
SHAMBHAVI CENTRE FOR CANCER AND GYNECOLOGY&
HCG,RANCHI
CASE 1
 35 YEAR OLD LADY PRESENTED WITH A 7
MONTH HISTORY OF PAINLESS LEFT BREAST
MASS
 NO FAMILY HISTORY OF BREAST CANCER

 HISTORY OF ON AND OFF FEVER AND WEIGHT

LOSS
 ON PALPATION,A LARGE FIRM,NON TENDER
BREAST MASS OCCUPYING ALMOST THE
WHOLE BREAST(8X6 CM) WITH OVERLYING
ERYTHEMA
 PALPABLE LYMPH NODE IN LEFT AXILLA
(1.5X2CM)
CASE 1 ….
 FNAC WAS DONE AND WAS SUGGESTIVE OF
MALIGNANT NEOPLASM
CASE 1…
 ADVISED FOR SURGERY BUT CAME TO
SHAMBHAVI FOR 2ND OPINION
 TRUCUT BIOPSY WAS ORDERED

 HPE S/O POORLY DIFFERENTIATED MALIGNANT

NEOPLASM
 IHC WAS ORDERED
 IHC WAS SUGGESTIVE OF CD 20 POSITIVE
DLBCL
 PATIENT WAS GIVEN 6 CYCLES OF R CHOP
FOLLWED BY RT AND IS CURRENTLY CURED
AND DOING FINE
CASE 2
 65 YEAR OLD POST MENOPAUSAL WOMAN
PRESENTED WITH A PAINLESS LEFT BREAST
LUMP OF 5X5 CM
 LUMP WAS PRESENT FOR PAST 2YEARS AND
WAS SLOWLY GROWING
 PATIENT WAS COMPLETELY ASYMPTOMATIC
EXCEPT FOR MILD BACKACHE AND CONSULTED
THE DOCTOR ONLY ON THE INSISTENCE OF HER
DAUGHTER IN LAW
 FNAC WAS DONE AND WAS SUGGESTIVE OF IDC
 PATIENT WAS COUNSELLED FOR SURGERY AND
UNDERWENT THE SAME AT A LOCAL HOSPITAL
 HPE REPORT SHOWED A MALIGNANT 5X6 CM
TUMOR…FINAL IMPRESSION:INVASIVE DUCTAL
CARCINOMA
 ARE YOU SATISFIED WITH THE REPORT?
 WHAT ELSE AS A SURGEON WOULD YOU LOOK
FOR?
CASE CONTINUED…..
 PATIENT WAS SENT BACK HOME.BUT HER BACK
PAIN CONTINUED TO INCREASE FOR WHICH SHE
CONSULTED AN ORTHOPEDIC SURGEON
 THE DOCTOR ORDERED A CT SCAN OF DL SPINE
WHICH WAS SUGGESTIVE OF METASTATIC DISEASE
 SHE CAME TO RANCHI AND A COMPLETE WORKUP
ALSO SHOWED LIVER METS AND AN LEFT
AXILLARY NODE OF 2X2 CM
 BIOPSY FROM AXILLARY NODE WAS DONE AND
WAS S/O IDC
 IHC WAS DONE AND SHOWED ER/PR STRONGLY
POSITIVE AND HER2 NEU NEGATIVE
 WHAT WOULD BE THE AVERAGE LIFE SPAN OF
THIS PATIENT?
 SHE WAS STARTED ON A CDK4/6
INHIBITOR(PALBOCICLIB) ALONG WITH
LETROZOLE AND IS STILL ALIVE AND IS
PROGRESSION FREE AFTER 2 YEARS OF
THERAPY WITH VIRTUALLY NO SIDE EFFECTS
 SHE ALSO RECEIVED PALLIATIVE RT FOR HER
BONE METS AND MONTHLY ZOLENDRONIC
ACID AND IS NOW COMPLETELY PAIN FREE
CASE 3
 45 YR OLD PERIMENOPAUSAL LADY W/O CCL
EMPLOYEE PRESENTED WITH A PROGRESSIVE
RIGHT BREAST LUMP FOR 3 MONTHS
 THE LUMP WAS APRROXIMATELY 2X3 CM WITH
NO PALPABLE AXILLARY LYMPH NODES
 FNAC WAS DONE WHICH WAS S/O IDC AND SHE
WAS ADVICED SURGERY
 METASTATIC W/UP WAS NEGATIVE
 SO THIS IS A CASE OF EARLY BREAST CANCER

 WHAT NEXT?
 PATIENT WENT TO TMC KOLKATA WHERE A
TRUCUT BIOPSY WAS DONE AND IT REVEALED
AN ER/PR NEGATIVE AND HER2 NEU 2+ TUMOR
 NEXT?
 FISH FOR HER2 NEU WAS DONE AND IT CAME
OUT TO BE POSITIVE
 PATIENT WAS GIVEN A CHOICE FOR BCS VS MRM
AND OPTED FOR BCS
 SENTINEL LYMPH NODE BIOPSY WAS DONE AND
IT CAME OUT TO BE NEGATIVE
 PATIENT WAS STARTED ON NEOADJUVANT
CHEMOTHERAPY WHICH CONSISTED OF 4
CYCLES OF EC FOLLOWED BY 12 CYCLES
WEEKLY PACLITAXEL PLUS TRASTUZUMAB
 THE PATIENT HAD A GOOD CLINICAL RESPONSE
TO THERAPY AND UNDERWENT BCS
 Tumor Cell Stimulation

ATP ATP
TK TK

Survival Gene Transcription Metastases

Cell Cycle Progression

Cell Antiapoptosi
Proliferation s
Angiogenesis
 Strategies to Inhibit Signaling
tyrosine Anti- mAbs Anti-ligand
kinase mAbs
“-mab”
inhibitors “-mab”
“-ibs”

ATP TK TK TK

- -
-
 SURGICAL PATHOLGY REPORT WAS
SUGGESTIVE OF RESIDUAL TUMOR
 POST OP RT WAS GIVEN AND PATIENT WAS
STARTED ON TDM1 WHICH WAS GIVEN FOR 1
YEAR AND PATIENT IS CURRENTLY ON
TREATMENT
TAKE HOME MESSAGE
 ALWAYS DO A METASTATIC W/UP BEFORE SURGERY
IN A CASE OF BREAST CANCER
 TRUCUT BIOPSY IS THE CURRENT STANDARD FOR
DIAGNOSIS
 PREFERABLE TO KNOW THE RECEPTOR STATUS
BEFORE PROCEEDING
 NACT IS PREFERRABLE IN MOST HER2 POSITIVE
AND TNBC CASES EVEN IN EARLY STAGES AND MAY
BECOME THE STANDARD OF CARE IN NEAR FUTURE
 LOTS OF DEVELOPMENTS IN FORM OF NEW DRUGS
WHICH HAS LED TO INCREASED SURVIVAL WITH A
GOOD QOL EVEN FOR METASTATIC BREAST CANCER
CASES
Thank
You