Case 2: Invasive Breast Cancer

Ketty Badrinath, M.D.

62 yr old Female was found to have a right breast abnormality on a screening mammogram.   This mammogram was repeated which revealed an abnormality measuring 1.5 cm suspicious of malignancy in the upper outer quadrant of the right breast.   She underwent a needle localization biopsy of this abnormality revealing infiltrating ductal carcinoma and DCIS.

PMHx:              History of benign disease in left breast.

PSHx:               Excision of breast lumps in left breast.   Benign.

Meds:                Vit E and calcium

Allergies:           Amoxocillin

Social:   She is a widow.   Menarche at 14 yrs of age and menopause at age 55.   She is grii pii.   (No hx of tobacco or alcohol consumption.)   (BCP x 2 yrs. No hx of ERT. )

Family Hx:   No family history of any type of cancer.

Review of Systems:    Negative.

PEx:     Was within normal limits except for mild echymosis and vague palpable abnormality at the   biopsy site.

Assessment:

  1. Infiltrating ductal carcinoma of right breast along with DCIS
  2. History of fibrocystic disease of left breast.

Recommendation:   She was advised lumpectomy and sentinel node biopsy pending further recommendations after sentinel node biopsy and ER, PgR data.

Pathology:   Infiltrating ductal carcinoma long with DCIS.   T 1 C, N 1 , M x .   Margins of resection clear.  

ER:           90% positive

PgR:         Negative

Her-2Neu:   Positive

Final Recommendation:   Adjuvant chemotherapy followed by Adjuvant Radiotherapy and Tamoxifen.

Follow-up:   Eight years later, the patient presents with metastases to liver, bones and brain.   Patient and family decided to go into hospice.