Expert: Claes-Gustaf Nordquist, M.D. - 10/16/2008

Question
Dear Dr:
My sister in Argentina Had this result in her biopsy and she had surgery removed the lump, and she will receive chemo and radiotherapy and hormono therapy, we want to know that it is enough and which new drugs are the best, we are very worry for her she is in her forties and she always was healthy.
I will apreciate your help!!
Thank you


Descripcion macroscopica
A) Cuadrantectomia mamaria derecha(hora 2) que mide 6.5x4.5 cm, y pesa 26.7 grs. parcialmente revestida por losange cutanea que mide 2.4x1.7 cm, reparada con 2 hilos cortos a nivel interno.Al corte, se observa una formacion tumoral blanquecina de consistencia indura que mide 1.7 x0.7 cm, la cual dista del margen externo y a 0.5 cm de la piel.
B)Ganglio centinela(primera muestra): tres formaciones ganglionares que miden entre 1.4 y0.4 cm.
C)Ganglio centinela(segunda muestra): dos formaciones ganglionares que miden entre 0.6 y 0.4 cm.
D)Linfadenectomia axilar derecha que mide 5x40cn, de la cual se aislan varias formaciones ganglionares.
Se efectuan biopsias intraoperatorias examinandose por separado tacos representativos de los distintos fragmentos detallados en la descripcion macroscopica.

Descripcion Microscopica


Los20cortes muestran la imagen de un carcinoma ductal invasor grado 3 del score de NOTTINGHAN (G3 N3 M2). El tumor presenta un borde infiltrante, moderada desmoplastia estrnal y aislados elementos linfoides peritumorales. La neoplastia infiltra la dermis reticular de la piel.
Se evidencian embolias neoplasticas angiolinfaticas.
El resto del parenquima mamario no presenta alteraciones significativas.
Los margenes quirurgicos estan libres de lesion distando el margen mas proximo a 0.5 cm.(externo).
Los 5 ganglios centinelas axilares derechos presentan metastasis carcinomatosas con compromiso de la capsula y de los tejidos blanods penganglionares(5/5).
Cuatro de los ganglios disecados de la linfadenectomia axilar derecha muestra una metastasis carcinomatosa con compromiso de la capsula y de los tejodos blandos periganglionares.
Adjuntamos en informe complementario el estudio de la determinacion de recptores hormonales y HER2-NEU.


Diagnostico

Glandula mamaria derecha cuadrantomia ( hora 2): Carcinoma ductal invasor, grado 3 del score de Nottinghan( G3 N3 M2)
Tamaño tumoral 1.7x0.7 cm
Margenes libres.
Ganglios centinela axilares derechos, reseccion: metastasis carcinomatosa 5/5
Ganglios axilares derechos, linfadenectomia: metastasis carcinimatosa 4/12  

Answer
First of all I do not know Spanish and my wife who does is at the moment abroad. I have therefore great difficulties with the reports you sent. I can only base my conclusions on what little I do understand or think - right or wrong - I have figured out. I would probably have suggested a mastectomy in this case but I have no serious objections to the way her case has been taken care of. If her cancer has positive hormone receptors she should have hormonal treatment! In this situation also both radiation therapy and chemo therapy are NECESSARY! But only her own dr. who has all available medical facts can decide the best drug combination for her chemotherapy. Since this is your sister and there may be genetic risks involved I do urge you to have your own beasts checked regularly! These risks may also involve any children of yours or of your sister.