Expert: Claes-Gustaf Nordquist, M.D. - 4/25/2008

Question
QUESTION: My mother got operated for breast cancer in 2005 with 4 cycles of cef presurgery and 2 cycles cef post-op along with 25 sessions of rt. no symtoms until mar 2008 when she had sensory motor seizures. mri showed 2cm sol in right fronto-parietal region. operated (complete excision) 4 weeks ago. In last two weeks she has gained 6 lbs of weight and significant swelling in abdomen, face, legs and arms. The physicians are not able to find the reason for swelling (cbc, bio-chemical, d-dimer are normal). mri shows no other lesion in brain. Any thoughts???

ANSWER: Based on her symptoms I can not exclude - in spite of the negative findings - that her cancer has spread elsewhere too. I do suggest a full body PET scan in order to search for any signs of tumor growth
elsewhere.


---------- FOLLOW-UP ----------

QUESTION: Forgot to mention that a whole body PET-CT was done on 12mar2008 showing no other lesion in the body. Can the arms/legs/back pain and swelling be associated with any bone infection? should I do a bmd test? Any role of cheemo you see (er/pr+, her2-)? she is on anastrazole currently. radiation oncologist has suggested 30gy-10sessions. is this sufficient? I know I am asking to many questions here but I am feeling very limited in terms of advises beyond here.

Answer
If so, no there are at the moment no signs of any tumour growth elsewhere. Without having full access to all clinical data it is very hard to give any advice in this situation. Well, she does need radiation therapy to her brain after surgery. The dose of 30 Gy may be ok, though I may have gone for 45 Gy - if the condition of the patient is ok.
Please do keep me posted.