Expert: Claes-Gustaf Nordquist, M.D. - 3/24/2009

Question
Dear Dr. Gustaf,

My mother (aged 61 years) recently discovered a lump near the right side of her left breast. An FNAC was suggested and the diagnosis was "Carcinoma of the Breast".

FNAC
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Date : 20-Mar-2009
Nature of Specimen : Breast Lump
Microscopic : Highly cellular smear shows loose clusters, groups and singly scattered pleomorphic large round or oval cells with scanty cytoplasm and hyperchromatic nuclei having prominent nucleoli. Background is necrotic  and shows and infiltrate of lymphocytes.
Diagnosis : Carcinoma of the breast.

CA125
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Date : 24-Mar-2009
Value : 2.60
Units : U/ml
Technology : C.L.I.A
Reference range : Adults : Less than 36 U/ml
Please correlate with clinical condition.



No others tests have been done so far and she has been asked to contact the Regional Cancer Center for further tests and treatments.  She will be going for tests on this wednesday (24-Mar-2009).

Can you give me your valuable opinion regarding the FNAC?
From this can we know whether it is invasive or not?
What further tests will she be undergoing?
Would she require chemo and/or radiation? What are the factors that decide these? Will there be long lasting side effects? Can she lead a normal life after this?
When can we know the stage of cancer? Just removal of the lump is not sufficient?
I read that the survival years is 5 years. If the cancer doesn't reappear can't she have a longer life span?

I know it will difficult for you to answer all my questions at this point. But we are all shattered and trying to gain as much as info from all resources.

There is a family history of breast cancer.
My mother's mother was diagonised with cancer of the right breast in 1982 (i do not know the details) and she had her whole right breast removed. She was doing fine after that and later died in 1987 due to an heart attack at the age of 64.

I am 31 now and a mother of a 4 year old child.
My sister is 26 and recently married and have no kids.
In 2006 i had a surgery for intraductal papilloma on my left breast. The biopsy was negative and clear of cancer cells. But occasionally i stiil feel heaviness in my left breats and left arm. I had a mammogram and ultra sound in 2008 which was okay.

Do me and my sister need to do regular checkups now because both our mother and grandmother had been diagonised...?
How frequent should we go for checkups and what are the test that we need to do...?
P.S : I have PCOS and my periods are not regular.


Thank you very much.
Jaya


Answer
I agree that this fine/thin needle aspiration biopsy (FNAC) - my former boss the late professor dr. Sixten Franzén, M.D., Ph.D. was one of the developers of this technique - does show a cancer. However it is NOT possible based on a cytological aspiration biopsy to conclude if the tumour is invasive or not. Only a surgical biopsy of the type "lumpectomy" can give us a full histopathology study of her tumor and thereby the knowledge of its invasiveness etc. If such a "lumpectomy" is possible depends on the size of her tumor. To better evaluate her situation she should undergo mammography (x-rays), ultrasound breast scans and MRI breast scans. And if necessary also other tests and investigations (PET scans, bone scans, CT lung scans and MRI bone scans, CT or MRI liver scans etc.). Please do keep me posted with the results. If her tumor is too big a lumpectomy is not possible. Then a mastectomy (partial or complete) will be necessary (including pathology studies of the surgical specimen instead of a lumpectomy). Also sentinel node biopsies may be necessary. Radiation therapy will probably also be necessary and chemotherapy and hormonal therapy may also be necessary. In this family history situation both you and your sister should have regular check ups.