Expert: Claes-Gustaf Nordquist, M.D. - 2/11/2010

Question
Dear Doctor,
I have asked a question before on which you have provide an answer I had already known. But, since this is a very important matter considering the life of a very good friend of mine, please do allow me to ask a new question which I will support with up-to-date diagnosis and informations in order for you to have more details and for me to know that I have tried to explain the situation as best as I could.  
Namely, it is my close relative and friend Meri Micevska, a 49 year old woman and a mother of two children: 19 years old Teona and 13 years old Julian. On March 13, 2007 she was diagnosed for Carcinoma Mucinosum Mammae (Colloid Carcinoma) on the left breast and which was surgically removed. The post surgical and histo-pathological findings and classification were: pTNM  pT  2   G   3   pN    3    pM X C  4  E    P    NG   Stage III C.
In the course of the surgery, 20 lymphatic glands were extirpated of which 12 were found to be positive on cancer proliferation.
Laboratory tests revealed cancer properties as: HER - negative, ER - +++, PGR - +++, K167 - 70% and p53 - 0%.
The follow up treatment included classical radiotherapy and 4 courses of EC-75 chemotherapy protocol (90 mg/kg Epirubicine 140 + Endoxan 1100 + 2 amp Newoban + 20 mg Dexametazone) followed by 4 courses of Taxotere 170 with pre-medication.
At that point the Rtg of lungs and Echo of the abdomen showed normal situation.

On February 4, 2010 Mery collapsed in a form of an epilepsy attack. MR examination showed a formation 2.5x2.1 cm in parieto-ocipitalis sinistra region of the brain. The operation was performed on February 8, 2010, removing the whole mass formation.
Histo-pathology examination confirmed the diagnosis Carcinoma mucinosum metastaticum cerebri originating from the breast cancer.

My question: Please do let me know what kind of treatment would you suggest now and what kind of examination trials would you recommend in order to monitor the possible reoccurrence of the cancer in other organs and tissues, and to react promptly and accordingly?

Thank you very much
Prof.Svetislav Krstic
Faculty of Natural Sciences and Mathematics
“St.Cyril and Methoodius” University
Skopje, Macedonia

Answer
Thanks for your confidence! well the only combination I can think of here and now is whole brain radiation therapy maybe in combination with hormonal therapy. BUT even with therapy her prognosis remains very bad unfortunately and her remaining survival time can in this situation - even with treatment - probably at most be measured in months! I'm sorry I have nothing better to tell you!



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