Expert: Claes-Gustaf Nordquist, M.D. - 2/26/2010

Question
QUESTION: My mom aged 67 years had a masectomy recently. Her biopsy result is Impression - No residual tumour is seen"
Only shows foci of heamohrrage reactive inflammation and repadative firbrosis.
Posterior resected margin is free.
Nipple and areola are free.
No nodal involvement is observed - 0/8.
ER - +ve 98%   
PGR - +ve 98%
Please guide if kemo/radiation will be required. If so what will be the dosage. how many sittings. any other suggestions
Thank you.

ANSWER: I suppose that a "lumpectomy" was done first as a biopsy where her tumour was removed surgically. Correct? If so do you have her pathology report from that surgery? I would like to read it. You can copy it here. It seems her whole tumour was removed successfully during her biopsy operation. If so you normally do not perform any mastectomy after such a lumpectomy but instead you give the operated breast - which is left intact fixed on the patient - radiation therapy up to 4500 cGy/rad in total dose over a period of 4.5 weeks with daily treatments 5 days per week with daily doses of 200 cGy/rad. Now since she had a mastectomy done instead there is no need for such irradiation except maybe to some (untouched) lymph node stations. But since there is no nodal involvement (was her sentinel node checked?) there is probably no need for any radiation or chemotherapy at all. But since her tumour was positive for hormone receptors she should have (anti) hormone therapy. I'm surprised that her breast was not left in place and radiation therapy given! Good luck!



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

QUESTION: Yes. A lumpectomy was done and a lump of size 3.5 cm was removed and sent to biopsy. The impression was "Infiltrating ductal carcinoma (mucinous carcinoma)
breast. Then the option of conserving the breast with radiation therapy was given. But my mom chose mastectomy. Then the mastectomy was performed and the result was that given in the previous mail. But during the PET scan the impression was "Increased metabolic activity in the right breast due to recent surgery (lumpectomy) and increased metabolic activity in the right auxiliary node". But while describing all the other parts "A node of size 17 mm in the lung. NO increased metabolic activity" has been stated. But no mention is made about this node in the impression. Should any follow up action taken for this node. Any other advice is welcome. I am very thankful to u for ur clear and immediate response. Thank u very much.

Answer
OK, I see. Well the tumour was then in my opinion a bit too big for lumpectomy and radiation. The metabolic rate in the axillary node seems to be a false alarm - if it was the right breast that was operated - since there was no nodal involvement in the pathology report. Yes I see that must be the case from the PET scan report. Yes there should be follow up check ups and if possible a biopsy due to the lung node. Good luck!


You can also reach me on: http://www.lifestylerescue.com/expert/health-fitness-advice/dr-claes-gustaf/128     There is no restriction to the number of questions there.