Expert: Claes-Gustaf Nordquist, M.D. - 8/26/2010

Question
Greetings from England :-)
BACKGROUND
Diagnosed in March 2010 with multi-focal invasive ductal carinoma.  ER/PR negative, HER2 positive.  10 (yes, ten!) tumours in left breast, the largest of which was 1.4cm. Others 3mm - 1.1cm. 8 nodes affected.  No further metastases.  Mastectomy and axillary clearance. Excellent margins.  FECx4 done, now on T+ Herceptin x 4, with H to continue for one year.   I am 44, with absolutely no risk factors and no family history of any cancer for at least 3 generations. BRCA negative.
QUESTIONS
1. Hospital has recommended to have radiotherapy to chest wall and supra clavicular fossa. Already have signs of lymphoedema. What is my risk of recurrence in this area; specifically supraclavicular fossa?  What is the statistical advantage of having radiotherapy?  I am worried about increasing further problems with lymphoedema.
2. What factors might influence recurrence?  ...is there ANYTHING I can do to reduce the chances of recurrence?  My diagnosis seems a little unusual and I'm unable to find anything in the medical litarature relating specifically to HER2 multifocal.
Thanks so much - Tack!

Answer
Your case is VERY special! I have never seen anything like it and I know of no statistics on any cases like this! But with this number of malignant tumours in one breast you must be regarded as a high risk patient. I agree with your doctors that radiation therapy in a case like this is IMPORTANT ! Such radiation therapy may to some extent increase your lymphoedema risk but the most important factor there is your armpit surgery and that has already been done. AND breast cancer is at least a potentially deadly disease which lymphoedema is not though by no means a picnic. So I have to insist that such radiation therapy is important in your case! If you happened to be my sister or my mother I would insist on such treatment! There are supraclavicular lymph nodes also draining the breast area. With so many tumours in your breast a spread to that area is also possible. And there was no surgery done there so it should be irradiated! Also the chest wall is important in a case like this! Apart from radiation therapy and what else that is being done there is in your case at present nothing else that can be done. Well, if I happened to be in your case I would probably also seriously consider removal of my right breast as a prophylactic measure in a case like this. But the choice is of course yours. If you keep it it should be watched closely! You are most welcome! Varsågod!


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