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Diagnosed With Breast Cancer. Scan Reveals Cancer Spread To Lung And Liver. What Is The Treatment?

Posted on Sun, 8 Dec 2013

Question: My 47 yr old wife was diagnosed with breast cancer 2.5 yrs ago. Her left breast and underarm lymph nodes removed. 3 nodes were cancerous. Now after a lump in her neck scans reveal the cancer has spread to her lung and liver. The oncologist says the spots are very small and had not shown on a scan 2 months ago. What is the treatment and prognosis.

Answered by Dr. Lokesh K N (6 hours later)

Brief Answer: Needs treatment if positive for cancer Detailed Answer: Hi XXXXXXX If the lump in her neck is positive for cancer by needle aspiration or biopsy, she definitely requires treatment irrespective of the size of other lesions. I think she must have received chemotherapy and radiotherapy after her first surgery. If the neck swelling is too small for these procedures, then she needs frequent regular followup with your doctor to find out the changing size of the swelling to initiate treatment soon if it requires. As you have not mentioned about taking any daily tablet, she may be a triple negative breast cancer which can relapse within 3 years. I think she needs chemotherapy if positive for cancer. Regarding prognosis, it depends on the hormonal status of the relapsed disease i.e good prognosis if hormone receptor positive and Her-2 negative. Hope I have answered your questions. Let me know if you need clarifications. Regards

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Lokesh K N (41 hours later)

Clarifacation needed. The biopsy of the lump in her neck was positive for cancer. Located in nodes. She received chemotherapy and herceptin after her masectomy followed by radiotherapy. Her breast cancer was ER positive HER2 overexspressed. She has been taking tamoxifen as a tablet for 2 yrs. She was also on a trial of Denosumab every 4 weeks by injection to her abdomen. This trial was ended on the new cancer spread discovery last week. During this trial she also supplemented with calcium and vitamin D. What specific treatment would you recommend and what is your oppinion of her prognosis ? PS I submitted this follow up 24 hours ago but I see no reply so I am submitting it again XXXX

Answered by Dr. Lokesh K N (5 hours later)

Brief Answer: Requires change of treatment Detailed Answer: Hi XXXXXXX ER positive is a good and Her-2 positive is a poor risk factor. As the biopsy of the swelling in the neck is positive for cancer, we need to know the ER and Her-2 status of the relapsed disease. If it is not feasible she has to be treated based on the ER & Her-2 positive status of earlier disease i.e harmonal therapy changed to aromatase inhibitor if postmenopausal with therapy against Her-2 like continuing trastuzumab or changing to pertuzumab/Trastuzumab-DM1. If it is a symptomatic disease in crisis may need chemotherapy. You need to discuss with your doctor for one of these options. The prognosis does not appear to be good as she has progressed even treatment with ant-Her-2 and tamoxifen within 3 years But relapse only as a swelling in the neck may have better prognosis compared to visceral(liver etc...) metastasis. Hope i have answered your query.

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Lokesh K N (16 hours later)

Your answer is OK but incomplete. You seem to have overlooked that there is visceral metastasis. If you read my original question I state -: "scans reveal the cancer has spread to her lung and liver. The oncologist says the spots are very small and had not shown on a scan 2 months ago." Can you revise your answer taking into account this metastasis. Particularily an estimate of your opinnion on her prognosis in months/years. XXXXX

Answered by Dr. Lokesh K N (9 hours later)

Brief Answer: even neck lump is metastatic Detailed Answer: If the lesions were not seen on repeat contrast CT/MRI scan, then its taken as no metastasis. But the lump in the neck is a metastatic disease. The prognosis is usually better than the wide spread metastatic disease. The median survival is around 2years in most of the studies.

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Lokesh K N (45 hours later)

I don't know how you keep getting the facts wrong. I clearly state, twice now, scans clearly show the cancer has spread to her liver and lungs on the last scan. It was the PREVIOUS scan, 2 months EARLIER that did not show any metastasis. Can I FINALLY get answers based on the facts to include treatment and prognosis. At present I am very unhappy with the answers and the lenghth of time taken due to you not reading the facts. XXXXX

Answered by Dr. Lokesh K N (3 hours later)

Brief Answer: She needs chemo or harmonal therapy Detailed Answer: Hi XXXXXXX I apologize for misunderstanding your query. She needs chemotherapy if visceral crisis or harmonal therapy like aromatase inhibitors if no crisis. Also needs anti her-2 therapy as mentioned earlier. Visceral metastasis and her-2 positive patients do poor. The average survival is around 2years. I sincerely hope this answers your question. You are most welcome to ask me further questions if you have any. All the best. Kind regards,

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Above answer was peer-reviewed by : Dr. Yogesh D