Recurrence of Breast Cancer: A Management Dilemma

22/10/2020 | By Dr. Jay Anam, Dr. Chetan Anchan

Surgery : Breast Surgeries

There is always a word of advice on the management of early breast cancer, locally advanced breast cancer as well as metastatic breast cancer. Not much is spoken or written about Locally Recurrent breast cancer.

Recurrence is a unique case scenario where it is not possible to have clear-cut guidelines. Precise and personalized treatment is the need of the hour.

Would like to discuss one such case scenarios.

Mrs N Sampat (name changed), a 55-year-old postmenopausal lady, diabetic and hypertensive presented with a 3 x 3 cms hard lump in her right breast. Mammography done confirmed it to be a BIRADS V (malignant) lesion; also another 2 x 2 cms, BIRADS V lesion was also seen. FNAC done confirmed it to be ductal carcinoma.

She underwent modified radical mastectomy (removal of the breast and axillary nodes). On her final histopathology report, she had hormone receptor-positive, multicentric Infiltrative ductal carcinoma of the breast with four positive nodes. As an adjuvant treatment, she received 6 cycles of chemotherapy followed by radiation therapy over four weeks.

She had been taking Tab Letrozole for last 5 years. Now after a disease-free interval of 5 years, at the age of 60 years in April 2020, she noticed a swelling just below the clavicle. Within three months this swelling rapidly increased to 7 x 7 cms. A pet scan done showed it to be an isolated tumor recurrence site.

A core biopsy confirmed it to be hormone receptor-positive recurrent breast cancer. A local MRI was done, showed involvement of Pectoralis major and Minor muscle, and tumour-causing compression of the axillary vein with 90-degree contact. The axillary artery and brachial plexus were free.

Patient Concern:

She was concerned about the inoperable and incurable status labelled to the disease by the local doctors.

Treatment Offered:

On the scan, the tumor mass appeared to be operable with adequate margins.

Wide excision of this lump was planned.

Clinical pictures are shown.

Wide excision of tumor mass with adequate margins was done and sent for final histopathology.

On histopathology, it was confirmed to be Recurrent Infiltrative ductal carcinoma with positive ER, PR receptors. The patient is planned for further chemotherapy and hormonal therapy.

Conclusion

It is possible to offer safe and curative treatment for recurrent breast cancer. Recurrence of breast cancer needs a patient-tailored treatment approach.

In our next post, we will discuss a patient where chemotherapy was used before surgery for a better outcome.