This is a medical report of a lady with breast cancer written by her Consultant in Radiology & Oncology of a private hospital, dated 10 September 2006.
To Whom It May Concern
The above named underwent an excision for a T2 N0 M0, Er / Pg R and C-erbB2 positive left breast cancer in 1999. This was followed by adjuvant radiotherapy (40 Gy in 15 fractions and boost 10 Gy in 5 factions), chemotherapy (5-Fluorouracil, Doxorubicin and Cyclophosphamide x 6 cycles) and Tamoxifen 20 mg daily.
She developed an unresectable extensive local recurrence in 2005. We put her on Vinorelbine and Capecitabine for 4 cycles followed by mastectomy in July 2006.
Comment by Cancer Answers: The date July 2006 in this report must be a mistake. It should read 2005).
Postoperatively, we continued chemotherapy (Vinorelbine and Capecitabine) for 2 additional cycles until August 2005. This was followed by radiotherapy to the left chest wall (40 Gy in 15 fractions over 3 weeks) in September 2005. We also put her on Megace 160 mg daily from September 2005 until May 2006.
We stopped Megace in May 2006 when she developed excessive weight gain. We restarted Tamoxifen 20 mg daily.
In July 2006, she developed nodules on left chest wall consistent with local recurrence. We added ovarian ablation using s/c Zoladex.
On 4 September 2006, she was found to have bilateral pleural effusion and more extensive erythematous lesion on left chest well. The pleural effusion was drained followed by pleurodesis using Bleomycin 45 units.
I have explained the bleak prognosis to the patient and her husband. I advised palliative chemotherapy. However, the patient was not keen.
Thank you.
Yours sincerely,
XX
Response from Cancer Answers: This is a well written medical report giving a detailed summary of what Betty (not real name) had undergone for her breast cancer. However, many people find it difficult to fully understand this report. Let us rewrite this report in layman’s term and provide more information for your understanding.
a) Betty had left breast cancer in 1999.
b) The lump in her breast was removed by surgery. The size of the lump was T2 – this label is given to a lump from 2 to 5 cm in diameter. N0 and M0 mean there were no spread to metastasis to the node (N0) or other organs elsewhere (M0).
c) The tumour however, was tested positive for Estrogen, Progesterone and C-erbB2 receptors.
d) Based on the above, Betty underwent the “full standard recipe” for breast cancer treatment 1) radiotherapy 2) chemotherapy and 3) taking the drug tamoxifen. The oral drug tamoxifen was given to prevent recurrence.
e) In 2005 – i.e. barely five years later, Betty suffered a recurrence – meaning the cancer came back. The previous standard treatment for breast cancer did not cure her. Tamoxifen did not help prevent recurrence either.
f) Betty underwent chemotherapy again, this time with a combination of stronger drugs. The reason for this chemotherapy was perhaps to shrink the recurrent tumour before a surgery was done. This is also a standard procedure.
g) In July 2005, the entire left breast was removed – mastectomy.
h) After the mastectomy, Betty had two additional cycles of chemotherapy.
i) Betty was again given radiotherapy to the chest well. Since her breast had been removed what was left was the bare chest. So this region was radiated.
j) After the chemotherapy and radiotherapy, Betty was put on Megace (megesterol acetate), a synthetic progesterone (a female hormone). Megace stimulates appetite and causes weight gain. It is unclear how the drug can stop cancer from growing. However, this switch of drugs was done because tamoxifen was found to be not effective.
k) Betty took Megace from September 2005 to May 2006 and this drug was discontinued after she suffered an unwanted side effect – weight gain!
l) The oncologist switched the oral drug from Megace to tamoxifen. She was asked again to take the previous drug that was found to be not effective for her earlier on.
m) One month later, in July 2006, she developed nodules on the left chest wall which had been irradiated ten months earlier (September 2005).
n) Betty had her ovaries ablated by using Zoladex. What is meant by ablation? This is a process to shut down the production of estrogen by the ovaries. This can be accomplished by surgery, radiation or drug. In this case, the oncologist chose Zoladex (goserelin acetate) – a hormone which is also used to treat prostate cancer. The drug is injected under the skin.
o) On 4 September 2006, Betty had fluid in both her lungs. There were also lesions on the chest wall where it was radiated earlier.
p) The oncologist explained to Betty and her husband the bleak prognosis and advised palliative chemotherapy. This means that Betty could still continue to do chemotherapy to help her cope with her symptoms – perhaps to improve her quality of life. This statement also implies that as far as a medical science is concern, there is no more hope of a "cure". Everything that needed to be done had been done and they had failed.
q) Betty was not keen to continue with her medical treatment. Her sister came to CA Care and asked for our help. The oncologist had told her that she had only two months to live.