What Can Be Done For Full Eradication Of Cancer?

Posted on Thu, 9 Jan 2014

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Thu, 9 Jan 2014 Answered on

Wed, 5 Feb 2014 Last reviewed on

Question : I had in 1989, on the left breast, a modified radical mastectomy, removal of left breast, under arm lymph nodes and lining over the chest muscles. In 1990, I had a simple mastectomy - removal of entire right breast.. A couple weeks ago, I had surgery to remove a lump above the left implant. Today I learned that is an "infiltrating carcinoma with lobular features". The pathology report reads that the specimen was bisected to reveal an ill-defined tan-yellow and tan-white area of firm soft tissue located in the center of the specimen measuring 1 x 0.9 cm and located 0.2 cm from the closest inked resection margin of the specimen. I have an appointment with the surgeon next Tuesday - but I am stressed out; and would like to learn what I can now as to the likelihood of a full eradication of the cancers.

Answered by Dr. Krishna Kiran Kannepalli (8 hours later)

Brief Answer: Hormonal treatment will suffice. Detailed Answer: Hi. Thanks for the query. Before I can give a specific answer in your case I would like to know some more details. Did you receive chemotherapy after the surgery on you left breast in 1989. Did you receive postoperative radiotherapy. What was the stage of the disease then. The right mastectomy was a prophylactic mastectomy or was it for DCIS (in-situ cancer). At present, there are a few options before you. As you have stated, the margins are free on the recently resected specimen. Because the tumor is ER positive, hormonal treatment will suffice. You need to undergo a metastatic work up to be sure there is no disease elsewhere in the body. If you did not receive radiation to the chest wall earlier, this might help.

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

Follow up: Dr. Krishna Kiran Kannepalli (9 hours later)

Dear Dr. Kannepalli, Thank you for your timely response. • I did not receive chemotherapy or postoperative radiotherapy after the surgery on my left breast in 1989. • I have just asked a doctor to review my medical record to answer 2 other questions you posed: o The stage of my disease in 1989 when I had the modified radical mastectomy of my left breast; and o the kind of mastectomy I had on my right breast in 1990: a prophylactic mastectomy or a DCIS (in-situ cancer). As soon as I get the answers, I will get back to you. Once again, thank you for addressing the matter. XXXX Dear Dr. Kannepalli, I have yet to receive answers to the questions you raised. From my own Internet research, however, I conclude that the mastectomy on my right breast in 1990 was a prophylactic mastectomy and not for DCIS. I am still waiting to learn the stage of my disease in 1989 when I had the modified radical mastectomy on my left breast. But I am pretty certain that it was an early stage. Recap: • infiltrating carcinoma with lobular features • Estrogen receptors: positive • Progesterone receptors: negative • HER-2 protein: negative • In 1989, I did not receive chemotherapy nor postoperative radiotherapy following a modified radical mastectomy of my left breast. Left underarm lymph nodes were removed. • In 1990, the right mastectomy was prophylactic and not for DCIS. • Pending: confirmation that my disease in 1989 was in an early stage Once again thank you for your assistance in this matter. XXXX

Answered by Dr. Krishna Kiran Kannepalli (5 days later)

Brief Answer: Awaiting your reply. Detailed Answer: Hi. I am still awaiting your reply on the previous reports. Please feel free to write back at your convenience.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Krishna Kiran Kannepalli (3 hours later)

Dear Dr. XXXXXXX My disease in 1989 was in fact in an early stage. Is there any other reply that you are waiting for from me? Francoise

Answered by Dr. Krishna Kiran Kannepalli (23 hours later)

Brief Answer: Hormonal treatment and close follow up. Detailed Answer: Hi. Thanks for providing me with the details. I read your histopathology report very carefully. The report describes that the tumor was extending up to the margin of resection. As per standard protocols, you might need a re- excision of the scar to be sure that there is no cancer at the margins. In case you want to avoid second surgery, you need to be on close follow up. Chemotherapy is not warranted in your case as the tumor is ER positive and is a small one. At 70 years of age, aggressive chemotherapy is not advisable. You should be started on one of the aromatase inhibitors like anastrazole or letrozole. Radiation therapy is also not warranted as it would be over treatment for what appears to be a small localized recurrence after a long disease free survival. The best option for you would be hormonal treatment + close follow up.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Krishna Kiran Kannepalli (28 minutes later)

Thank you Dr. Kannepalli, Yesterday, my husband and I saw the oncologist surgeon who operated on me. He and you agree that additional surgery is in order due to the fact that the tumor was extending to the margin. I will be undergoing a full-body PET scan this Saturday and an MRI of the breasts on Tuesday. He has not yet ruled out radiation or chemotherapy. That will be decided upon after the surgery and tests. If either of the two treatments are in order, radiation, he said, would probably be considered before chemotherapy would. He is also sending the tissue to a lab for an oncotype DX breast cancer test. Your findings and his are a great relief to me. Thank you for your timely and detailed attention to this matter. XXXX

Answered by Dr. Krishna Kiran Kannepalli (3 days later)

Brief Answer: Brief answer: please follow your oncologists advic Detailed Answer: Detailed answer: Thank you for getting back with the details. As told, please follow your oncologist’s advice. It is going in the right direction. Thank you too!

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar