Diagnostic Investigations And Treatment Modalities Of The Stage Four Metastatic Breast Cancer

Diagnostic Investigations and Treatment Metastatic Breast Cancer

Patient’s risk factors and Aetiology

Catelyn Stark a 50-year-old female diagnosed as four stage of metastatic breast cancer. The most common factor of Catelyn disease is her age. The risk of developing breast cancer increases as a woman ages and, in most cases, the disease develops in women over 50 years old. There are many other factors which are important to considered in the case of Catelyn such as “Personal history of breast cancer”, as descripted in the history, she has painless lump in the upper outer quadrant of her left breast. Three years later, Catelyn returns to her GP complaining of ongoing lower back pain and unexplained weight loss. Positive lymph nodes are also a risk factor. The more positive lymph nodes, the greater the need to prescribe chemotherapy. In patients with 1 to 3 lymph nodes positive, the result of Mamma graph may be low risk and chemotherapy does not clinically represent an added value (Wagle et.al. 2018).

After subsequent diagnostics, Catelyn is diagnosed with stage four metastatic breast cancer due to genetically mutated ductal epithelial cells. On examination, she is found to have moderate non-pitting oedema of the left arm. Family history of breast cancer is one of the vital factor to considered for examination of metastatic breast cancer.

Pathophysiology

The definitive diagnosis of cancer is established by the specialist in pathological anatomy by observing the malignant cells obtained in the biopsy under a microscope. From these cells you will be able to define the tumor, evaluate the prognosis and possible treatments. The factors it evaluates are:

Tumor size: The larger the tumor, the greater the risk that it will recur.

Histological type: Depends on the cells from which the tumor derives. Ductal carcinoma is the most frequent (80 percent of cases), followed by lobular carcinoma.

Histological grade: Provides information on the maturation (growth) of tumor cells. The most differentiated are the most mature, grade I and least aggressive; the least differentiated are those of grade III.

Lymph node involvement: The prognosis of the disease is established by the number of lymph nodes that have been affected . The greater the number of lymph nodes, the greater the risk of relapse.

Hormonal receptors: The specialist will analyze if the tumor cells are in the hormones estrogen and progesterone.

HER-2 : It is the receptor 2 of human epidermal growth factor, a protein that participates in the growth of cells. HER-2 is present in normal cells and in most tumors. However, in 15-20 percent of breast tumors is found in high concentrations, causing the tumor to be more aggressive (Swenerton, et.al. 1979).

Treatment

In the case of Catelyn, different treatment methods can be applied.

Surgery

The surgery is used with the intention of removing the tumor and analyzing the lymph nodes of the axilla. There are two surgery options:

Conservative: The specialist will remove the tumor and a small amount of healthy tissue around it. As indicated from SEOM, this option allows the breast to be conserved, although, in general, it requires that after the operation radiotherapy be administered to eliminate the tumor cells that remain in the breast. This option can be done depending on the size of the tumor, the breast and the patient's wishes.

Mastectomy: The specialist will remove the entire breast. Under these circumstances, patients can rebuild their breast. This option can be done by removing the breast or after finishing all treatments. The right time depends on several factors related to the treatment and the patient's preferences.

Sentinel node biopsy

The sentinel node is the first lymph node where it is possible for the tumor to spread. To locate it, the specialist will inject a blue dye near the tumor that will flow through the lymphatic vessels until it reaches the lymph nodes. The procedure that the professional will follow is to remove the first lymph node that receives the substance and check if the tumor has arrived. If the tumor has spread to the lymph node, the lymph nodes will have to be removed (O’Shaughnessy, J2005).

This technique is not indicated in all circumstances.

Radiotherapy

Radiation therapy is used to avoid tumor cells from increasing and / or destroying them . It can be used as:

Adjuvant therapy: Specialists can recommend it as a local management to eliminate possible growth cells that remain after acting surgery.

Palliative therapy: To get rid of the symptoms of lymph node or bone involvement.

Systemic therapy

Unlike surgery or systemic therapy or radiotherapy, does not act nearby, this treatment influences the entire form. It is managed verbally or intravenously and is dispersed to all structures. The goal of this action is to decrease the hazard of relapse in the disease and death.

Concept Map

center170180474345764540502920772160Catelyn Stark

12573008572500Symptoms nipple discharge

moderate non-pitting oedema of the left arm

oral contraceptive pill for the last three years

425894422796500 lower back pain and unexplained weight loss

Diagnosis1341120144145 Metastatic Breast cancer Stage IV

43357804508589154045085

Treatment -----Surgery

Clinical manifestation, Pathophysiology

Tumor size: The larger the tumor, the greater the risk that it will recur.

Histological type: Depends on the cells from which the tumor derives. Ductal carcinoma is the most frequent (80 percent of cases), followed by lobular carcinoma.

Histological grade: Provides information on the maturation (growth) of tumor cells.

References

O’Shaughnessy, J. (2005). Extending survival with chemotherapy in metastatic breast cancer. The oncologist, 10(Supplement 3), 20-29.

Swenerton, K. D., Legha, S. S., Smith, T., Hortobagyi, G. N., Gehan, E. A., Yap, H. Y., ... & Blumenschein, G. R. (1979). Prognostic factors in metastatic breast cancer treated with combination chemotherapy. Cancer Research, 39(5), 1552-1562.

Wagle, N., Painter, C., Anastasio, E., Dunphy, M., McGillicuddy, M., Stoddard, R., ... & Balch, S. (2018). The Metastatic Breast Cancer Project: Partnering with patients to accelerate progress in cancer research.