Kas 7-7E: A patient with breast cancer I.
59 years old woman, married, ex-clerk, regularly followed up after breast cancer cured 6 years
ago, now coming with a headache, pain of thorax spine and vertigo.
Family history: grandmother and aunt died of breast cancer
Past medical history: last 9 years has been suffering form IHD, smoker (from the age of 20,
10-15 cg/day).
History of the present complaint: 6 years ago she underwent right mastectomy and axilar
lymphadenectomy due to invasive ductal breast cancer (pT3N1M0, ER +), followed by
cytotoxic chemotherapy (6 cycles) and Tamoxifen (5 years). Now she is coming with a
headache, vertigo and pain of thorax spine shooting to the sternum.
Physical examination: limited mobility because of vertigo, but able to walk with support.
Main problem is a severe pain of the lower part of thoracic spine.
Chest wall is clear, scar after mastectomy with no signs of local recurrence, no palpable
lymfadenopathy. Left breast: no pathology. Performance status according to the WHO: 2.
Other examinations: CX-Ray and XRay of the thoracic spine: no lung metastases, normal
mediastinum, compression of vertebra Th 7, absence of the left pedicle in Th 5 and Th 8 is the
sign of osteolysis. CT of the brain: multiple brain metastases.
Bone scan: foci of pathologic accumulation in Th 5,7,8. Liver US: no metastases.
FBC: Hb 10.8 g/dl, ery 3.01 x 1012/l, leu 5.9 x 109/l, trombo 156 x 109/l, normal biochemistry,
FW 58/72, Oncological markers: CEA 15.4 ug/l, CA15.3: 158 kU/l (normal ratio 0,0-33,0
kU/l)
Tasks and questions:
What is this patient’s prognosis? What is the aim of the treatment?
What is the most often metastatic site of breast cancer?
Is hormonal therapy applicable in all patients with breast cancer ?
Possibility of supressing pain in this patient.
Is further follow-up of this patient necessary after completion of primary treatment? If
yes, why, how often and which investigations are recommended?
6. Pathology: Types of Breast cancer
7. Way and meaning of grading in breast cancer
8. Funcional disorders of breast
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