Patient 1: MDA
49-year-old when first seen by me.
She had undergone modified radical mastectomy, left, with deltopectoral flap at Ospital ng Maynila Medical Center 2011 (5 years before at age 44) for a 12-cm invasive ductal carcinoma. Axillary nodes – 2/46 positive. Underwent postop chemotherapy – fluorouracil, adriamycin, cyclophosphamide then radiation. ERA / PRA – negative.
On consultation in 2016 with me, multiple palpable nodules (recurrences) noted on the left chest area above the deltopectoral flap. Palpable node on the right supraclavicular area. Bone scan showed metastasis to left 2nd rib. Chest x-ray showed a pulmonary nodule. Ultrasound of the liver was negative for metastasis.
Another chemotherapy regimen (unknown) initiated by a medical oncologist – received 2 cycles. No response.
Patient died within one year after the 2016 consultation with me.
Patient 2: TD
She was 59 years old when she consulted me for a breast cancer about 4 cm in size. Still operable. She deferred her cancer treatment for one year because she wanted to do it after her retirement from government service at age 60.
She came back to me after her retirement. The breast cancer was already inoperable. I had to refer her to a medical oncologist for an adjuvant chemotherapy. The mass shrunk to the point that I could do a modified radical mastectomy, which I did.
However, she died from distant metastasis one year after – at age 61.
Note: Patient autonomy: The right of patients to make decisions about their medical care without their health care provider trying to influence the decision. Patient autonomydoes allow for health care providers to educate the patient but does not allow the health care provider to make the decision for the patient.
Patient 3: MJF
60-year-old teacher who had breast cancer in 2010. Underwent modified radical mastectomy. Nodes – 8 positive. ERA – positive; PRA – negative; HER-2-NEU – positive. Postoperative adjuvant chemotherapy – cyclophosphamide, methotrexate, 5-fluorouracil.
One year postop, local recurrence and bone metastasis. Did not want chemotherapy and radiotherapy. Tamoxifen, then letrozole, with alternative medicine. Developed pulmonary metastasis – one year after. Died 2 years after (7 years after operation).
To post more in the future.