Honc: Late recurrence of breast CA

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Oncologic History The patient had a screening mammogram in 05/2000 which revealed a 4.3 cm mass which was found behind the right nipple. In 09/2008, underwent right radical mastectomy with lymph node dissection. Pathology revealed invasive ductal adenocarcinoma, SDR grade 2 of 3. Surgical resection margins were clean and 1 of 25 lymph nodes were positive. ER is immunochemically very positive. PR is moderately positive and HER-2 was also positive. She underwent 4 cycles of Adriamycin and Cytoxan without Taxol, as well as 6 weeks of XRT all completed in 2000. CT of the chest and bone scan 01/2002 revealed no definite evidence of metastatic disease. Subsequent yearly diagnostic mammograms revealed no recurrence of cancer. She completed 5 years of antiestrogen therapy. Patient does not follow with oncologist. back 12
Past Surgical History Social History • Right mastectomy 2000 • ORIF L ankle 9/2008 • Cholecystectomy 1980 Allergies Adenosine, Phenobarbital, Venlafaxine, Tamoxifen, Anastrozole, Sucralfate • Married to a statistician at U of C • Used to distribute Cephalon cookware, now retired. • Denies alcohol • 30 pack year remote smoking history • Denies illicit drugs Procedural history EGD 2009: Normal esophagus. Bilious fluid found in cardia and in gastric body. Localized mildly erythematous mucosa found in gastric antrum. Otherwise normal stomach. -bilious gastric fluid may have been secondary to delayed gastric emtying or bile reflux -recommended upper GI series and gastric emptying study (not complete) 13
Page 1 and 2: Morning Report August 11, 2011 Nanc
Page 3 and 4: MKSAP Question On physical examinat
Page 5 and 6: MKSAP Question Which of the followi
Page 7: MKSAP Question Although most cases
Page 10 and 11: HPI Summary • Nausea and associat
Page 14 and 15: Physical Exam • BP 100/52 Pulse 8
Page 16: Differential Nausea/Vomiting 16
Page 19 and 20: Labs 13.7 9.2 261 38.9 HbA1C 7.5 13
Page 21: Mechanism of Nausea and Emesis •
Page 24 and 25: 6 weeks later, returns to PCP…
Page 26 and 27: Indications for referral 26
Page 28 and 29: CT Abd/Pelv • Metastatic disease.
Page 30 and 31: MRI Head • Multiple lesions in th
Page 32 and 33: CT Chest • RUL pulmonary nodule h
Page 34 and 35: Brain metastasis • Any cancer can
Page 36 and 37: Sir William Richard Gowers (20 Marc
Page 38 and 39: Patient course • Started on oral
Page 40 and 41: Primary Tumor CTCs Bone Marrow Expa
Page 42 and 43: Brain metastasis in HER2+ breast ca
Page 44 and 45: References • Keane JR. Neurologic

Honc: Late recurrence of breast CA

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