Treatment experience of a patient with bone metastases from breast cancer

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Transferred from the real doctor's notes of the Little Lotus App

【Basic information】Female, 41 years old

【Disease type】Breast cancer bone metastasis

【Treatment Hospital】Zhangzhou City Hospital of Fujian Province (Top 3)

【Treatment plan】Chemotherapy + bone protection therapy + endocrine therapy

【Treatment cycle】Six cycles, long-term treatment

【Treatment result】 His condition was stable, and he was discharged from the hospital after recovery

First, the first acquaintance with the patient

This patient felt relatively young when he came to the doctor, and he did not expect to have undergone several surgeries. She was seen for more than half a year because she had found a tumor in the right supraclavicular fossa. The patient's mass is located on the edge of an old surgical scar that, at first glance, is a scar left by the incision and reduction of the clavicle fracture and the scar left after the internal fixation is removed. The patient's swelling is hard, the boundaries are not clear, it is not easy to push, and it does not look like a good thing.

The patient showed me a hospitalized medical record.

The patient visited the local hospital two years ago because of the discovery of breast mass, when the lump was about the size of "apple" (6cm), after the outpatient ultrasound examination, the local doctor directly recommended hospitalization surgery, the lump was removed and the pathology was confirmed as breast cancer, and then arranged for breast cancer modified radical resection. The operation went smoothly, and no special findings were seen from the surgical records, discharge records, and admission records at that time.

Postoperative pathology: right breast invasive ductal carcinoma (moderate differentiation), immunohistochemistry: HER2 (2+), ER (70% moderate intensity +), PR (80% strong +), Ki-67 (50%+), axillary lymph nodes (7/10).

Diagnosis: right breast invasive ductal carcinoma p-T3N2M0-III.A.

The local hospital did not perform FISH tests, and six cycles of chemotherapy were performed after surgery (fluorouracil 500 mg d1-5 + calcium folinic acid 0.2 g d1-5 + docetaxel 120 mg d3 + cyclophosphamide 600 mg d1). Endocrine therapy was given only with tamoxifen after chemotherapy. The patient refuses radiation therapy. A follow-up examination was done six months, one year, and one and a half years after the operation, and no tumor recurrence and metastasis were found.

"Hey!" After reviewing the patient's mass and related paper materials, I can only sigh. Eighty percent of the patient's neck problems were metastatic breast cancer. I did another part of the patient's examination and found no other problems for the time being. I could only admit her to the hospital for further examination and make a treatment plan based on the results of the examination. Patients reach advanced breast cancer, palliative chemotherapy is the most basic treatment.

Second, the patient's treatment process

After the patient was admitted to the hospital, the examination of common metastases of breast cancer was done, there were no obvious problems in the examination of breast, lungs, liver, skull, etc., and the patient did not have obvious bone pain, fractures and other bone metastases, but the whole body bone imaging examination suggested bone metastasis of the right shoulder blade bone, and further did the magnetic resonance of the shoulder joint to suggest multiple metastases of the soft tissue around the clavicle on the right side. A pathological biopsy of the right supraclavicular fossa lymph node was taken under ultrasound guidance to confirm breast cancer metastasis. Further immunohistochemistry suggests ER (80% medium-strong +), PR (40% medium-strong+), HER2 (2+), Ki-67 (hot spot 60%+). In situ hybridization prompt for HER2(2+): HER2(-).

Combined with the patient's immunohistochemistry and genetic testing, the diagnosis is: stage r-IV., HER2(-), HR(+). The patient was given a white slice at the local hospital and re-performed immunohistochemistry, confirming that the molecular type at that time was consistent with the molecular type of the current metastatic foci. Based on the patient's previous use of chemotherapy drugs, according to the breast cancer diagnosis and treatment guidelines, patients with HER2-negative hormone receptor-positive advanced breast cancer should first consider endocrine therapy in the absence of visceral crisis. The patient was advised to change and upgrade endocrine drug therapy, but the patient refused, because the medical insurance reimbursement for the relevant drugs selected by the adjustment plan was extremely limited, and she could not afford the treatment cost of the standardized plan. I have encountered many similar situations, and I have deep sympathy for the patient, and I want to give her the most standardized treatment at present, but I can't help it.

I finally chose to give the "TEC" regimen chemotherapy 6 cycles, with ...

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