Breast Cancer

Metastatic ductal carcinoma of the breast

This 50-year-old woman first suffered the diagnosis of breast cancer in her left breast.

The size of this upper outer quadrant lesion was 2.1cm in maximum diameter.

The histology at lumpectomy was invasive and in situ ductal carcinoma. The tumor was ER 100% and PR 20% positive. 20% of the tumor showed mucinous differentiation (colloid carcinoma).

The surgical stage of the disease at presentation was T2, N0, M0,GII.

Adjuvant treatment consisted of six cycles of CMF and radiation, which resulted in clinical remission.

Three years later the patient developed bone metastases, which were treated with Zometa and Tamoxifen. Follow-up CAT scans and bone scans revealed complete response to hormonal blockade.

Two years later despite Tamoxifen the cancer re-appeared with multiple metastases in the spinal column.

These failed to respond to Femara (Letrozol), Arimidex, Taxol, Platin, and Gemcitabine.

She was then treated with Xeloda (Capecitabine) and Avastin, which produced remission that lasted two years.

The tumor recurred with multiple bone metastases, massive left supraclavicular, cervical, mediastinal and axillary nodal metastases along with a malignant left pleural effusion, pulmonary metastases and skin metastases to the left anterior chest wall.

In response to OncoPherese the nodal mass in the left neck and supraclavicular fossa decreased from 5.5 x 8.0 cm to 1.0 x1.0 cm. Her skin disease over the sternum and left breast resolved. Her left sided pleural effusion resolved. Her chest x-ray continued to demonstrate a diffuse reticular pattern in the left lower lobe. Her bone metastases resolved by bone scan and her mediastinal adenopathy resolved by CAT scan.

Metastatic ductal carcinoma of the breast with carcinomatous peritonitis

This 55-year-old woman initially presented an indurated right breast with diffuse erythema of the skin of the entire breast along with palpable adenopathy in the right axilla.

Staging work-up revealed ascites and multiple liver metastases. No pulmonary metastases or bone metastases were visible radiographically.

An MRI of the brain was negative for intracerebral metastases. Biopsy of right breast mass revealed infiltrating ductal carcinoma.

The tumor was ER/PR positive and HER-2/neu intermediate.

Initial treatment was Taxol/Carboplatin/Tamoxifen every three weeks for eight cycles. Post treatment PET/CT revealed 30% tumor reduction. Tamoxifen was continued after chemotherapy but she developed rapid disease progression within months.

She was referred for OncoPherese. Upon presentation she had tense ascites and intractable nausea and vomiting secondary to rapidly progressive carcinomatous peritonitis confirmed by CAT scan and peritoneal cytology, along with numerous 3-4 cm liver metastases.

The right breast was replaced by tumor and fixed to the chest wall. There were numerous enlarged pathologic right axillary nodes.

The left breast demonstrated multiple pathologic nodules and pathologic nodes were palpable in the left axilla. There were palpable tumor masses in the enlarged right hepatic lobe.

After two weeks of treatment with OncoPherese, her ascites decreased and she was able to eat normally. After three months of treatment both breasts were normal to physical examination and the bilateral axillary adenopathy had resolved. This was confirmed by CAT scan.

She regained her pre-morbid weight and returned to full physical activity including daily tennis and swimming.

The ascites resolved as did the CAT scan evidence of carcinomatous peritonitis. The liver metastases decreased by more than 50% and the residual masses failed to contrast enhance. Radiographic evaluation concluded that these were scar tissue.

Locally-advanced Stage C invasive ductal adenocarcinoma of the breast

This 60-year-old woman presented with the diagnosis of locally advanced invasive carcinoma of the left breast.

She had noted a progressively enlarging mass in the upper outer quadrant of the left breast for six months. The mass was bi-lobed at the time of core biopsy and measured 5 x 5 x 6 cm in the primary mass and 4 x 3 x 3 cm in the second lobe lateral to the first.

There were several palpable nodes in the low axilla. Chest x-ray and bone scans were negative. Serum CBC, chemistries and tumor markers were negative.

The core biopsy revealed invasive ductal carcinoma as well as extensive intraductal carcinoma and multiple areas of carcinoma in situ. The tumor was ER positive, PR weakly positive and HER-2/neu focally 2+ Dako scale.

She was offered neo-adjuvant chemotherapy and mastectomy but refused.

She also refused mastectomy and any hormonal therapy.

Instead she sought this experimental immunologic extracorporeal treatment.

Because of her persistence all of her physicians agreed to pursue one month of OncoPherese and if after that she had any evidence of disease she would proceed with standard therapy.

After one month of OncoPherese she enjoyed complete regression of the palpable disease in the axilla and reduction of the palpable disease in the breast to less than one centimeter.

She then agreed to surgical removal of the residual breast mass at a university hospital. Histology revealed extensive necrosis and inflammatory cells but no residual cancer cells.

There was no evidence in the excised tissue of carcinoma in situ or intraductal carcinoma. She then began Tamoxifen but stopped this drug after a few months due to side effects. She then switched Femara, which she continued for over 5 years.