v*****e
发帖数: 30 | 1 国内的好朋友最近诊断乳腺癌。她有一个年幼的孩子，真的很替她着急担心。最近化疗
两个疗程之后，白细胞下降得很厉害。这里附上她的诊断和问题，这里哪位好心的大侠
能给回答一下？ 她已经把问题翻译成了英文.
Specimen Type: Specimen of modified radical mastectomy right breast
Tumour Site/Location: 2.5 cm from the top of the nipple
Size of Tumour: 2.5 x 2.3 x 1.4 cm
Tumour Type: Mucinous carcinomas, ductal carcinoma in situ was seen around
the surrounding area (low and intermediate grade)
Histologic Grade: (blank)
Intravenous Tumor Thrombus: (+) Nerve Invasion: ( - )
Nipple: no cancer cell detected Skin: no cancer cell detected
Base: no cancer cell detected
Breast Tissue Adjacent to Surgical Residual Cavity: (blank)
Remaining Quadrant of Breast Tissue
The upper inner quadrant: no cancer cell detected
The inner inferior quadrant: no cancer cell detected
The upper outer quadrant: no cancer cell detected
The outer inferior quadrant: no cancer cell detected
Breast conversation: (blank)
Number of lymph glands found:
No lymph node metastasis amongst axillary lymph glands (0/16)
lymph node metastasis (Right intramuscular) (1/1)
Specimen of 2 epidermoid cysts (subcutaneous fat nodules), size of 0.5-0.6cm
were sent separately
另外，她也有heterogeneity of occupying nodes in both ovaries (teratoma)。
以下是她的几个问题：
Q1. Does she really need 6 courses of TC? Given that her tumour type is
mucinous carcinoma, and one lymph node was found positive.She is wondering
whether she must complete all 6 cycles with this TC plan, especially when
she encountered grade 4 neutropenia 24hrs after receiving the G-CSF shots of
the first 200ug in the second course. (Her doctor chose this plan for
reduced stomach irritation, when she asked for a milder treatment.)
Q2. To deal with lower WBC counts, would it be possible to choose any
mild agent and take it as prevention method instead of G-CSF as a rescue
method, given the latter causes some serious side effects? Which agents are
they?
Q3 Is PICC necessary for her, regarding the TC agents she receives?
She hasn’t installed PICC for her chemo yet, though staff at her hospital
strongly recommended her to accept PICC. So far her vein looks fine after
two courses of treatment. She is wondering if the TC agents would make an
irreversible permanent damage on her vein. She is obviously only allowed to
use her left arm for future IV and other penetrations. However, as it is hot
summer in Shanghai, she is also concerned a little about the maintenance of
the PICC.
Q4. What about the teratoma in her ovaries in the near future? Would the
therapy have any impact on it? Does she need to have her ovaries removed?
Would this be a replacement for any of the above therapy?
在此预先谢过各位了！ | I****a
发帖数: 407 | 2 1) Need patient's age and hormone/Her2 receptor status, family history and
medical history to answer this question more precisely
2) Can use Naulasta which is almost the standard here
3) PICC is not absolutely needed for TC.
4) No idea about ovarian business
【在 v*****e 的大作中提到】
: 国内的好朋友最近诊断乳腺癌。她有一个年幼的孩子，真的很替她着急担心。最近化疗
: 两个疗程之后，白细胞下降得很厉害。这里附上她的诊断和问题，这里哪位好心的大侠
: 能给回答一下？ 她已经把问题翻译成了英文.
: Specimen Type: Specimen of modified radical mastectomy right breast
: Tumour Site/Location: 2.5 cm from the top of the nipple
: Size of Tumour: 2.5 x 2.3 x 1.4 cm
: Tumour Type: Mucinous carcinomas, ductal carcinoma in situ was seen around
: the surrounding area (low and intermediate grade)
: Histologic Grade: (blank)
: Intravenous Tumor Thrombus: (+) Nerve Invasion: ( - )
| v*****e
发帖数: 30 | 3 感谢Icetea!
Here is the info:
patient age: 41
Family history: no breast cancer family history
medical history: no
Breast cancer with modified right radical mastectomy (right breast) and
axillary lymph node
dissection on 20th of May, 2011.
A lump under her right armpit was self-found but it was not checked out
until 1 and a half months later.
Her histopathology report has revealed that a tumour which was noted to be
at 2.5cm from the top of the nipple, 2.5 cm from the nipple.
It is also reported this is a mucinous carcinoma with ductal carcinoma in
situ was seen around the surrounding area. The grade is ‘low –
intermediate’.
No lymph node metastasis amongst axillary lymph glands (0/16);
One lymph node metastasis (Right intramuscular) (1/1)
ER (+++), PR (+++), Her-2/Neu (+), CK 5/6 (-), CK14 (-), CAM5.2 (+), E-cad (
+), EGFR (-) and Ki67 of 5%.
Is this info enough? Please let me know if you need more data.
Thank you so much!
【在 I****a 的大作中提到】
: 1) Need patient's age and hormone/Her2 receptor status, family history and
: medical history to answer this question more precisely
: 2) Can use Naulasta which is almost the standard here
: 3) PICC is not absolutely needed for TC.
: 4) No idea about ovarian business
| I****a
发帖数: 407 | 4 According to Adjuvantonline. The risk for relapse in 10 years for her is
about 57%. With chemotherapy, the absolute risk for relapse is cut down by
16%. With additional hormonal therapy, the absolute risk is cut down by 17.5
%. If combined, the absolute risk is cut down by total of 30%.
This also holds true for overall survival in 10 years. 10 out 100 patients
will be saved if chemo is used. Therefore, the benefit is substantial if she
receives both chemo and hormonal therapy.
Hope it helps. | v*****e
发帖数: 30 | | v*****e
发帖数: 30 | 6 Thanks a lot for previous answer and help!
My friend now is undergoing "decreased WBC" problem. Here is her question:
I went to cancer cnter and TCM hospital yesterday. this is my rountine
visit right before each chemo cycle. (I will start my 3rd course soon)
I may be very sensitive to the Docetaxel(T agent), so my WBC got extremely
low in the second course already. My TCM doctor was very concerned. She even
suggested me to change the chemo plan! She is a surgery and TCM doctor
specialized in breast cancer. Her concern is that i may not be lucky to get
back my WBC when it drops very low next time, even with the shots (the shots
for increasing the WBC)!
Of course my doctor in Cancer hospital disagree to change the plan, but
agreed to lower the dosage a little. and this time we only have domestic
medicine to use (last time I used imported med and my WBC drops hard). so my
guess is that the side effect might be lower.
What do you think about her low WBC? any solution?
Many thanks! |
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