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Is surgery necessary for breast cancer?

Monday, 16 March 2009
Answered by: Dr. Mukhopadhyay
Consultant Oncologist
Batra Cancer Center, Moolchand Hospital
New Delhi
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Q. My 70 years old mother is suffering from breast cancer and it has spread to the liver too. We have given her 15 cycles of chemotherapy with Herseptin and Taxol + Lapatanib. Her ER PR test was negative but her2 was positive; now the doctors are suggesting surgery. We are afraid to go for surgery? Please suggest.

A.  It is not very clear from your mail whether your mother had a metastatic disease at presentation or developed the liver metastasis (spread to the liver) later on. The mere mentioning of Her2neu positivity does not convey any meaningful information either. Her2neu should be 3+ on IHC (Immunohistochemistry) or positive on FISH technique for the drugs, that you have mentioned, to be active. If your mother has shown a good response to the chemotherapy with all the liver lesions going away then a toilet mastectomy (removal of the breast only for a fungating or bleeding tumor) is indicated. You must keep in mind two things - 1) If the metastatic disease is present then mastectomy is not going to cure your mother. A toilet mastectomy can be done only for pure cosmetic reasons and to give a better quality of life to her. 2) If metastatic disease is present but she does not have any problem as far as the primary disease site is concerned then a mastectomy is not going to solve anything because she will continue to harbour disease elsewhere. In this scenario lighter oral chemotherapy with lapatinib + capecitabine should continue till she lives or there is disease progression.

A.  It is not very clear from your mail whether your mother had a metastatic disease at presentation or developed the liver metastasis (spread to the liver) later on. The mere mentioning of Her2neu positivity does not convey any meaningful information either. Her2neu should be 3+ on IHC (Immunohistochemistry) or positive on FISH technique for the drugs, that you have mentioned, to be active. If your mother has shown a good response to the chemotherapy with all the liver lesions going away then a toilet mastectomy (removal of the breast only for a fungating or bleeding tumor) is indicated. You must keep in mind two things - 1) If the metastatic disease is present then mastectomy is not going to cure your mother. A toilet mastectomy can be done only for pure cosmetic reasons and to give a better quality of life to her. 2) If metastatic disease is present but she does not have any problem as far as the primary disease site is concerned then a mastectomy is not going to solve anything because she will continue to harbour disease elsewhere. In this scenario lighter oral chemotherapy with lapatinib + capecitabine should continue till she lives or there is disease progression.

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