Question:
Cancer Patient - Short breathing & Swelling in arm?
Hitesh
2010-11-21 03:49:49 UTC
I am enclosing the details of investigations carried out on the patient along with details of treatment provided.

2. Height: 5 feet 5 inches
3. Weight 65 Kg.
4. Age 50 years

Initially a lump was found in the right breast and as per the advice of General Physian, she was on Vitamin E from March 2009 to June 2009. The lump apperred to reduce in size.

The patient was on homeopathic medicine during July and August 2009. The patient found relief in pain and size of lump.

ER / PR - HER2 +

On 1st September, we consulted the Cancer Specialist. The results of Investigation Reports conducted on his advice are enclosed.

(1) PET Report: IMPRESSION: - DATED: 15/09/09

VIABLE PRIMARY PATHOLOGY IN THE RIGHT BREAST
ACTIVE METASTATIC LYMPHADENOPATHY INVOLVING

• Right Cervical, Bilateral, Superaclavicular and Right subclavicular Nodes
• Right axillary Nodes
• B/L Internal Mammary Nodes
• Mediastinal Nodes


Treatment Given

Chemotherapy was started on 1st October 2009. The following Doses were administered:

Chemotherapy on 1st October: 09
Cylco 900 mg + EPI 90 mg + 5FU 900 mg through vein. same before next PET

Chemotherapy on 8th October 09

Chemotherapy on 22nd October 09

Chemotherapy on 18th November 09

(2)
ADVICE PET

(2) PET Report: IMPRESSION: - DATED: 1/01/10

PET CT Reveals residual disease involving right breast with metastatic lymphadenopathy (Bilateral axillary, Bilateral supraclavicular, right infraclavicular and Mediastinal)

As compare to previous outside PET.CT study dated 15.09.09, there is regression in size and metabolic activity of right breast lesion and metastatic lymph nodes. However, left axillary lymph nodes show increase in size and metabolic activity. This needs FNAC correlation to exclude prolonged post chemotherapy inflammatory changes.


Chemotherapy Drug Changed, New Treatment started

Chemotherapy on 9th Jan 2010
Paclitaxel 100 + Carboplatin 150 + Ifosfamide 2 gm through vein Same before next PET

Chemotherapy on 29th Jan 2010
Chemotherapy on 9th Feb 2010

Chemotherapy on March 2010

Chemotherapy on 26th March 2010

Chemotherapy on 9th April 2010

ADVICE PET

(3) PET Report: IMPRESSION:- DATED : 04/05/10


PET CT Revels hypermetabolic bilateral axillary, cervical & Mediastinal lymphadenopathy.

As compared to previous PET CT dated 01.01.10, there is metabolic resolution of right breast lesion. There is increase in hypermetabolism of many of the lymph nodes, especially left lower deep cervical, left axillary & prevascular on right side. Findings are suspicious for progression. In immediate post chemotherapy period concomitant post chemotherapy inflammatory changes cannot be ruled out.

(3)


Chemotherapy Drug Changed, New Treatment started



Chemotherapy on 10th May 2010
Gencite 1.2 + Carboplatin 150 through vein

Chemotherapy on 19th May 2010

Chemotherapy on 26th May 2010

Chemotherapy on 03rd June 2010

Chemotherapy on 10th June 2010

Chemotherapy on 11th June 2010

Chemotherapy on 12th June 2010

Chemotherapy on 09th July 2010

Chemotherapy on 28th July 2010

Chemotherapy on 29th July 2010

Chemotherapy on 30th July 2010

Chemotherapy on 18th August 2010

Chemotherapy on 19th August 2010

(4)
Chemotherapy on 20th August 2010
Gencite 1.2 + Carboplatin 100 through vein


ADVICE PET


(4) PET Report: IMPRESSION: - DATED: 04/10/10


PET CT Reveals –

• Hypermetabolic Cervical, Bilateral axillary, Bilateral supraclavicular, Mediastinal & retroperitoneal lymphadenopathy – likely of metastatic pathology
• Hypermetabolic right breast lesion – likely malignant (suggest FNAC)
• Hypermetabolic left breast lesion(needs clinical and mammography correlation)
• Mildly hypermetabolic lung nodules are suggestive of metastases.
• Right pleural effusion.


In compression to the previous PET CT study dated 04.05.10 , there is increase in metabolic activity of few lymph nodes are seen in right upper cervical, Mediastinal , bilateral hilar & retroperitoneal regions. Hypermetabolic breast lesions, bilateral lung nodules and right pleural effusion are new developments




Chemotherapy Drug Changed, New Treatment started

ORAL Chemo

Chemotherapy on 7th Oct 2010 for 14 Days
Capnat 500 + Temodex 20 + Pyridoxine Hcl. 10

Chemotherapy on 20 Nov 2010 for 14 Days
Capnat 500 + Temodex 20

With the above details, your advice is solicited

She is suffering from cough.

She has swelling in her both arm including hands

Short Breathing

pain when urinating


Please help me to find out a solution because she is suffring form this swelling & short breath Problem from more then one month.
Three answers:
2010-11-21 12:48:25 UTC
Someone should sue her “General Physian” for being a quack and possible criminal charges.

Why has she not undergone surgery?
Dr.Gagan Saini
2010-11-21 16:45:36 UTC
Good summary.

My comments in short:

1. she has metastatic incurable disease.

2. She is failing all lines of chemotherapy.

3. Most probably her present condition is due to pl effusion and large lung nodules. also check her hemoglobin and counts etc, there might also be an infection.

4. Cough is due to tumor- can be taken care of with Codeine syrup.

5. This may help you: You must get Her2 tested with FISH and check whether or not it is 3+, if it is 3+ then Herceptin may benefit.

6. It is unfortunate that so many people run to homeopaths who prescribe arbitrary and non evidence based therapy only to progress the disease to incurable extent
2010-11-21 12:54:46 UTC
go to hospital mybe she needs fluid drained


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