Breast Cancer Treatment

[Aamna2009]

Dear Sir/Madam:
My aunt is recently diagnosed with breast cancer. She is 42 years old. She is married but have no child. she doesent have any other disease.
This is what her report is saying

Micro: IMMUNOHISTOCHEMICAL STAINS:
          Estrogen Receptors: Positive(>90%)
          Progesterone Receptors: Positive(>90%)

Diagnosis: BREAST, BIOPSY(REFFERED SLIDE AND BLOCK):
               Favor invasive ductal Carcinoma, grade-III
Note: Additional immunohistochemical stain for cytokeratin is suggested to confirm the epithelial nature of this poorly differentiated tumor



Please advise me what sort of treatment she should get. is it easily curable?what is the best treatment for this type of cancer and how costly it can be?
Her hb level is 13. does hb level has any connection with cancer?
looking forward to your reply.
Best regards
Aamna

[Kamal S Saini, MD, MRCP (UK), DM]

Hi,
A CT scan and bone scan is usually is done on demand in Pakistan, and report available the same day, or next day at most. HER2 testing may take time, and it is not necessary to wait for its result before starting treatment.
It is important to do these staging tests quickly to establish one important fact: is there any metastasis (spread to distant organs) or not. Since she has only had a lumpectomy, the CT will help the surgeon decide if she needs revision surgery (including axillary dissection). Please ensure that a cancer surgeon evaluates her quickly.
The treatment for metastatic breast cancer is different from the treatment for non-metastatic breast cancer.
High grade (grade 3) cancers, especially in younger women (your aunt is only 42) tend to be more aggressive.
She will also need chemotherapy, irespective of the stage of her cancer spread. The exact sequence of treatment (additional surgery if any, chemotherapy, radiation, tamoxifen) will be decided by your oncologist based on the test results.
Good Luck!

[Aamna2009]

Dr Kamal
Thank you so much for your advise...
please tell me one more thing
Actually her lump was removed about a month ago but due to slow evaluation of it we have recived this result jst a day before yesterday....
kindly tell me we should go for these tests you have mentioned above at this stage or go for a surgery?...as i have also read some material in this regard over the internet....and it is mentioned that the grade three type spreads agressively in the body...but if we ll go for these tests  it will again take more time..
what is your recomendation
we should go for the surgery or do these tests first?..as u have more knowledge about it...
looking forward to your kind advise again
Best Regards
Aamna

[Kamal S Saini, MD, MRCP (UK), DM]

Hi Aamna,
According to the reports mentioned by you, your aunt has got breast cancer (hormone positive, high grade).
The first step would be to confirm the stage of cancer by performing a CT scan of thorax and abdomen and a bone scan. Then, additional tests on the biopsy sample needs to be done, including HER2 testing. Depending on the stage of tumor, the next step can be planned. Early or locally advanced breast cancer can be treated with of surgery, chemotherapy, radiation, hormones, and Herceptin (trastuzumab) if indicated.
Breast cancer treatment has significantly improved over the past two decades. Please ensure that she is quickly evaluated by a qualified oncologist.
All the best!