Breast Cancer: Go for a mastectomy!

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Jane (not real name) is a 42-year-old Indonesian from Surabaya, Indonesia. About two months ago she felt a lump in her right breast. She went to consult a doctor in a private hospital in her hometown. An USG indicated a 32 x 30 x 18 mm solid mass at 10.30 o’clock of the right breast. The doctor suspected cancer which had probably spread to the lymph nodes of the arm pit. Her left breasts was normal.

A biopsy was done on 5 September 2016 and the results suggested:

  1. Infiltrating ductal carcinoma, right breast.
  2. Suspicious lymphadenopathy right axilla.

The doctor in Surabaya suggested that Jane remove her whole right breast. She decided to seek a second opinion and came to consult a doctor in one of Penang’s cancer hospital. A CT of the body was done.

Impression:

  1. There is a 5.7 x 3.2 cm enhancing lesion in right breast, suggestive of breast tumour.
  2. Right axillary lymph nodes.
  3. Uterine fibroids.

The doctor in Penang also suggested surgery to remove her breast. In early October 2016, Jane came to seek our advice.

These are what we told her this morning:

  1. The scan and the biopsy confirmed that this is malignant. The best option is to have the right breast removed.
  2. To avoid, unnecessary problems later, a mastectomy should be done — not a lumpectomy. The tumour is too big for a lumpectomy any way.
  3. In fact, Jane should not have gone to the “cancer hospital” when she first came to Penang. This cancer hospital only offers chemo or radiation to patients, besides scanning. So why incur unnecessary cost? Jane should have gone to a hospital that has doctors to do the surgery (which the “cancer hospital” does not offer).
  4. What hospital to go to and which surgeon should do the surgery? This is what Jane wanted to know. Based from the feedback of our patients, we suggested the following:
  5. Go and see Dr. Y at Z hospital. He is cheaper and can do a good job.
  6. If Jane prefer another doctor, then Dr. C from D hospital is another option. He is a breast specialist. But the cost of the procedure would be higher.
  7. Bring the USG, biopsy and CT scan to the surgeon and discuss with him what he can do to help. Make a request that the surgeon go ahead with the surgery. To save cost, ask not to undergo anymore scanning or biopsy again. Anyway, there is a lump in her breast — whether it is cancerous or not, Jane must have it removed.
  8. Based on the meeting with Jane and her doctor, she should decide which doctor or hospital is more suitable for her. If she is not happy with the doctor during the consultation, then our advice is go and find one who is more caring and compassionate. Don’t worry. There are many doctors in Penang! So make your right choice.
  9. It is better that Jane do the surgery in a hospital in Penang than in Surabaya. Costs of treatment in a Penang hospital is far cheaper than that of the hospitals in Indonesia. In addition, patients told us that Penang hospitals are cleaner and more organised.
  10. Our final advice — go and talk to the surgeon. Then make up your own mind, who and where you want to do the surgery. Even though we advised Jane to see Dr. Y and/or Dr. C we made it clear to Jane what we do not benefit from this advice. We don’t get any “referral fee” and we also do not know these doctors personally. We do this purely out of our desire to help another fellow being in need.
  11. Our “consultation fee” this morning for talking almost an hour is “zero”! God bless.

We shall give you an update if Jane comes back to see us again after her mastectomy.

 

 

 

 

 

 

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Breast Cancer: IDR 4 Billion Gone, One Breast Lost

Jenny (not real name) was 44 years old when she found a lump in her right breast. A mammography done in a Singapore hospital on 21 December 2009 indicated no mammographic evidence of malignancy.

An ultrasound done on 22 December 2009 in another hospital showed the following:

Right breast

  • 1 o’clock palpable nodule, 2.15 x 1.8 x 0.9 cm
  • 2 o’clock nodule, 0.72 x 0.56 x 0.39 cm
  • 12 o’clock nodule, 0.36 x 0.54 x 0.29 cm

Left breast

  • 4 o’clock nodule, 0.84 x 0.72 x 0.41 cm
  • 10 o’clock nodule, 0.45 x 0.74 x 0.22 cm

Bilateral axillary lymph nodes

  • Right – 1.07 x 1.35 x 0.66 cm
  • Left – 1.31 x 1.44 x 0.55 cm

A lumpectomy was done and the histology report showed:

  • Extensive high grade ductal carcinma-in-situ with foci of stromal invasion.
  • Largest grade 3 invasive ductal carcinoma is 12 mm across.
  • Lymphovascular involvement suspected.
  • Multiple resection margins involved.
  • Tumor is positive for estrogen and progesterone receptors.
  • There is HER2 and p53 over-expression.

In September 2010, Jenny and her husband came to seek our advice. We told Jenny to go and have her entire right breast removed. She hesitated and we did not get to see Jenny again until 5 years later.

In November 2015, Jenny and her husband came to seek our help again and shared with us her IDR 4 billion adventure with the oncologists in Singapore.

Listen to our conversation that day.

 

 

Gist of our conversation.

Chris: You came in 2010.

Husband: Dr. Chris asked to go for mastectomy. My wife did not want to go for the operation. She had chemo.

C: Wait, first there were lumps in her breast. Why did you not want to go for operation?

H: Afraid.

Chemo and More Chemo — Bleeding Financially

C: After you consulted us, you went home and then went to see an oncologist in Singapore. You had chemo. Did you ask if the chemo was going to cure you?

H: The doctor said, yes can cure — guarantee!

C: Oh, that oncologist guaranteed that the cancer could be cured? Another breast cancer patient also went to this same oncologist — also guaranteed a cure! But unfortunately, after chemo and more chemo the cancer went to her brain. She eventually died (see story under comment). So for you, chemo after chemo — also can cure?

H: The lump was gone.

Jenny: Normal.

H: Normal but the oncologist kept wanting us to have more chemo. So we ran away from that oncologist.

C: Why did you run away from that oncologist?

H: Cannot afford to pay anyway — we were bleeding financially.

C: Oh, you ran away because you could not afford paying for the treatments. That was after how long of receiving the chemo?

H: Almost one to one and half years of chemo like in the chart below (chart prepared by husband).

1-chemo-injections

Note: From 25 October 2011 to 14 June 2012, Jenny received:

  • 12 injections of Herceptin.
  • 16 injections of Navelbine.
  • 20 injections of 5-FU.
  • In addition, she was given Eprex and Gran (self administered at home) to deal with her low blood counts. Refer to comment section to know what this blood boosting injection is all about.

Another oncologist: Don’t worry. We have a lot of medicine to treat you!

C: You ran away from the first oncologist and found another one. This oncologist once told a patient, “Don’t worry, we have a lot of medicine to treat you!” And this oncologist gave you one drug after another? When one medicine is not effective, change to another one? So you were started on oral drugs. Was it cheaper?

H: Ya, much cheaper because my wife just need to swallow the pills.

Jenny: Cheaper!

C: Did you ask the oncologist if the medicines were going to cure you?

J: Just to control.

C: How long were you taking these medicines — one type after another?

H: A long time, from January 2013 to November 2015. When the first round of oral drugs failed, the oncologist started her on Herceptin injections as well.

2-Oral-1

  • January 2013 to November 2013: On Cyclophosphamide + MTX. PET scan showed failure.
  • December 2013 to July 2014: On TS1 + Herceptin injection.
  • July 2014 to October 2014: On Herceptin injection + Kadcyla (Trastuzumab emtansine)
  • October 2014 to November 2014: Back to oral drug TS1 again + Tykerb (lapatinib).

3-Oral-2a

  • January 2015 to June 2015: On Herceptin injection + Tykerb (lapatinib) again.
  • July 2015 to September 2015: On Herceptin injection + Perjeta (pertuzumab) + Taxotere + Filgratim (Gran).
  • November 2015: On Aromasin (exemetane).

C: What happened after taking all those oral drugs for more than a year?

H: The cancer came back again. The oncologist then started her on Herceptin injection again. She had a total of 7 injections.

C: Did you ask if this kind of injection was going to cure her?

H: The oncologist said the medicine given earlier did not work. Because of that the medicine had to be changed and changed. After one medicine failed another different medicine was tried. Then the doctor tried Kadcyla injection. This too did not work and the doctor changed to lapatinib. After lapatinib failed it was back to chemo injection again.

C: Then what eventually happened?

H: When the cancer did not go away in spite of all those treatments, Jenny had to remove her breast. After the mastectomy the doctor wanted to continue giving her chemo again — more Herceptin and pertuzumab (Perjeta).

Confused

C: I am really confused!

H: Me too. I also know that Herceptin can adversely affect the heart.

C:  When you first came to see us, I asked you to remove your breast. But you did not do that. You opted for chemo. Then after chemo and more chemo and also spending a lot of money you also lost your breast. How much did you spend for all those treatments?

H: A lot of money, about IDR 4 Billion.

C: Do you think the oncologists are good?

H: They spin money!

J: More and more chemo, until we have no more money!

Comments

When injecting toxic chemo drugs into patients, the oncologists also gave their patients Eprex and Gran. These are blood boosting shots. Perhaps this was done as a precaution because chemo could make the platelets, red and white blood go down. Perhaps too this is also a way to keep patients happy and well. Of course patients pay for such injection. But what is not known to patients is that this “red juice” and “white juice” may encourage tumor growth! Dr. Otis Brawley is an oncologist. Read what he wrote below:

Read juice

Different Oncologist, Different Business Model but Similar Pathetic Story

  1. Cure Guaranteed!

APT 1 APT 2 APT 3

From: http://bookoncancer.com/productDetail.php?P_Id=76

 2. We have a lot of medicine to treat you!

Hw 1

Hw-Composite-1 Hw-Composite-2

Hw 2

From: http://bookoncancer.com/productDetail.php?P_Id=75

One final note. IDR 4 billion — I could not imagine how “big a sum” this is. A patient who went to China for treatment of his lung cancer also spent a similar amount. And he came home just as disappointed. According to his wife, IDR 4 billion is worth 2 bungalow houses if you live somewhere around Medan.

 

 

 

Breast Cancer: A War Lost After Mastectomy, Reconstructive Surgery, Chemo and Radiation

Cellulitis After Breast Reconstruction Surgery and Chemo

The file of EC laid buried on my table for almost four years. At first I thought I wanted to write her story but then perhaps it was not necessary – let her secret go away with her, buried in her grave! But on 13 August 2012, a lady came to our centre for help. She too had breast cancer. And her story resembled EC’s case. This make me think again – I should write this story!

EC – an Indonesia female, was 40 years old when a mammogram on 29 August 2003, showed the following results:

Following further evaluation, EC was diagnosed with breast cancer. She subsequently underwent a biopsy leading to a right mastectomy with axillary clearance. At the same time she had a right breast reconstruction with latissimus dorsi flap and saline implant.

The histology reported a Grade 3 ductal carcinoma measuring 2.5 x 2 x 1 cm. Three of 17 dissected lymph nodes showed metastatic disease. None of the 2 lymph nodes in level 2 showed metastatic disease.

The immunohistochemistry showed the tumour had hormonal receptors as below:

Taking into account of the 3 involved lymph nodes, EC was started on adjuvant chemotherapy with Cyclophosphamide and Andriamycin (A + C) for 4 cycles. Another 4 cycles of taxol was schedule after the AC. However, the use of taxol had to be aborted due to severe reaction and complications as explained by her oncologist’s report dated 6 January 2004:

She tolerated chemotherapy fairly well with growth support using Granocyte. Although she is not diabetic on repeated measures, she unfortunately developed repeated episodes of skin infection following the last dose of Cyclophosphamide and Andriamycin. 

There was substantial celulitis over the implanted right breast. For that reason, EC is finding it difficult to proceed with further chemotherapy with the fear of recurrent flare of cellulitis. 

Since there is a fear of further exacerbation of her cellulitis with ongoing chemotherapy, Tamoxifen  for 5 years was proceeded instead.  As she has already achieved post menopausal status, there is no further recommendation for ovarian ablation at this stage.

EC took Tamoxifen from 2003 to 2005. She received Zometa injection (for bone) ever six-monthly.

Her progress was monitored regularly.

  1. 3 April 2004: Mammogram and ultrasound of her left breast and CT of thorax and abdomen showed everything in order. A bone scan on 5 April 2004 showed no specific evidence of bone metastasis.

21 March 2005:  Mammographic findings are unchanged. On the four-quadrant ultrasound examination, there are two hypoechoic nodules demonstrated within the left breast. These are benign looking lesions. These ultrasound finds are already present in a previous examination dated 3 April 2004 and allowing for technical differences, are essentially unchanged. CT scan of the thorax does not reveal any mediastinal lymphadenopathy or pulmonary nodules. Two hypodense lesions demonstrated in the liver were also seen previously with no significant interval change in size or in character. These may represent small hepatic cysts.  Bone scan showed no specific evidence of bone metastasis.

(Note: Tamoxifen was stopped and changed to Arimidex in 2005 until 2008).

27 March 2006: No suspicious lesion is seen in the left breast. A small cyst is seen at 9 0’oclock position. The other cyst demonstrated previously is not seen today.  Ultrasound of abdomen showed liver is normal in size and there are two small cysts present. These are likely to correspond to the hypodense lesions seen in previous CT scan done in March 2005. No solid mass seen. No pulmonary nodules demonstated. No hilar masses seen. No specific evidence of bone metastases.

5 July 2007: No mammographic evidence of malignancy. Tiny left breast cyst. No focal solid mass lesion is visualised. Ultrasound of abdomen showed a 1.9 x 1.7 x 1.5 cm anechoic cyst in segment 7 of the liver. This appears to have shown slight interval increase in size. The previously noted subcentimetre cyst in segment 6 is no longer seen. No other abnormality is seen.

17 December 2007: Bone scan showed no specific evidence of any new bone metastases. Ultrasound of liver showed no sonographic evidence of hepatic metastases apart from a 1.9 x 1.8 x 1.6 cm anechoic cyst in segment 7 of the liver.

15 January 2008: Due to rising tumour markers, PET was ordered to assess for recurrent disease. The cancer had spread to her brain.

EC underwent a craniotomy or brain surgery to remove the tumour.  Her tumour was consistent with metastatic carcinoma, possibly breast.

Oral drug Arimidex was abandoned and EC was given Aromasin instead. Zometa injection was continued as usual – every six-monthly.

11 February 2008: EC received 5 times of stereotactic radiotherapy to her brain.

17 July 2008: The cyst in her liver seemed to grow bigger.

EC received another 5 times of stereotactic radiotherapy to her brain.

20 October 2008: Her brain surgery and 10 radiation treatment did not cure her brain cancer. The tumour recurred.

24 October 2008: EC and her husband came to Penang to seek our help. EC was prescribed Capsule A, Brain 1 and Brain Brain 2 teas and Breast M, C-tea plus Brain Leaf Tea.

Comments

Unfortunately EC was not able to follow our therapy properly. We always tell patients – our herbal teas are smelly and taste awful. They have to be brewed and this could be a great chore indeed. And if you have undergone chemo and radiation, the chances are that you will suffer when you first start taking the herbs.  Well, but that could not be as bad as the chemo or radiation side effects. Nevertheless, some people are less tolerant when they come to us. The reality is – they expect magic even if medical science has failed them.

We did not get to meet EC and her husband again after their initial visit to us. They had decided to continue with more medical treatments. When nothing worked, EC decided to give up and turned to God for a miracle. She then died.

EC and her husband told us that after the reconstruction surgery and chemotherapy, her breast became red, swollen and painful. I wondered what could have caused this. If you read the oncologist report above, an innocent-sounding terminology was used –cellulitis. What doesthis actually mean? The word cellulitis means inflammation of the cells.  Specifically, cellulitis refers to an infection of the tissue just below the skin surface.

The following are information from the internet when I searched for breast reconstruction and cellulitis,and breast implant infection.

Someone posted this question – Is cellulitis of a reconstructed breast (after breast cancer) common?and she wrote: I have gotten cellulitis of my reconstructed breast three times in the last six months. The first time I was hospitalized for a week. I was very sick and it was very painful. Is this a common occurrence? http://www.medpedia.com/questions/1823-is-cellulitis-of-a-reconstructed-breast-after-breast-cancer-common

The Answers:

  • Cellulitis is an inflammatory reaction involving the skin and underlying subcutaneous tissue. Patients who undergo surgery for breast cancer, whether in the setting of breast conservation or mastectomy, are at risk of developing infection at the surgical site and in soft tissue. Surgical trauma predisposes patients to skin infection. Postoperative skin infections develop after 2%–7% of all surgical procedures. The incidence of surgical site infections is 12.4% following mastectomy with immediate implant reconstruction.
  • Infection following breast implants is an uncommon event. This is somewhat surprising, since the human breast is not a sterile anatomical structure. Treatment of the periprosthetic infection usually involves implant removal, but salvage by systemic antibiotics is sometimes possible. ( http://www.ncbi.nlm.nih.gov/pubmed/2663982)
  • Infection can occur with any surgery. Most infections resulting from surgery appear within a few days to weeks after the operation. However, infection is possible at any time after surgery. Infections with a breast implant present are harder to treat than infections in normal body tissues. Toxic Shock Syndrome has been noted in women after breast implant surgery, and it is a life-threatening condition. Symptoms include sudden fever, vomiting, diarrhea, fainting, dizziness, and/or sunburn-like rash. A surgeon should be seen immediately for diagnosis and treatment for this condition. http://www.lookingyourbest.com/info/breastimplant-complications.php 

Complications of Breast Implants 

  • After having breast implant surgery, about 30% of women will require further surgery within 10 years of their initial operation.
  • Additional surgery may be needed as a result of complications such as capsular contracture (hardening of the scar capsule around the implant, see below), age-related changes to the breast or the shell of the implant rupturing (splitting).
    • If you are having an implant fitted for breast reconstruction following a mastectomy (breast removal) you may have a greater risk of infection and bleeding.
    • Most infections can be treated using antibiotics. But if your breast becomes severely infected, you may need to have the implant removed to prevent further complications developing. You should be able to have the implant re-inserted once the infection has cleared up. http://www.nhs.uk/Conditions/Breast-implants/Pages/Complications.aspx 

Why not solve one problem at a time?

I am fully aware that for some ladies losing a breast is most traumatic. Many patients come to us with rotten breast and they still harbour the hope that I would say herbs can cure their breast cancer. When I suggested removal of their breast, they hesitated. To get the message across I said this: You choose – you life or your breast. In the 16 years dealing with cancer patients, I rarely come across patients who had breast reconstruction after a mastectomy.  I also understand some ladies are very sensitive about their body image. They want their breast replaced immediately after losing one.

One lady told us, she only agreed to undergo a mastectomy after her husband promised that she could go for a breast reconstruction. While writing this article, one lady came. She has just had a mastectomy. I asked her: How is it like – the mastectomy? She replied:  I don’t know. I went in and when I came out I felt one breast was gone. Then I knew that it was cancerous. This lady just laughed after that! To her saving her life comes first. She and her surgeon had made an agreement that she would not want a needle biopsy but rather the tumour be removed and tested immediately. If it was found to be malignant, the surgeon would proceed with the mastectomy right away.

I just wonder – why does someone want to rush into trying to fix problems all at once – immediately? Removal of the cancerous breast is not a cure. The cancer can recur. Would it not be sensible to wait until everything looks promising first before you move to the next problem of the missing breast? If there is a flare up of cellulitis as in the above case, are you not making your problem more complicated? Why not solve one problem at a time?