Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Tuesday, April 20, 2004

    This is why I hate breast cancer:

    I have a 46-year-old patient who was diagnosed and treated 19 months ago. At surgery she had no lymph nodes, and whole body scan showed no sign of metastases. She had radiation and chemo and was expected to do well.

    Three weeks ago, she started having headaches. At first they were mild, but steadily worsened. I checked her over and ran a CA 15-3 level (that's an enzyme used to track the spread of breast cancer); it was normal. She started vomiting. I ordered an MRI.

    Her brain was full of metastases.

    We admitted her to the hospital, started her on steroids and radiation, and she got better quickly - but a CT scan showed widespread mets in her liver, adrenals, and chest (in the lymph nodes).

    She wants to be aggressive, and we can buy her some time - how much, I don't know. But how an initially innocuous-looking tumor can spread like wildfire, less than six months after she completed radiation therapy... these are the cases that remind me that we don't have cancer under control, and we probably never will. You can follow the protocol, do all the right things, and still wind up with Stage IV breast cancer in a matter of months.



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