Fall, 2013
Diagnostic Methods
  • Abdominal CT
    • Diffuse lytic bone lesions are noted throughout the visualized portions of the spine involving all vertebral levels, also involving the sacrum particularly on the left side, bilateral ileum particularly in the posterior ilium on the left, and the right inferior iliac wing, as well as rib lesions, are consistent with innumerable bone metastatic lesions.
    • Multiple masses are seen in the liver; innumerable hepatic metastases. The largest lesion measures greater than 6 cm.
  • Mammogram
    • On right, extensive distortion within the medial breast with associated pleomorphic calcifications. Seen deep to the nipple on MLO view.
    • Within upper right breast, abnormal distortion identified as well.
    • On left, a small well circumscribed oval mass is seen within outer breast.
  • Breast Ultrasound
    • At 2 o’clock in right breast, there is a large ill-defined mass with extension to the skin surface with internal calcifications and posterior shadowing.
    • At 10 o’clock in right breast, a shadowing mass approx. 2 cm also identified.
    • Left breast reveals a small well circumscribed oval mass which appears solid.
    • BI-RADS, Category 5; highly suggestive of malignancy
  • Sonographic Appearance
    • Taller than wide
    • Shadowing
    • Positive blood flow
    • Located in UO Quadrant
  • Ultrasound-guided Breast Biopsy by computerized vacuum system
    • Invasive Ductal Carcinoma stage 4 with no carcinoma in situ identified.
Sidebar
  • Why computerized vacuum biopsy instead of the more economical methods available?
    • Vacuum systems avoid need for open (surgical) biopsies
    • Acquire more tissue than needle biopsy
    • Sometimes can remove entire cyst or lesion in question
Treatment Options
  • Hormone Therapy in conjunction with Trastuzumab if HER-2 positive cancer; pertuzumab if not
  • Chemotherapy, either systemic or regional (delivered directly to a certain area)
  • Radiation therapy and/or surgery for
    • The open breast wound
    • Any cancers pressing on the spinal cord
    • Blockages that may occur in the liver
Prognosis
  • According to the American Cancer Society’s 2011 data, 81, 970 women 50-64 years old were diagnosed with invasive ductal carcinoma of any stage and of those 11,620 died.
  • Stage IV Invasive Ductal Carcinoma is the most advanced form of the disease
  • African American women are the second highest group (closely behind Caucasian women) to have invasive ductal carcinoma
  • 95% of new cases of ductal carcinoma and 97% of breast cancer deaths occur in women older than 40 years
Sources
  • Heywang-Köbrunner, S., Heinig, A., Hellerhoff, K., Holzhausen, H., & Nährig, J. (2009). Use of ultrasound-guided percutaneous vacuum-assisted breast biopsy for selected difficult indications. Breast Journal, 15(4), 348-356. doi:http://dx.doi.org.ezproxy.cfcc.edu/10.1111/j.1524-4741.2009.00738.x
  • Treatment of Invasive Breast Cancer, by Stage. American Cancer Society. (February, 2013). doi: http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-treating-by-stage
  • American Cancer Society. Breast Cancer Facts & Figures 2011-2012. Atlanta: American Cancer Society, Inc