Breast Cancer Metastatised to Liver After Surgery, Chemotherapy, Radiotherapy and Arimidex - Part 1

By Chris Teo, Ph.D.
A 27-year-old lady came to our centre on 4 April 2007, desperately seeking help for her mother, Chan. Chan, 56-year-old, is a non-smoker and does not drink any alcohol. She is a hawker doing business with her husband. Her father had liver cancer while her mother had uterine cancer. Chan had her menopause when she was 52 years old. Three years later she had a 3 cm x 3 cm swelling in her right breast. She did not seek medical attention until six months later. Smears from fine needle aspiration cytology (FNAC) of the right breast lump showed clusters of malignant epithelial cells indicating ductal carcinoma. On 14 April 2005, Chan proceeded to have a mastectomy together with the removal of 25 lymph nodes. Vascular and lymphatic invasions were noted. The immunochemistry study indicated receptors for estrogen and progesterone were positive, C-erbB2 was positive and p53 negative. The cancer was staged as T4N2Mx.
Chan recovered well from her surgery. On 26 May 2005, she was started on her chemotherapy with FEC (5-FU, epirubicin and cyclophosphamide). She had a total of six cycles of chemotherapy. In addition, Chan received 25 radiation treatments. In January 2006, Chan was started on Arimidex (anastrozole,1 mg daily) and was asked to come back to the hospital for check up every three months.
A mammogram of her left breast on 23 April 2006 showed no evidence of malignancy. An ultrasound of her abdomen done on the same day showed no evidence of liver metastasis. A bone scan was also done and indicated no sign of bony metastasis. Chan was asked to continue with Arimidex. The medical record on 7 November 2006 indicated: “no lump felt in her breast and patient had no complaints.”
According to her daughter, in December 2006, Chan started to have pains in her body. When she woke up she had difficulty walking. If she walked for a short distance her heart-beat increased. Sometimes she wheezed. Chan continued to take the Arimidex as directed (and she is still taking it as of this writing).
On 23 April 2007, Chan went to consult a specialist of a private hospital. She presented with shortness of breath and palpitation. She was found to be anemic. Her blood works showed: haemogloboin = 6.5 (normal 11.7 to 15.7), platelet = 28,000 (normal 150,000 to 400,000), ESR = 116. Chan was given platelets. CT scan of her abdomen and pelvis on 26 April 2007 showed her liver was enlarged. There were numerous hypodense nodules in both lobes of her liver. The radiologist concluded that these liver nodules represented liver metastases most likely derived from the breast cancer.