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Case Presentation: Recommending Treatment for Early Stage HER2-Positive Breast Cancer Case Presentation
Patient Case:
The patient is a 38-year-old woman who presents to the oncology clinic for treatment recommendations with a newly diagnosed left breast cancer.
Her oncologic history began 3 months ago when she noted a painless lump in her left upper outer breast while in the shower. She initially thought it was related to her menstrual cycle but when it persisted, she presented to her gynecologist for evaluation. She reported she never had a prior mammogram and had no family history of breast or other cancers. Lisa has a history of gestational diabetes that resolved postpartum, is overweight (BMI 28) and has hypertension controlled with a diuretic. She has delivered 1 child (G1P1) and is interested in possibly having another child in the future. She works as an editor at a publishing firm full time and is married.
Examination revealed a firm mass as well as a mobile slightly enlarged left axillary lymph node.
Her gynecologist ordered imaging. Diagnostic mammogram revealed a 2.8-by-1.5 cm mass in the left breast upper outer quadrant. An ultrasound confirmed a 3.0 cm solid mass and 1 lymph node in the left axilla slightly enlarged (1.5 cm) with a mildly thickened cortex. No other abnormalities were noted on imaging of either breast.
Biopsy of the left breast mass revealed a grade 3 invasive ductal carcinoma, ER: 0 PR: 0 HER2: 3+ by IHC, FISH-positive (ratio 4.2, copy number 18). A lymph node biopsy was performed and was negative for cancer. Bloodwork (CBC, LFTs, metabolic panel) results were unremarkable. Echocardiogram was within normal limits.
