41yr F. Known Breast-cancer stage 3 diagnosed 1 year ago. Received recent neoadjuvant chemotherapy this month. Pc increase in size and tender axillary mass on a previously biopsied mass. We aspirated that fluid. What are your thoughts. Also entire right breast is tumour.

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Case was diagnosed one year back as stage three was it considered for surgery then or received only neoadjuvant chemotherapy (number of chemotherapy cycles not mentioned) now presenting with advanced disease occupying entire breast needs only palliative treatment.To consider for Surgery it may be toilet mastectomy(debulking) followed by local Radiation (palliative). Chemotherapy also considered with changed regimen.Symptomatic treatment is important

Thank you sir
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It can be stage 3A , 3B or3C It can be operable or inoperable. I think it is operable . Since neoadjuvant chemotherapy had already been given Best option know is minimal surgery I.e simple mastectomy followed by radiotherapy of operative site and a axillary region. A hormonal therapy should be started. This protocol can prolong survival

Thank you sir
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SINCE.. IT. IS. ALREADY... VERY. LATE... ADVISABLE.... 1. LOCAL. TREATMENT... ..MASTECTOMY . ... RADIATION 2. SYSTEMIC. TREATMENT... ..HORMONAL. THERAPY ..CHEMOTHERAPY.. 3. RULE. OUT... ....EXTENSIVE. METASTASES

Having started neoadjuvant CT go for Pateys mastectomy and complete adjuvant CT Tamoxifen 20mg OD for few years is beneficial Regarding RT for Timor bed and axilla discuss with radiation oncologist and decide Confirm there is no distal met.

Thank you sir
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Chemotherapy Surgical intervention like mastectomy followed by RADIOTHERAPY . Now it needs proper assessment of clinical evaluation by surgeon to which way is safe for pt . As per my opinion prognosis is poor in type of advance cases.

Thanks Dr Dinesh Gupta
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How many nact cycles..poor response shows failure if chemo regimen..and calls for change in chemo agents..however..restaging followed by mrm..is also an option at this stage

Thank you sir
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what was exact histopathology report. Can consider change in chemotherapy regimen if not responding or progressive lesion. Can consider surgery(MRM) with axilla dissection but negative margin with adequate lymph node dissection should be the goal with touch of a surgical oncologists

Thank you sir
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As per your statement it Stge III & gien Chemotherapy. It would have been ideal you should have done simple Mastectomy ,& Axillary lymph nodes excision.

Thank you sir
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A locally advanced breast cancer , as it is progressing on neoadjuvant CT , now as such it looks inoperable, re think on 2 Nd line chemotherapy

Thank you sir
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What about the mobility of axillary swelling If they are fixed palliative radio therapy may help

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