Monday, 17 September 2012

The Dreaded Confirmation Letter

The morning clunk from the . confirming my up coming treatment...

Dear Miss S,

Re: Mendoza, Sarah. DoB 29/07/1970 Sex F NHS **********

       18 M*** F*** Road, ******** Middlesex *** ***


1.         Left mastectomy and LD reconstruction October 2009 for wide spread high grade DCIS with micro invasion.

2.       3mm recurrence in reconstructed left breast with C5 axillary node August 2012 (Grade 3, ER 6/8, PR -, Her2 +++)

Many thanks for asking me to see this 42 year old youth worker whose history is well known to both of us. She underwent left mastectomy and LD reconstruction in October 2009 for fairly extensive high grade DCIS of the left breast with small areas of micro invasion. She remained well for 3 years thereafter but noticed a small nodularity in the left reconstructed breast which was subsequently biopsied confirming a recurrence of her disease. An excision of the area has confirmed a 3mm grade 3 invasive ductal carcinoma with excision complete but the margins being positive but HER2 staining was strongly positive. Despite there being no lymphovascular invasion a separate left axillary node also noted C5.

Mrs Mendoza who came with her husband and daughter is a type II diabetic although only diet controlled since the age of 19. She has two daughters aged 22 and 8 and in addition has a loop diathermy for CIN of the cervix in 1996.

Clinically her wounds have healed well and she will receive adjuvant FEC 75 chemotherapy which will commence on the 18th September in view of the Grade 3 nature of her recurrence and her HER2 positivity

She will receive a total of 6 cycles of chemotherapy followed by adjuvant radiotherapy to the reconstructed left breast and thereafter a year of adjuvant herceptin coupled with Tamoxifen which she will take for a total of 5 years. Her longer-term outlook is excellent but I do note that she is peri menopausal with her mother having reached the menopause at age of 36. I have warned her that it is very likely that her periods will cease with the chemotherapy.

With many kind regards

Yours sincerely

Mr L
All I’m going to say is roll on tomorrow morning J

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