Please, read this repot in conjunct

Please, read this repot in conjunction with several reports given to her family in the past.
WORKING DIAGNOSIS:
Advanced metastatic breast cancer to the bone, liver, brain, spine on failed several lines of chemotherapy for symptomatic treatment.
This patient was first time seen in King Faisal Specialist Hospital Research Center in 2016. At that time, she presented with advanced locally left breast which was treated in the referring hospital with neoadjuvant chemotherapy FAC 3 cycles and she underwent left MRM followed by 3 FAC. At that time, the patient was referred to us for radiation and when we saw her we found that HER-2/neu was positive so we gave her adjuvant Herceptin total of 1 year. The patient after that was stable for several years. She was put on hormonal treatment. She had no evidence of recurrence of her disease. In 2012, she presented with symptoms suggestive of bone metastasis and at that time her investigation was done and revealed that she had bone metastasis but there was no visceral metastasis. She was challenged again with Herceptin and also hormonal manipulation as well as radiation for her bone metastasis and also she was put on Zoladex at that time for her bone metastasis. The patient continued to have regular followup with us with stable condition. After about a year ,she became more symptomatic and after workup, we found that she had multiple bilateral pulmonary nodules and focal lesions in the liver so we decided at that time to give the treatment with docetaxel and Herceptin. She had the treatment tolerated well and she had excellent response to the chemotherapy and the patient was left on Herceptin for several months but docetaxel was discontinued after 8 cycles.. Unfortunately in 2014, she had mild progression in the liver so we treated her with capecitabine as well as Herceptin and she was stable for several months. In fact, she had Herceptin for about 16 cycles at that time and she had also several cycles of capecitabine with stable disease and she had more or less about 17 cycles of capecitabine. In 2015, she started to progress on capecitabine so we discontinued capecitabine and in September 2015 we started her on weekly Taxol Herceptin and pertuzumab. The patient had at that time good response at the beginning but unfortunately within few months she presented with headache and she was found to have multiple brain metastasis. At that time, we referred her to radiation and unfortunately her condition after that continued to deteriorate with further progression of her disease in the liver and bone as well as the lung. The patient also had multiple brain metastasis unresectable and she continued really to her progression of her symptoms. She came today in my clinic in June 2016 and this patient as I mentioned before had poor performance status, she had extensive intracranial and extracranial metastasis. The

النتائج (العربية) 1:

يرجى قراءة هذا التنظيم بالاقتران مع تقارير عدة نظراً إلى عائلتها في الماضي.تشخيص العامل:متقدمة سرطان الثدي المنتشر إلى العظام، الكبد، الدماغ، العمود الفقري في فشل عدة خطوط للعلاج الكيميائي لعلاج الأعراض.This patient was first time seen in King Faisal Specialist Hospital Research Center in 2016. At that time, she presented with advanced locally left breast which was treated in the referring hospital with neoadjuvant chemotherapy FAC 3 cycles and she underwent left MRM followed by 3 FAC. At that time, the patient was referred to us for radiation and when we saw her we found that HER-2/neu was positive so we gave her adjuvant Herceptin total of 1 year. The patient after that was stable for several years. She was put on hormonal treatment. She had no evidence of recurrence of her disease. In 2012, she presented with symptoms suggestive of bone metastasis and at that time her investigation was done and revealed that she had bone metastasis but there was no visceral metastasis. She was challenged again with Herceptin and also hormonal manipulation as well as radiation for her bone metastasis and also she was put on Zoladex at that time for her bone metastasis. The patient continued to have regular followup with us with stable condition. After about a year ,she became more symptomatic and after workup, we found that she had multiple bilateral pulmonary nodules and focal lesions in the liver so we decided at that time to give the treatment with docetaxel and Herceptin. She had the treatment tolerated well and she had excellent response to the chemotherapy and the patient was left on Herceptin for several months but docetaxel was discontinued after 8 cycles.. Unfortunately in 2014, she had mild progression in the liver so we treated her with capecitabine as well as Herceptin and she was stable for several months. In fact, she had Herceptin for about 16 cycles at that time and she had also several cycles of capecitabine with stable disease and she had more or less about 17 cycles of capecitabine. In 2015, she started to progress on capecitabine so we discontinued capecitabine and in September 2015 we started her on weekly Taxol Herceptin and pertuzumab. The patient had at that time good response at the beginning but unfortunately within few months she presented with headache and she was found to have multiple brain metastasis. At that time, we referred her to radiation and unfortunately her condition after that continued to deteriorate with further progression of her disease in the liver and bone as well as the lung. The patient also had multiple brain metastasis unresectable and she continued really to her progression of her symptoms. She came today in my clinic in June 2016 and this patient as I mentioned before had poor performance status, she had extensive intracranial and extracranial metastasis. The

النتائج (العربية) 2:

يرجى قراءة هذا التقرير الغير بالتعاون مع العديد من التقارير نظرا لعائلتها في الماضي.
التشخيص العمل:
. متقدمة من سرطان الثدي النقيلي حتى العظم والكبد والدماغ والعمود الفقري على عدة خطوط فشل العلاج الكيميائي لعلاج الأعراض
وأول مرة شهد هذا المريض في مركز الملك فيصل التخصصي بحوث في عام 2016. في ذلك الوقت، وقالت انها قدمت مع متقدمة الثدي الأيسر محليا الذي كان يعالج في المستشفى مشيرا مع العلاج الكيميائي المواد الجديدة المساعدة FAC 3 دورات وخضعت ترك MRM تليها 3 FAC. في ذلك الوقت، كان يشار المريض لنا عن الإشعاع، وعندما شاهدنا لها وجدنا أن HER-2 / NEU كان إيجابيا حيث أعطينا لها مساعد هيرسيبتين مجموعه 1 سنة. وكان المريض بعد ذلك مستقرا لعدة سنوات. وقالت انها وضعت على العلاج الهرموني. انها ليس لديها دليل على تكرار مرضها. في عام 2012، قدمت مع أعراض توحي الانبثاث العظام وفي ذلك الوقت كان يتم التحقيق بها وكشف عن أن لديها ورم خبيث العظام ولكن لم يكن هناك ورم خبيث الحشوية. كانت تحدى مرة أخرى مع هيرسيبتين، وكذلك التلاعب الهرموني وكذلك الإشعاع لها الانبثاث العظام وأيضا أنها وضعت على Zoladex في ذلك الوقت بالنسبة لها الانبثاث العظام. استمر المريض لمتابعة منتظمة مع لنا حالة مستقرة. بعد نحو عام، أصبحت أكثر أعراض وبعد workup، وجدنا أن لديها العديد من العقيدات الرئوية الثنائية والآفات التنسيق في الكبد لذلك قررنا في ذلك الوقت لإعطاء العلاج مع DOCETAXEL وهيرسيبتين. وقالت انها علاج جيد التحمل وكان لديها استجابة ممتازة للعلاج الكيماوي وترك المريض على هيرسيبتين لعدة أشهر ولكن تم وقف DOCETAXEL بعد 8 دورات .. للأسف في عام 2014، وقالت انها تقدم معتدل في الكبد حتى أن عالجناها مع كابسيتابين وكذلك هيرسيبتين وكانت مستقرا لعدة أشهر. في الواقع، كان لديها هيرسيبتين لمدة 16 دورات في ذلك الوقت وكان لها أيضا عدة دورات كابسيتابين مع المرض مستقرة وانها أكثر أو أقل عن 17 دورات كابسيتابين. في عام 2015، وأنها بدأت في التقدم على كابسيتابين ذلك فإننا توقف كابسيتابين وفي سبتمبر 2015 بدأنا لها على أسبوعية تاكسول هيرسيبتين وpertuzumab. وكان المريض في أن زمن الاستجابة جيدة في البداية ولكن للأسف في بضعة أشهر قدمت مع صداع وانها وجدت لديك عدة ورم خبيث في الدماغ. في ذلك الوقت، أشرنا لها للإشعاع وللأسف حالتها بعد أن استمر في التدهور مع مزيد من تطور مرض لها في الكبد والعظام وكذلك الرئة. كان المريض أيضا العديد من ورم خبيث في الدماغ الغير قطوعة وتابعت حقا لها تطور أعراض لها. وقالت إنها جاءت اليوم في عيادتي في يونيو 2016 وهذا المريض كما ذكرت كان قبل ورداءة الوضع الأداء، وقالت انها داخل الجمجمة واسعة والانبثاث خارج القحف. ال