The cancer stuff

Here’s the clinical stuff (I was seventeen when all this started forty years ago):

1980-81: Hodgkins Lymphoma Stage IIAE nodular schlerosing.

Tumours in neck and chest area. Treated with MVPP (mustine, vinblastine, prednisolone, procarbazine) therapy, 6 course regimen over 8 months. Followed up with staging laparotomy, appendectomy/splenectomy and lymphangiogram. Then upper mantle Radiotherapy to probably 40 or 44gy 5x weekly for 4 weeks (completed Jan 1981). Suffered radiation pneumonitis following last doses and treated with high dose steroids.

1985 and 1992: Pneumonia

1993: Pericarditus Treated with IV antibiotics and followed up with Pneumovax II vaccination (repeated 2012).

March 1999: Left breast IDC (radiation-related) Grade III stage T2 (14mm) N1 (2/17 lymph nodes positive) M0. ER/PR negative but C-erb status unknown

Left segmental resection + axillary clearance, followed by adjuvant FEC (fluorouracil, epirubicin, cyclophosphamide) 6 courses, plus low dose local RT followed by Tamoxifen 2 years. Early menopause.

2000: Secondary lymphoedema Left arm, managed with compression and exercise, plus MLD in the first year.

2001: ITP (idiopathic thrombocytopaenic purpura) Treated with Prednisolone

2008: Fracture left wrist | 2009: Fracture right wrist, plate inserted.

Nov 2011: Left breast recurrent IDC Grade 3 ER/PR/HER2 Neg, Staging pTN1c (T1 15mm).

Treated in December with bilateral simple mastectomy (prophylactically to the right, clinically to the left). Discussed adjuvant therapy with docetaxel and cyclophosphamide but decided against because of increase risk of myelodysplasia, effects on bone marrow, and risk reduction (of recurrence) only 3-4%. Consultants very sure that recurrence risk is 15-20% under normal conditions.

Aug 2012: Left chest wall recurrent IDC Grade 3 (T3 P3 M3, staging rpT1c).

Surgical excision in Sept of 11mm adenocarcinoma in lower flap of left mastectomy. Tumour extends into dermis but not epidermis, no vascular invasion seen. Followed up with 6 cycles of docetaxel/carboplatin November 2012 – February 2013

2015 Fracture: left clavicle

Late effects

  • Recurrent upper and lower respiratory tract infections throughout lifetime.
  • Hypercholesterolemia and osteopenia (schlerotic lesions, in the T4 vertebral body, left humerus, left ilium (top of pelvic bone).
  • Asplenetic.
  • High risk cardio esp coronary artery disease and respiratory issues (see below)
  • Multi-nodular goitre.

Cardiac & Respiratory late effects

  • Detectable heart murmur
  • 2015: AV Node Disease – Presenting with blackouts 1x Jan 2015, 3x March 31-17 April. Pacemaker Medtronic RELIA REDR01 mode DDD fitted 24th April 2015 at Salisbury Hospital. | Subsequent Device Clinic f/u’s show high V-pacing at 80%. | May 2020 PVARP change from auto to 210 MS to prevent upper rate behaviour, unable to reduce V pacing due to high grade AV block
  • 2018: Abnormal result on routine Exercise Stress Echocardiogram at Salisbury.
  • 2020: Now under the care of specialist cardio-oncology unit at Barts Hospital. LVEF confirmed 45%. Investigations March – September 2020:
    • CMRI (Feb): normal biventricular size with preserved LVEF and septal bounce, D-shaped septum and dilated pulmonary trunk suggestive of RV pressure loading. No previous infarction focal fibrosis.
    • CT chest abdomen pelvis (Feb 2020 RUH Bath) – some element of lung disease – no obvious signs pulmonary embolism with apical scarring fibrosis and traction bronchiectasis as before.
    • Stress echo (May): Limited systolic contractile reserve, evidence of diastolic dysfunction and pulmonary hypertension = no evidence of contractile reserve with LV capacity size and LVEF remaining constant. Evidence of diastolic dysfunction at peak. Exercise induced pulmonary hypertension with increasing TR velocity from 2.25m/sec to 3.8 m/s (58mmHg)
  • Referrals: Pulmonary Hypertension team Barts Heart Centre/Imperial College Hospital
  • Also a barium meal investigation to f/u or rule out possible oesophageal dysmotility, at RUH Bath

Genetics Tested negative for BRCA1 and BRCA2

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