See The Difference

A 41 year-old-female is diagnosed with recurrent breast cancer in the right axilla. Chest
CT reveals extensive axillary lymphadenopathy and a 1 cm hypodense area in the
liver which is “likely a cyst”. No additional areas of disease are identified. She
begins treatment with docetaxel and capecitabine. After chemotherapy, chest CT
demonstrates persistent right axillary lymphadenopathy, and a bone scan is
negative. She begins radiation therapy. PET/CT ordered post chemotherapy and
radiation reveals intensely hypermetabolic foci in the right axilla as well as metastatic
sites in the liver, hilum, mediastinum and bilateral lungs.

She begins treatment with single agent vinorelbine. Three months later she complains of
excruciating pain in her right pelvis and hips. Bone scan is negative. CT scans of the
abdomen and pelvis identify no metastatic disease with stability of the previously
mentioned hepatic cyst. MRI of the hips is inconclusive for bone metastases and
shows no adenopathy. In a subsequent office visit, slight enlargement of an axillary
lymph node is noted, and her CA 27.29 has increased from 18 to 36. PET/CT ordered for
therapeutic monitoring identifies marked progression of the patient’s disease in the axilla and bilateral lungs with new sites of disease in the liver and extensive bone metastases in the scapula, thoracic, lumbar, and sacral spine and pelvis. Based on the findings, additional systemic treatment options are reviewed.