Occult breast cancer found in the axillary lymph nodes during diagnosis of four cancers

What happened, in summary

A 70-year-old woman sought medical care for postmenopausal bleeding. During the same assessment, clinicians also found several suspicious skin lesions. Within two months, she was diagnosed with cervical cancer, melanoma, multiple basal cell carcinomas, and a breast cancer that had not produced a detectable tumor in either breast.

A staging PET-CT showed a focus in the left axilla. Fine-needle aspiration found invasive ductal carcinoma cells consistent with breast origin. The cancer was estrogen receptor 90% positive and showed HER2 overexpression, with CK19 and mammaglobin staining supporting the breast diagnosis. Mammography, ultrasound, and MRI did not identify a primary breast lesion. The breast cancer was classified as TxN3M0.

She underwent dissection of level I and II lymph nodes in the left axilla. Cancer was found in 12 of 15 removed nodes. Additional breast-cancer treatment included adjuvant chemotherapy, trastuzumab, letrozole, and radiation to the left axilla.

Her cervical and skin cancers were treated separately and were not incorporated into the breast-cancer treatment course. Almost four years after the initial presentation, she was alive without recurrence. She continued anti-estrogen treatment and oncology follow-up without reported adverse effects. The patient emphasized how important coordinated care was while several clinical teams treated four different cancers at the same time.