Triple-Negative Breast Cancer Recurring in Groin Lymph Nodes

What happened, in summary

A woman in her early 50s noticed a hard lump in her right breast that had been present for 3 months. Examination and imaging found a tumor about 3 cm across with several enlarged, matted lymph nodes in the right armpit. Biopsy showed triple-negative invasive ductal carcinoma. Scans found no distant spread, and the cancer was classified as stage IIIA.

She received paclitaxel and carboplatin every 3 weeks for 6 cycles, producing a partial response. A modified radical mastectomy found no remaining cancer in the breast, but 6 of 25 axillary lymph nodes still contained cancer and 2 showed extranodal extension. She then completed 50 Gy of radiation to the chest wall, armpit and area above the collarbone over 5 weeks. Capecitabine was advised afterward, but the financial burden of prolonged treatment led her to decline it.

Five months after completing treatment, she developed pain and swelling in the right groin. Evaluation confirmed an unusually located breast-cancer metastasis in an inguinal lymph node, with additional right iliac and deep pectoral lymph-node disease. She received 20 Gy of palliative radiation to the groin and pelvic nodes in 5 treatments. Four weeks later, her groin pain had fallen by more than 60%, and she could walk more comfortably for a short time.

She then started palliative capecitabine and completed 3 cycles. Her overall condition worsened, and she developed repeated vomiting, headache and seizures that raised concern for brain metastases. She died about 4 months after the inguinal metastasis was discovered.