Breast cancer recurrence involving the bladder and bones

What happened, in summary

A postmenopausal woman was treated in 2004 for multifocal right invasive ductal Stage III breast cancer. The original cancer was ER-positive, PR-positive and HER2-negative. She underwent a right modified radical mastectomy and an elective left mastectomy. She completed 5 cycles of 5-fluorouracil, epirubicin and cyclophosphamide with radiation, but chemotherapy was stopped because of toxicity and febrile neutropenia.

She remained in remission for 87 months. In 2012, she developed worsening urinary urgency, frequency and incontinence. Cystoscopy showed abnormal bladder tissue, while CT found bladder-wall thickening and bone metastases at T8, T12 and the right frontal skull. A bladder biopsy confirmed metastatic breast adenocarcinoma, establishing Stage IV recurrence. The metastasis was ER-positive, PR-negative and HER2 1+.

Fulvestrant was started for metastatic disease. Her urinary symptoms resolved within 2–3 months, and the bone metastases remained stable for about 2.5 years. After nearly 3 years, the cancer progressed with new bone involvement at T5 and T10 and extension into the rectosigmoid and anorectal regions. She switched to paclitaxel, but a stroke, neuropathy and further disease progression led to its discontinuation.

In December 2015, she started palbociclib but tolerated it for only 2 months. In July 2016, she chose to stop anticancer treatment and entered hospice care. She died in October 2016 from pulmonary haemorrhage, 47 months after metastatic disease was diagnosed.