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[Healthcare in Low-resource Settings 2014; 2:2151] [page 39]

Advanced bilateral breast 
cancer, stage T4c N3 M1
Poras Chaudhary, Hemant Khowal
Lady Hardinge Medical College and
Associated Dr. Ram Manohar Lohia
Hospital, New Delhi, India

Abstract

The present study reports a case of advanced
bilateral breast cancer with distant metastasis
of 4 years for which the patient did not seek
any medical advice. The aim of reporting this
case is to highlight the fact that such advanced
cases are still seen in developing countries.

Introduction                                   

A 40-year-old lady had bilateral breast lump
of 4 years over right side and 3 years over left
side, involving almost the entire breast on both
sides, for which she did not consult any clini-
cian. She then developed multiple ulceration
and nodules over right breast followed by left
breast with complete distortion of nipple areo-
la complex over right side followed by develop-
ment of similar nodules over anterior abdomen
(Figure 1). 

Case Report

Breast biopsy was suggestive of invasive
ductal carcinoma, estrogen and progesterone
receptors were negative and Her-2-neu was
also negative, and biopsy from abdominal wall
nodules was suggestive of metastatic deposits.
Imaging revealed metastasis to lungs and lum-
bar spine. This was a case of bilateral breast
carcinoma, stage T4c N3 M1, and the prognosis
is poor in such a case.1,2 Chemo and radiother-
apy with toilet mastectomy were the only
option.1,2 Bilateral toilet mastectomy was done
and the patient received 3 cycles of chemother-
apy (FEC regime – 5-fluorouracil, epirubicin,

and cyclophosphamide). After completion of 6
cycles of chemotherapy, the patient was
reassessed and radiotherapy was given to the
bony metastasis. A written consent for publish-
ing her case was obtained from the patient.

Discussion

It is not rare to see such locally advanced
inoperable breast cancers with multiple dis-
tant metastases in many developing countries
such as India. Breast cancer accounts for 19-
34% of all cancer cases among women in India
and carries a high mortality due to presenta-
tion at late stage of the disease. The reason for
this kind of scenario is lack of awareness and
non-existent breast cancer screening pro-
grams.3 Somdatta et al.3 concluded that aware-
ness about breast cancer is low amongst
women even in urban community and there is
a need for awareness generation programs.
Awareness regarding breast self examination
among young generations is useful and it is
the most important viable tool for early detec-
tion.4 Gupta5 concluded that health education
programs through various channels are need-
ed to increase the awareness and knowledge
about breast self examination. 

Conclusions

In underdeveloped and developing coun-

tries, there is a need for awareness generation
programs to educate about breast cancer to
decrease mortality due to this common cancer.

References

1. Novoa VA. Toilet mastectomy: palliative
treatment in women with advanced breast
cancer. Ginecol Obstet Mex 2002;70:392-7.

2. Russell RCG, Norman SW, Christopher
JKB. Bailey and love’s short practice of
surgery. London, UK: CRC Press; 2004.

3. Somdatta P, Baridalyne N. Awareness of
breast cancer in women of an urban reset-
tlement colony. Indian J Cancer 2008;45:
149-53.

4. Shalini, Varghese D, Nayak M. Awareness
and impact of education on breast self
examination among college going girls.
Indian J Palliat Care 2011;17:150-4.

5. Gupta SK. Impact of health education
intervention program regarding breast self
examination by women in a semi-urban
area of Madhya Pradesh, India. Asian Pac
J Cancer P 2009;10:113-7.

Healthcare in Low-resource Settings 2014; volume 2:2151

Correspondence: Poras Chaudhary, Lady
Hardinge Medical College and Associated Dr Ram
Manohar Lohia Hospital, Baba Kharak Singh
Marg, New Delhi 110001, India. 
Tel./Fax: +91.9891.4473.358. 
E-mail: drporaschaudhary@yahoo.com

Key words: bilateral breast cancer, toilet mastec-
tomy, India.

Received for publication: 23 November 2013.
Revision received: 31 January 2014.
Accepted for publication: 2 July 2014.

This work is licensed under a Creative Commons
Attribution 3.0 License (by-nc 3.0).

©Copyright P. Chaudhary and H. Khowal 2014
Licensee PAGEPress, Italy
Healthcare in Low-resource Settings 2014; 2:2151
doi:10.4081/hls.2014.2151

Figure 1. Ulceration over bilateral breast
with distortion of nipple areola complex
over right side and nodules over anterior
abdominal wall.

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