Students can understand the reason for Teacher Du's hesitation by just looking at the patient's medical records.
"The pathology of her tumor showed that it belongs to Luminal B type." Du Haiwei read the pathology report written on the medical record.
The family member who accompanied the patient should be the patient's mother, who responded, "Yes, yes, the doctor got the report after the operation and told us that this classification is not bad and the treatment effect will be relatively good. I don't know why the index can't be reduced after taking the medicine."
"One-third of patients will develop resistance to these drugs, which means that the drugs do not produce the therapeutic effect that the doctor wants to achieve after taking them," Du Haiwei said. "Her pathology report showed that her tumor was estrogen-dependent. If these drugs were effective, they could interfere with estrogen receptors. Now it seems that they are ineffective."
The two students sitting opposite discovered that Teacher Du was not silent. He would definitely say what he needed to say and was very patient with the patients' families.
The family member said: "We heard these words from the breast surgery doctor, who said that we need to come to your gynecology department for surgery."
"She is too young and has lymph node metastasis. Has the breast surgeon discussed these issues with you?" Du Haiwei continued to ask in a steady voice.
To judge a cancer patient's condition, including the prognosis, a comprehensive analysis of all the data is necessary. It is not enough to only look at the pathological classification. It is absolutely necessary to combine factors such as the stage and the patient's age to make a judgment.
The so-called Luminal B type of this patient is a very delicate condition. The test results show that the estrogen receptor ER and progesterone receptor PR are positive, and the human epidermal growth factor receptor HER2 is negative. These indicators indicate that endocrine therapy may have a targeted effect on the tumor cells of this patient. For breast cancer patients, endocrine therapy can be said to be the most life-saving method. For example, triple negative, which is the most feared by doctors and patients in clinical practice, cannot be treated with endocrine therapy, so the survival rate of this type of patients is the lowest.
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The worst thing about Luminal B type compared to the best Luminal A type is that another indicator Ki-67 is not very good. High Ki-67 means that the tumor cell proliferation is high and the tumor cell proliferation in the body is too active. Therefore, in the staging of this patient, we can see the results shown by Ki-67: the tumor was found to be large in size during tumor resection, there was lymph node metastasis, the staging was 100% poor, and the surgery was performed radically. No matter how the surgery is done, it is definitely impossible to remove all the cancer cells in the patient's body. The patient is too young, has a fast metabolism, and the possibility of tumor cell recurrence is too high. In summary, based on the doctor's clinical experience, the prognosis of this patient is not ideal.
"I heard the doctor over there mention it." The family member lowered his head, his voice filled with sorrow.
"After the removal, the tumor may continue to recur. If this is the case, are you sure you want her to undergo another operation?" Du Haiwei asked.
Sometimes the cruelest part of being a doctor is having to explain the consequences again and again to patients and their families.
The patient's mother wiped the tears from her eyes and said the most depressing words: "Doctor, she is only in her early twenties."
Doctors are the most knowledgeable about young people getting sick. I don't know how many of them I meet every day. Take Pan's classmates for example. For people like Teacher Du, I've seen so many of them that I'm numb.
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