PATIENT 1: Female (XX), Yuan Zhong

Ms Zhong noticed a small lump in her breast and therefore had a mammogram and biopsy
DOB: 20th April, 1978
Tumour size: 1cm
Breast cancer stage: localised, grade III
Immunohistochemistry result: HER2 positive, ER negative, PR negative, high Ki67, high mitotic
index

What is the average prognosis for (i) 5-year and (ii) 10-year survival for patients diagnosed with a
tumour having these characteristics? How does prognosis change if the cancer has already spread
at diagnosis – compare 5 positive lymph nodes versus 10 positive lymph nodes.
 Crist
84% survival after 5 years and 77% survival at 10 years with no adjuvant therapy after surgery.
For 5 positive lymph nodes, 59% survival chance after 5 years and 47% survival after 10 years.
For 10 positive lymph nodes, 46% survival after 5 years and 34% survival after 10 years.
Prognosis becomes worst if the cancer has already spread at diagnosis. (turn this into graph)

PATIENT 2: Female (XX), Sana Mahmassani

Prior to her diagnosis, Ms Mahmassani’s s sister had breast cancer and her mother had ovarian
cancer
DOB: 9th May, 1983
Breast cancer stage: localised to the breast, Grade III, tumour size 2cm with no lymph node
involvement
Immunohistochemistry result: HER2 negative, ER negative, PR negative, high Ki67, high mitotic
index

What are the likely psycho-social impacts of this diagnosis for this patient?
 Crist
 Emotional Reactions
o Anxiety
o Depression
o Guilt (Self-blame)
o Fear
o Repression
 Social Functioning
o Sexuality
o Social isolation

Patient 2 is diagnosed with Grade III breast cancer. Due to the fact that her sister had previously
been diagnosed with breast cancer and her mother with ovarian cancer, her diagnosis would be
adding more stress and having a negative impact on her overall mental health. She may develop
symptoms of psychological distress which includes depression, fatigue, pain, difficulty concentrating
and inherently self-blame due to the diagnosis. Due to the physical deformity from surgery, she
would be more aware of her body image and this may lead to social isolation and effect sexuality as
well.

Zangardi, M., Spring, L. M., Blouin, G.C., Bardia, A. (2017). Ribociclib for post-menopausal women with
HR+/HER2- advanced or metastatic breast cancer. Expert Review of Clinical Pharmacology, 10(11),
1169-1176. doi: 10.1080/17512433.2017.1376653
de Groot, A., Kuijpers, C. and Kroep, J. (2017). CDK4/6 inhibition in early and metastatic breast cancer: A
review. Cancer Treatment Reviews, 60. 130-138.
Boughton, M., & Halliday, L. (2008). A challenge to the menopause stereotype: Young Australian women's
reflections of 'being diagnosed' as menopausal. Health & Social Care in the Community, 16(6), 565-572.
doi:10.1111/j.1365-2524.2008.00777.x

Turner, J., Kelly, B., Swanson, C., Wetzig, N. (2004). Psychosocial impact of newly diagnosed
advanced breast cancer.

PATIENT 3: Female (XX), Juliet Capulet

A tumour was detected in Ms Capulet as part of routine mammogram screening
DOB: 23rd December, 1947
Breast cancer stage: localised, Grade I, 3cm
Immunohistochemistry result: ER positive and PR positive in 100% of cells, HER2 negative, low
Ki67

Based on the immunohistochemistry results, what targeted therapies would you recommend for
this patient?

Zangardi, M., Spring, L. M., Blouin, G.C., Bardia, A. (2017). Ribociclib for post-menopausal women
with HR+/HER2- advanced or metastatic breast cancer. Expert Review of Clinical Pharmacology,
10(11), 1169-1176. doi: 10.1080/17512433.2017.1376653

PATIENT 4: Female (XX), Aarti Harvey

DOB: 23rd December, 1945
Breast cancer stage: localised, Grade I, tumour size 0.7cm
Immunohistochemistry result: HER2 negative, ER positive and PR positive

Describe the likely appearance and distribution of the patient’s tumour in her body
 Crist