Case Study Anatomy of an Oncologist - Janet

Highly Sensitive, Measurable Metastatic Breast Cancer

The extent of Dr. Blumenschein’s practice was very large and included over 2000 patients. Consequently, the spectrum of tumor activity in these patients was diverse and heterogeneous. At the most favorable end of the spectrum were patients with well-differentiated, slow growing,  and drugsensitive cancer clones in whom a  complete remission could be obtained with chemotherapy alone.

Janet, a 56-year-old administrative assistant, had been diagnosed with advanced primary breast cancer in her left breast. The cancer had metastasized to her lungs, liver, bone, and axillary and supraclavicular lymph nodes. Her primary physician was alarmed and started her on a course of FAC. She was ready for her second course of FAC when she was seen by Blumenschein. His physical examination indicated that she had already begun to respond to FAC. Her lungs were clear, her lymph nodes had regressed, and the mass in her left breast had vanished. Her liver had decreased in size and her liver function tests also had begun to improve. Staging studies confirmed these findings.

Therefore, Blumenschein continued the FAC regimen for a total of nine courses during which her bone lesions showed blastic healing. Subsequently, he elected to follow her at 3-month intervals for the next 5 years. At that point, follow-up visits were scheduled every 6 months. After 10 years, he saw her annually. Blumenschein considers Janet to have been cured, but because blastic healing of bone lesions occurs in the absence of radiologic change she is technically classified as being in stable partial remission rather than in complete remission.