EFTA00587652.pdf

Noa Efrat (Ben-Baruch), MD Oncologist License No. 15606 Specialist license No. 10084 For appointments: December 21, 2015 Anat Maoz Identity Card No. Age: 49 M + 4, Painter Ethnicity: Ashkenazi Family history: Both grandmothers had breast cancer at age 60+ Genetics: Negative for common mutations Concomitant diseases: No Regular medications: No Gynecology history: Leukeran since 2013 History of Present Illness: In 2006, at age 40, was diagnosed with advanced breast cancer without lymph node involvement. RS-23. Underwent lumpectomy and sentinel node resection. Received radiotherapy and Tamoxifen. Finished taking Tamoxifen in 2009. Since 2010 has been followed with serial imaging for suspected T1 metastases. In 2013 had a definitive diagnosis of T1 metastasis. Underwent surgery — fixation, focused radiation and resumed Tamoxifen therapy. For more than a year she has been complaining that the right axilla does not feel right — no imaging studies. In September, 2015, she developed right hand numbness. Underwent a systemic work-up which revealed: 1. Tumor spread to the right axillary lymph nodes (PET/CT and directed US) 2. T1 destruction with invasion into the canal (PET/CT and MRI) 3. Rise in tumor markers 4. No evidence of additional spread Has begun taking Leukeran + Letrozole. Is scheduled to begin taking Xgeva. There may be a slight improvement in the neurological complaints. Axillary discomfort has improved. T1 surgery had been recommended followed by stereotactic radiation — at this point in time the patient is refusing surgery. On examination: In good state of health. I could not palpate with certainty any axillary lymph nodes. Director, Oncology Institute Kaplan Medical Center Rehovot AM.2 EFTA00587652