Patient: invasive ductal carcinoma, left lymph node metastasis 5/18, immunohistochemistry: ER+ ,PR+ ,HER2+++, left breast conserving lymphatic removal surgery. Now he is going to undergo chemotherapy. CT scan: nodular shadow in the upper outer quadrant of the left breast, about 1.2 X 0.9 cm, with slightly blurred margins, and no significant thickening of the adjacent left breast skin. The left axillary lymph nodes were enlarged, about 1.8 x 1.4 cm. There were no obvious enlarged lymph nodes in the mediastinum, internal breast area or supraclavicular area. There were no obvious masses or nodules in either lung, and no obvious fluid in the chest cavity. The left breast-conserving lymphatic clearance surgery was performed. The second chemotherapy is now underway. Local doctor’s chemotherapy regimen: ACX4,THX4 including targeted therapy. 1. Is breast-conserving surgery feasible? Or should I have a mastectomy? 2.The local doctor said that because the patient has advanced breast cancer, the treatment cost is huge, is there any other option? 3.What is the specific meaning of chemotherapy regimen: ACX4, THX4 including targeted therapy? 4.What does the doctor mean when he says that the outcome is very poor? Why? Doctor: 1. Breast-conserving surgery generally has several conditions: small tumor, early stage, young patient with breast-conserving desire. However, breast-conserving surgery is not suitable for you, unless neoadjuvant chemotherapy is done before surgery. 2. From the pathological point of view, the above plan is possible. Of course, radiotherapy is required after chemotherapy (preferably within six months after surgery), and then endocrine therapy for 5 years. And the treatment of targeted therapy H (Herceptin) should last for 1 year. The above treatment plan including radiotherapy and chemotherapy targeted therapy endocrine therapy combined together is the best treatment strategy. 3, ACX4,THX4 means 4 cycles of AC regimen and 4 cycles of TH regimen. AC means the combination of adriamycin or epi-adriamycin and cyclophosphamide, TH means the combination of paclitaxel (paclitaxel or doxorubicin) and Herceptin, of which Herceptin is a targeted drug that needs to be used for 1 year, about 300,000-400,000, which is a self-financed drug. Mainly for HER2+++ this indicator. 4, poor prognosis means easy to recurrence metastasis. Because there are more lymph node metastases, that is to say, 5 of the 18 lymph nodes you cleared have metastases. Evidence from bulk clinical trials shows that the risk factors for recurrent metastasis of breast cancer are: tumor larger than 2 cm; more than 4 lymph node metastases; age less than 35 years; receptor negative (ER,PR); HER2 overexpression (that is, strong positive). The more of the above factors are occupied by the patient, the higher the risk of recurrence, and the number of lymph node metastases is directly related to the prognosis. Don’t worry too much, according to the above program active treatment, healthy life, happy mood will definitely have a different life! Endocrine therapy can be chosen as depot treatment + aromatase inhibitor.