What to do now?

francis · Regular Joined: 12 Jun 2005 Posts: 35

My wife is 51 yrs. old. She was diagnosed on May 23, 2005 as having invasive ductal carcinoma of the right breast. Combined Bloom-Richardson Grade of I-II. Estrogen and progesterone negative. HER-2-NEU positive. MRI showed size of tumor as least 3.4 cm. Tumor within 1 cm of prepectoral fascia. Blood work normal. Bone scan shows no sign of spread. CT PET scan to be done this week. We have seen two surgeons, one of which staged this as Stage IIa; the other would not offer an opinion on that yet. We've seen two oncologists, both of whom have suggested neoadjuvant chemo: one doctor suggested this primarily for breast conservation; the other seemingly more for treatment value (allows one to see if chemo is working etc.). After neoadjuvant chemo, it would be either lumpectomy and radiation or mastectomy. That is what I know as of now.

Questions:

1. What other tests should we do at this time?

2. Is not doing chemo an option?

3. What benefit do we get from chemo as opposed to mastectomy w/o chemo? The statistics are hard to pin down. What recurrence or survival benefit does she get by having chemo for this type of cancer?

4. How quickly should we move to surgery or chemo?

5. Can a mastectomy be safely done given the 1 cm distance from the prepectoral fascia? Does this argue for neoadjuvant treatment to shrinh the tumopr before surgery?

5. Anything else I should be thinking about?

Thanks very much.

Francis

leo · Owner Joined: 23 Sep 2004 Posts: 1574

Dear Francis,

Thanks for posting. Here are my thoughts on your questions:

1. What other tests should we do at this time?

None, it seems they've all been done.

2. Is not doing chemo an option?

I don't think so. For tumors this size and stage, chemo is indicated.

3. What benefit do we get from chemo as opposed to mastectomy w/o chemo? The statistics are hard to pin down. What recurrence or survival benefit does she get by having chemo for this type of cancer?

It is hard to predict what is best because the disease is not fully staged yet. Without knowing if sentinel lymphnodes or axillary lymphnodes are affected, a full treatment plan can not be outlined.

4. How quickly should we move to surgery or chemo?

Initiating therapy should be done soon, but not necessarily in an unrgent type of situation. Think about it, discuss with other people. I would say don't wait for more than a couple of weeks.

5. Can a mastectomy be safely done given the 1 cm distance from the prepectoral fascia? Does this argue for neoadjuvant treatment to shrinh the tumopr before surgery?

Yes, surgeons are very skilled at doing this. If she receives neoadjuvant therapy it could shrink it some and make the procedure easier.

5. Anything else I should be thinking about?

Seems like you're doing an excellent job. Find a good doctor that you both trust and move on.

best of luck
Leo
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Leonardo F - Webmaster Cancer Forums
Disclaimer: this information is for informational purposes only. It is not medical advice.

francis · Regular Joined: 12 Jun 2005 Posts: 35

Thank you very much for your reply. We are still in a bit of shock about all this, so all informed feedback really helps.

One more question: someone has suggested carboplatin and taxol for neoadjuvant, as opposed to the more standard adriamycin, cytoxen and taxol. Any thoughts about that?

Francis

francis · Regular Joined: 12 Jun 2005 Posts: 35

Leo,

One more follow-up to your reply.

You said "Without knowing if sentinel lymphnodes or axillary lymphnodes are affected, a full treatment plan can not be outlined." Is this determination made before neoadjuvant chemo begins? If so, how is it done? Will the CT and PET tell us?

Thanks,

Francis

leo · Owner Joined: 23 Sep 2004 Posts: 1574

Hello

At this point you have a *clinical* stage, not a pathological stage. Basically you have someone with a T2N0M0 tumor, grouped as Stage IIA. At this point the decision has to be made between: Lumpectomy with Axillay dissection or sentinel lymphonde versus total mastectomy with surgical axillary staging.

Sentinel lymphnode is done during surgery. Axillary lymphnode dissection is also done during surgery

Neoadjuvant chemotherapy is given if patient with large tumor who wishes to have breast conserving therapy. (for stage IIA, IIB and IIIA)

regards.
Leo
_________________
Leonardo F - Webmaster Cancer Forums
Disclaimer: this information is for informational purposes only. It is not medical advice.

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