Why does my cancer team have varying opinions?

Derbygirl

Diagnosed last month with invasive, early stage 1, grade 2 breast cancer. I'm waiting for pathology from last week's re-excisional lumpectomy. Lymph node biopsy was negative. 5% positive receptors. Breast Surgeon and Oncology Radiology recommended lumpectomy and radiation. Medical Oncologist recommended mastectomy and chemo. I chose lumpectomy and radiation. Has anyone had varying opinions? What's treatment for recurrence? Who treats me after radiation?

Jadie

Hi Derbygirl

I can only help you with one question. My mother had a lumpectomy followed by rads almost 8 yrs ago. She has been followed up by her raditaiton oncologist ever since. She (the radiologist) schedules her yearly mamograms also. First she had mamograms every 3 months narrowing down to every 6 months now yearly.

Decisions for your treatment will be entirely up to you and I am sure that you will make the right decisions for yourself. Maby you should do research to help you understand your options. One thing you might want to research is the long term side effects of chemo and rads.

My mother was 77 when she had treatment and she did great. A little worn out by the end but none the less she handled it great. I had bc at 49 and did chemo and rads. Rads was a breeze compared to chemo. That was almost 5 yrs ago.

I wish you the best with your treatments. Keep us posted as to how you are doing.

seof

I have heard of treatment team members having varying opinions. I think if mine had done that, I would have sought the opinions of other specialists and gone with the majority opinion. As far as who treats you after radiation, if that is the last stage of your treatment, I would ask for the same tests they used to say you had cancer to begin with. If those tests show nothing, then go back to your regular MD/Gynocologist/whoever you saw before cancer. That's just my opinion. Your best bet is probably to ask your radiologist and surgeon.

best wishes, seof

noelleon

I was diagnosed w/DCIS last June. Had lumpectomy in September. Started rads for 6 weeks in Oct. and now I have been on tamoxifen for 6 months. After rads were finished, I continue to see by breast surgeon (who sends me for follow-up mammos and ultrasounds and in another 6 months I am going for a breast MRI). Being on tamoxifen, my gynocologist is sending me for pelvic/transvaginal ultrasounds. I just saw my breast surgeon this past week and I have another appt. in January.

cabbott

There is an overwhelming amount of information to learn to make very significant decisions when you are diagnosed with cancer and you get almost no time to look up all those things before you commit. That makes decision making VERY stressful. Rather than take a shot in the dark and guess what is right for your cancer, I would hightail to the best breast center in the best University teaching hospital and ask them about the standard of care for your particular cancer. It is great that you caught it early at stage 1. That's the good news. But I suspect that the grade 2 and the 5% positive receptors mean that it is borderline aggressive. That means that it may reoccur if you don't wipe it out. It may not be the sort responsive to tamoxifen that works with ER+ cancers. However, it might be very responsive to chemo of the right sort. Yep, the nasty stuff, but remember that chemo is strong medicine designed to kill nasty cancer.You will have to decide what is the best route to go. I'm sure you will make the best decision for you. Chemo definately has side effects and is tough at times, but it also can work wonders for many folks. Most doctors now believe that whenever possible a lumpectomy plus radiation is equal or superior to a mastectomy as long as you get clean margins. If the cancer is in more than one place and two lumpectomies are not cosmetically acceptable, mastectomy with (or without) reconstruction, with or without radiation is standard of care. Aggressive tumors and those found near the armpit often get radiated even if you have a mastectomy. At least they recommend it, but the decision as always is yours. That is because they cannot make any guarentees. Most breast surgeons do followup the following way: see you until all stitches are heal and then see you every 3 months for 2 years, every six months for 2 years, and then once a year till they decide to dismiss you. Some stop the regular visits at 3 years because of time constraints. I could bounce the visits between my oncologist and surgeon so that I was seen according the above schedule but saw the two alternately so that the oncologist could keep up with my meds. If you have chemo, you probably see your oncologist frequently that year to handle how you are doing and decrease the side effects as much as possible.

Derbygirl

cabbott said:

There is an overwhelming amount of information to learn to make very significant decisions when you are diagnosed with cancer and you get almost no time to look up all those things before you commit. That makes decision making VERY stressful. Rather than take a shot in the dark and guess what is right for your cancer, I would hightail to the best breast center in the best University teaching hospital and ask them about the standard of care for your particular cancer. It is great that you caught it early at stage 1. That's the good news. But I suspect that the grade 2 and the 5% positive receptors mean that it is borderline aggressive. That means that it may reoccur if you don't wipe it out. It may not be the sort responsive to tamoxifen that works with ER+ cancers. However, it might be very responsive to chemo of the right sort. Yep, the nasty stuff, but remember that chemo is strong medicine designed to kill nasty cancer.You will have to decide what is the best route to go. I'm sure you will make the best decision for you. Chemo definately has side effects and is tough at times, but it also can work wonders for many folks. Most doctors now believe that whenever possible a lumpectomy plus radiation is equal or superior to a mastectomy as long as you get clean margins. If the cancer is in more than one place and two lumpectomies are not cosmetically acceptable, mastectomy with (or without) reconstruction, with or without radiation is standard of care. Aggressive tumors and those found near the armpit often get radiated even if you have a mastectomy. At least they recommend it, but the decision as always is yours. That is because they cannot make any guarentees. Most breast surgeons do followup the following way: see you until all stitches are heal and then see you every 3 months for 2 years, every six months for 2 years, and then once a year till they decide to dismiss you. Some stop the regular visits at 3 years because of time constraints. I could bounce the visits between my oncologist and surgeon so that I was seen according the above schedule but saw the two alternately so that the oncologist could keep up with my meds. If you have chemo, you probably see your oncologist frequently that year to handle how you are doing and decrease the side effects as much as possible.

Interesting that you would mention "aggressive" because the Surgeon is doing more lab next week to determine that. Re-excisional biopsy resulted in clean margins, however, Surgeon ordered pathology on scar tissue which indicated high grade DCIS. She now recommends a third attempt to excise more tissue with clean margins based on the fact that it's all in the same small area of the breast. Oncology Radiologist agrees. Don't know what Medical Oncologist will say. His visit is next week. Could there be more??? The anxiety of waiting for results or definitive treatment is killing me. You mentioned a teaching facility. The cancer specialists are part of a teaching facility in my area which happens to be where my HMO insurance requires me to be seen. Hope that I'm in the best hands possible. Thanks for your reply.

cabbott

Derbygirl said:

Interesting that you would mention "aggressive" because the Surgeon is doing more lab next week to determine that. Re-excisional biopsy resulted in clean margins, however, Surgeon ordered pathology on scar tissue which indicated high grade DCIS. She now recommends a third attempt to excise more tissue with clean margins based on the fact that it's all in the same small area of the breast. Oncology Radiologist agrees. Don't know what Medical Oncologist will say. His visit is next week. Could there be more??? The anxiety of waiting for results or definitive treatment is killing me. You mentioned a teaching facility. The cancer specialists are part of a teaching facility in my area which happens to be where my HMO insurance requires me to be seen. Hope that I'm in the best hands possible. Thanks for your reply.

It sounds like you are in good hands from your description. I started with a general surgeon in a small town and transferred to a teaching facility when I realized the difference. Going to a breast surgeon who does a lot of these operations makes a big difference in recovery time but it is still stressful! I hope your wait goes quickly and the findings are positive. ((((HUGS))))
C. Abbott