BRCA Test & Oncotype DX test - when???

np312

My mom (59 yrs old) was diagnosed recently with BC. Her surgery is this Friday (modified radical masectomy with nodes removal). Surgeon suggested masectomy due to the location of tumor. It is 2.2 cm. We were told that one of the nodes looks suspicious that's why the removal instead of Sentinel Node Biopsy.


Have a question about BRCA test - when do we ask Dr. to do this test????? After the surgery????


Also what about Oncotype DX test??? After the surgery????

Her pathology report says grade 1.

Are there any other questions/test I should be talking to the Dr. about?????

Will she have to go thru radiation & chemo????

We are just overwhelmed with all these info. Please answer if you know. Thanks in advance for your help.

cabbott

Questions
You didn't say whether you are going to a breast oncology surgeon or if you are going to the local general surgeon in town. There can be a difference in what they recommend. Most of the time these days the standard of care is to try to do a lumpectomy followed by radiation. If margins are repeatedly dirty (that means they are not free of cancer) the surgeon may recommend a mastectomy, but usually they will do what they can to avoid taking more tissue than necessary. Even with mastectomies there are differences. A simple mastectomy takes less tissue than a modified radical mastectomy. Sometimes chemo can be done before the operation to shrink a particularly large tumor. Most surgeons will not mind if you want to go for a second opinion. You don't want to wait forever to get around to removing the tumor, but you don't have to get it done the week you find out either. Cancer can take anywhere from about a month to almost a year to double depending on the aggressiveness. So if you can get a second opinion and surgery in place within a month's time, you won't be risking much and you might be saving a lot. If nothing else, you might have the peace of mind knowing that two surgeons agreed that a mastectomy was the best course of action and that the sentinel node operation was not the best option for your mom.

You didn't say why you want the BRCA test. If you have a lot of breast cancer and/or ovarian cancer in your immediate family,you could get a referral for the test. Ask the surgeon you are going to what the procedure is for a referral where you live. They probably will recommend against it if she is the first to get breast cancer in the family. That is because only a fraction of breast cancers are BRCA positive. Most are unknowns. Young breast cancer survivors, especially those under 40, are often advised to get tested as well. Usually genetic counseling is done so that you will understand the test results and what your risk is.

While lumpectomies are just about always followed by radiation, mastectomies often aren't. However, a friend of mine had cancer right near her armpit. The surgeon did a mastectomy and recommended radiation to kill whatever she missed because of the area in question. The oncologist will decide what kind of medical followup treatment is needed based on your mom's kind of cancer. Some can be controlled with hormone treatments like the aromatase inhibitors. Some can be treated with biologicals like Herceptin. Some will respond best to chemo. The path report gives a lot of the information that those decisions are based upon. Some of the treatment decision trees in another part of this website can give you an idea of whether chemo is likely based on your mom's cancer type and size. Good luck! I will be thinking of you.

C. Abbott

NorcalJ

Hi NP,
You've come to a
Hi NP,

You've come to a great place to ask questions, but sorry the circumstances got you here.

The BRCA 1 and 2 are done on your mom,I think it's a blood test, while the Oncotype DX is actually done on the tumor after surgery. There is a great web site re: Oncotype DX. It helps determine what type, and how much chemo your mom might need. I'm not sure about timing on the BRCA tests. It might also be important for you to have that one.

Write all your questions down and if possible, go with her to the Dr. Write the answers down too, because it's amazing what we hear and don't hear during this stressful time.

Ask the onco. what the next step is if they find the sentinal node is positive---how many other nodes they would take out, or if she'd need to have a second surgery. Also, get copies of any pathology reports from biopsies, and the surgery. Then have them explain any terms you don't understand, until you DO understand. Sometimes the Dr.s don't realize they're using unexplained medical terminology to explain the reports, until you get them to define everything. Most importantly---no question is dumb!

Good luck to you both,and let us know how she does.

np312

Thanks - have more questions
C. Abott - thank you so much for the detailed info. The surgeon is a general surgeon. The reason the masectomy was recommended in my mom's case is bcuz the tumor is too close to the chest wall and lumpectomy would not give good results - they had given us option for pre-op chemo BUT my mom was not too keen on keeping the breast so masectomy was decided.

np312

NorcalJ said:

Hi NP,
You've come to a
Hi NP,

You've come to a great place to ask questions, but sorry the circumstances got you here.

The BRCA 1 and 2 are done on your mom,I think it's a blood test, while the Oncotype DX is actually done on the tumor after surgery. There is a great web site re: Oncotype DX. It helps determine what type, and how much chemo your mom might need. I'm not sure about timing on the BRCA tests. It might also be important for you to have that one.

Write all your questions down and if possible, go with her to the Dr. Write the answers down too, because it's amazing what we hear and don't hear during this stressful time.

Ask the onco. what the next step is if they find the sentinal node is positive---how many other nodes they would take out, or if she'd need to have a second surgery. Also, get copies of any pathology reports from biopsies, and the surgery. Then have them explain any terms you don't understand, until you DO understand. Sometimes the Dr.s don't realize they're using unexplained medical terminology to explain the reports, until you get them to define everything. Most importantly---no question is dumb!

Good luck to you both,and let us know how she does.

thanks
Thanks NorcalJ

I will ask the dr. for the oncotype DX test to be done - IS it a standard test nowadays OR do you have to request it??????

Also, my mom is getting lymph node dissection (all nodes will be removed) so no second surgery needed for that.

thank you so much for the advice - I always accompany my mom at her visits - it helps her keep her strength & spirits up.

This is a wonderful place - thanks.

NorcalJ

Surgery
Sounds like you've really been researching all your options. The Oncotype DX is only done if the tumor is (I think) 2 cm or less. But tell your Dr. you are interested in it if it's appropriate. You might want to check with your mom's insurance to make sure the test is covered. Most do cover it.

Are they doing a sentinel Node biopsy? That's the node closest to the tumor. If not, why not? Sometimes, if they do the SNB, and don't find any cancer there, they can stop and not take any more nodes out. How do they know, before surgery, if they need to take ALL of them out, or just a few?

Good luck to your mom. Let us know how she does.

np312

norcalJ - thanks
the dr. said that when it looks "suspicious" - they will take out all the nodes and will not go the route of SNL biopsy. in my mom's case - the team of experts (they meet weekly to discuss cases) decided that it is best to do lymph node dissection on the right side (that's where the tunor is).

Also - they could not do biopsy of the node when they biopsied the tumor because the node was too close to the lung.

I am just trusting the dr and hope we are making the right decisions.

What do you think about the lymph nodes removal decision????

NorcalJ

It sounds like your
It sounds like your hospital has a tumor board where they discuss the cases and decide the best way to go, amoungst the Dr.'s treating your mom.

I too had surgery scheduled on a particular date, but went for my 2nd opinion and postponed the surgery. In my case, the 2nd opinion was at a university based hospital that is a National Cancer Institute, which means they do research. I ended up having surgery about a month later, but with the 2nd opinion Dr., and have had every confidence in that decision. This is,obviously, a life changing decision (notice I didn't say "life and death" because it's all about living), and your mom has to be comfortable with the decision. Ask the Dr., if she wants to get a 2nd opinion, what a delay would mean.

I was hesitant about going for the 2nd, until I realized that I was a bit panicked, and had spent more time researching a new car than my options. Wouldn't it be nice to get 2 opinions that say the same thing, then to wonder a few weeks later? Like Cabbot said, you don't want to wait forever, but a couple of weeks usually won't change the prognosis.

Good Luck---and remember to breath.