Need recommendations- invasive ductoral carcinoma grade 3 - FISH Negative

anjukakkar2003

Hi,

I am recently detected with Left breast cancer. Invasive ductor Carcinoma Grade 3. Its harmone positive and Her 2 negative cancer. Fish report is negative. Cancer is spread to Lymph node. I had appointment with Surgeon and oncologist. They both have different opinion.

General Surgeon recommendation is Chemo first followed by surgery. Rationale: If they go with surgery first they have to remove infected Lymph node and they also have to pull all other lymph nodes to check for cancer cells and remove the infected lymph nodes. There is a risk of developing Lymphedema in this case.

Oncologist recommendation: he is recommending surgery first. Per him if chemo makes me sick then surgery will be delayed. Also per him its not clinical proven that chemo will work for harmone postive and Her2 negative cancer. So ites better to go for surgery first remove cancer cells and then start with chemo.

I am confused after the discussion with both the doctors. I need some help and advice from this community on their treatment plan and journey

RocDocVic

https://csn.cancer.org/discussion/327849/need-recommendations-invasive-ductoral-carcinoma-grade-3-fish-negative

What chemo drugs does your Oncologist propose using and how many cycles? I have invasive ductile carcinoma HER2 positive and hormone negative. I started with chemo for 6 cycles, every three weeks, using the cytotoxic chemo drugs Docetaxel and Carboplatin (they kill all cancer and good cells), plus Herceptin and Perjeta for HER2 positive cells. This was followed by surgery. The tumor shrank enough that I qualified for a lumpectomy instead of having a mastectomy. They also took 3 Sentinel lymph nodes for testing. The pathology report results for the tumor and lymph nodes indicated no cancer cells found. I will be starting radiation therapy in one month and additional Herceptin and Perjeta for HER2 for 6 more months to make sure that any escaped cells are killed.

If it were me, I'd request a 2nd opinion from a different Oncologist and discuss the proposed drugs. Personally I'd prefer the chemo 1st followed by surgery. Let the chemo drugs go after the cancer cells 1st to try and minimize taking all of the lymph nodes. They can test a few of the lymph nodes removed during surgery. If they and the tumor margins are positive there are follow-up chemo drugs to make sure it is taken care of. Ask about these drugs too. They refer to this as Adjuvant treatment.

anjukakkar2003

https://csn.cancer.org/discussion/comment/1714375#Comment_1714375

Thanks for your response. As of now they have not planned any treatment. Oncologist recommendation is to get surgery done before Chemo. He has not discussed any chemo medication/ plan with us.

I am taking appointments for 2nd opinion.

RocDocVic

https://csn.cancer.org/discussion/comment/1714379#Comment_1714379

I would want to know which drugs he proposes to use before making any decisions. Have him explain how every chemo or targeted drug works and what the purpose is. Same goes for 2nd opinions, and ask about the use of Adjuvant treatment drugs if you go with treatment 1st followed by surgery, and need additional treatment. They have some newer Adjuvant drugs but not sure if they cover hormone positive and HER2 negative cancer.

You can research the drugs, and also go to the Susan G Komen website to look up information.