Help with Decisions Diagnosed

simmonsg · May 2003

I was recently diagnosed with breast cancer - invasive ductal - size 1.5 cm with clean tissue margins and with negative node involvement. My estrogen and progesterone receptors are both postive and my HER2/NEU is positive (3+). I have an appointment next week with an onocolgist to discuss treatment options. Several people have told me that the recommendation with be radiationa and chemo - is there any one on this message board who has any information as to the standard treatment options? I am confused as to why chemo would be given for such a small tumor with all clean tissues and nodes. Can anyone help?

rainyday · May 2003

Hi, I was also recently diagnosed with the same stats as you. Only difference is that my HER2/neu was 2+. I saw my oncologist yesterday and although I had expected to do just radiation followed by tamoxafin, he recommended a short course of AC (12 weeks, 4 X) for two reasons:
While I had 16 negative nodes, the tumor (1.5 )has probably been around for a long time and there is a chance that there may be some cells that got away through other means. The HER2/neu+ which occurs in only 25-30% of invasive breast cancers can be an indicator of a more aggresive cancer(although there is little info on node negative and HER/neu - I've looked), has a weaker prognosis and has a higher recurrence rate. So... while we don't want any cancerous cells floating around we particularly don't want the HER2. That said, HER2/neu has been shown to be very receptive to Adriamycin. So...He said " you are young (43), strong and healthy, do the AC and then the radiation. I hope this helps. I am going through exactly the same decision making process; weighing the potential risks of AC (and the hair loss) with the potential benefit of a slightly lower recurrence rate and the knowledge that if there were any nasty strays they will probably get zapped. Good Luck and let me know what you decide. I am going to do the chemo. I am having the heart scan on Wednesday.

bunnie · May 2003

Hi my tumor was quite a bit bigger than that but the only reason i could think that they are saying chemo is for the same reason the gave me chemo is just too make sure that there is no floating cancer cells.I had no nodes involved and they still had me go through four treatments of chemo.hope this helps some.like the old saying goes better safe than sorry.bunnie

tem31 · May 2003

<<<<I am confused as to why chemo would be given for such a small tumor with all clean tissues and nodes. Can anyone help?>>>>
I would think you'd just have radiation. It also depends on the surgery you have as well. If it's a lumpectomy, they do radiation for sure. If it's a mastectomy, they may suggest both. This is what I did. Also they sometimes suggest chemo first to shrink the tumor. Just write these questions down and wait for an answer from the Oncologist. I had all different suggestions/answers and come to find out my oncologist had a different plan for me. There's a terrific book and fairly short called "Be a Survivor" by Vladimir Lange, MD and it can give you more in depth information on treatment plans.

JKAlley · May 2003

rainyday said:
Hi, I was also recently diagnosed with the same stats as you. Only difference is that my HER2/neu was 2+. I saw my oncologist yesterday and although I had expected to do just radiation followed by tamoxafin, he recommended a short course of AC (12 weeks, 4 X) for two reasons:
While I had 16 negative nodes, the tumor (1.5 )has probably been around for a long time and there is a chance that there may be some cells that got away through other means. The HER2/neu+ which occurs in only 25-30% of invasive breast cancers can be an indicator of a more aggresive cancer(although there is little info on node negative and HER/neu - I've looked), has a weaker prognosis and has a higher recurrence rate. So... while we don't want any cancerous cells floating around we particularly don't want the HER2. That said, HER2/neu has been shown to be very receptive to Adriamycin. So...He said " you are young (43), strong and healthy, do the AC and then the radiation. I hope this helps. I am going through exactly the same decision making process; weighing the potential risks of AC (and the hair loss) with the potential benefit of a slightly lower recurrence rate and the knowledge that if there were any nasty strays they will probably get zapped. Good Luck and let me know what you decide. I am going to do the chemo. I am having the heart scan on Wednesday.

Hi, I agree with rainyday, the combination of a 3+ her2nue and an envasive tumor means there is potential for a more aggressive cancer. I say go for the more aggressive treatment to fight it. While chemo sucks, especially ac, you'll get through it. I had a bigger invasive tumor, positive nodes, and am also a 3+ her2neu. Knowing I am doing everything I can and taking the most aggresive treatment I can get gives me peace of mind. Good luck and God bless.

simmonsg · May 2003

tem31 said:
<<<<I am confused as to why chemo would be given for such a small tumor with all clean tissues and nodes. Can anyone help?>>>>
I would think you'd just have radiation. It also depends on the surgery you have as well. If it's a lumpectomy, they do radiation for sure. If it's a mastectomy, they may suggest both. This is what I did. Also they sometimes suggest chemo first to shrink the tumor. Just write these questions down and wait for an answer from the Oncologist. I had all different suggestions/answers and come to find out my oncologist had a different plan for me. There's a terrific book and fairly short called "Be a Survivor" by Vladimir Lange, MD and it can give you more in depth information on treatment plans.

I started out with a lumpectomy - but the clear margins were not large enough and they need to do the sentinal node biopsy - so I ended up with what is considered a partial mastectomy with lots of clean tissue and nodes. Thanks for the suggestions on the book - I have done alot of reading already and anything else to help me know more is welcome.

simmonsg · May 2003

rainyday said:
Hi, I was also recently diagnosed with the same stats as you. Only difference is that my HER2/neu was 2+. I saw my oncologist yesterday and although I had expected to do just radiation followed by tamoxafin, he recommended a short course of AC (12 weeks, 4 X) for two reasons:
While I had 16 negative nodes, the tumor (1.5 )has probably been around for a long time and there is a chance that there may be some cells that got away through other means. The HER2/neu+ which occurs in only 25-30% of invasive breast cancers can be an indicator of a more aggresive cancer(although there is little info on node negative and HER/neu - I've looked), has a weaker prognosis and has a higher recurrence rate. So... while we don't want any cancerous cells floating around we particularly don't want the HER2. That said, HER2/neu has been shown to be very receptive to Adriamycin. So...He said " you are young (43), strong and healthy, do the AC and then the radiation. I hope this helps. I am going through exactly the same decision making process; weighing the potential risks of AC (and the hair loss) with the potential benefit of a slightly lower recurrence rate and the knowledge that if there were any nasty strays they will probably get zapped. Good Luck and let me know what you decide. I am going to do the chemo. I am having the heart scan on Wednesday.

Thanks for the feedback - I have been reading lots of stuff on the internet and as much as I hate it, it seems that chemo might be the safest route - while I am not looking forward to the side effects - I am more scared of feeling like I am sitting on a ticking recurrence time bomb. I guess the oncolgist and I will have a lengthy discussion next week. Thanks again and good luck with your treatment. I'll keep you in my thoughts.

sashi · May 2003

You didn't mention your age but that could be a factor. I was only 44when I was diagnosed and because of that my oncologist told me to have chemo and radiation. Good luck!

inkblot · May 2003

Hi!

I know it's a tough time right now...figuring out all the options, etc...

From my own research, the different medical opinions, etc., it seems that the most important reason for your doctor advising the AC, is the Her2/neu factor. As someone else said here, it indicates a bit more aggressive form of cancer, in which case the chemo is a bit more insurance.

My tumor was very similar to your own except that I was hormone negative. My Her2/neu was also a 3+. I had also anticipated only needing radiation following my lumpectomy. After the final path report was in though, the chemo was recommended. And in cases such as ours, it's considered "aggressive" treatment.

The AC chemo isn't fun but not so bad for the majority of women. When we consider its potential, it seems reasonable. However,
we're all different and I know that you will make the best choice for yourself. That's the most important thing...to feel that you've done the
the best/right thing for you. Arming yourself with good info really helps.

If you haven't checked them out already, go to:
www.nci.nih.gov A wealth of info there, including good info on Her2/neu. Hope it may be helpful to you.

Wishing you the very best.

Love, light and laughter,
Ink

DyeanaD3326 · May 2003

I had a tumor slightly under 2 cm. 7 years ago with negative receptors(your positive receptors are better). I was told they now treat anything over 1 cm. with chemo, because the larger a tumor, the chances are greater that a little piece breaks out of tumor into the bloodstream(hope I explained that correctly.) I had CMF(cytoxin, meth., and 5-FU). No adriomycin, did not lose hair, had 8 treatments over 6 mos time. It is more of an insurance policy, and in my case, I am glad I did it.Will never know the road not taken, but here I am, still in remission and know volunteering with the American Cancer Society. But research ALL facts and get several opinions from doctors. Good luck and God Bless!

rainyday · May 2003

simmonsg said:
Thanks for the feedback - I have been reading lots of stuff on the internet and as much as I hate it, it seems that chemo might be the safest route - while I am not looking forward to the side effects - I am more scared of feeling like I am sitting on a ticking recurrence time bomb. I guess the oncolgist and I will have a lengthy discussion next week. Thanks again and good luck with your treatment. I'll keep you in my thoughts.

You hit the nail on the head "a ticking time bomb". That is what I was feeling about only doing the radiation before they suggested chemo. What if a little piece travelled through a vein etc. I don't want to do the chemo but like you I have young kids and even if I didn't, I still have a very long list of things that I want to do... Good Luck.

lindadelrio · May 2003

Hello, 4 years ago I was diagnosed with "insitu" of the ductal glands. I had a masectamy due to the fact that it took up over half of my breast. My nodes came back clean. My only treatment was the surgery. In January of this year I found 1.7 cm "infiltrating" lump in the very bottom of the same breast. When the biopsy came back my ER and my PGR came back negative but my HER2/NUE was positive. My nodes came back negative. I am currently going through chemo. When I am done in September I will go to a radioligist for an opinion on radation. The reasoning I was told to go through all of this is to kill any and hopefully all cancer cells in my body that could be anywhere. I decided that it was a good idea to go through chemo and radiation if need be so that I may not have to deal with this again. I have a 4 year daughter and a 7 year old son. My goal is go become a grandma in many, many years from now. I feel this is my best option to achieve my goal.

Hope this helps.
Linda in Del Rio, Texas

leann · May 2003

lindadelrio said:
Hello, 4 years ago I was diagnosed with "insitu" of the ductal glands. I had a masectamy due to the fact that it took up over half of my breast. My nodes came back clean. My only treatment was the surgery. In January of this year I found 1.7 cm "infiltrating" lump in the very bottom of the same breast. When the biopsy came back my ER and my PGR came back negative but my HER2/NUE was positive. My nodes came back negative. I am currently going through chemo. When I am done in September I will go to a radioligist for an opinion on radation. The reasoning I was told to go through all of this is to kill any and hopefully all cancer cells in my body that could be anywhere. I decided that it was a good idea to go through chemo and radiation if need be so that I may not have to deal with this again. I have a 4 year daughter and a 7 year old son. My goal is go become a grandma in many, many years from now. I feel this is my best option to achieve my goal.

Hope this helps.
Linda in Del Rio, Texas

Hello! None of you mentioned reconstruction. Just wanted to share my experience with the gap flap(alot of people know about the diep flap) which takes fat from your behind and transfers it to your breasts. The results are amazing. Please email me with any questions
Leann

geral · May 2003

Hi!

The recommendation of radiation & chemo sounds in-line with your diagnosis, but I'm not in the medical profession, just a fellow survivor.

I do strongly recommend that you get 2 opinions on treatment options. Even if you have faith in what your current Oncologist recommends, it never hurts to get a second opinion. This should give you more confidence in what you're doing to conquer cancer and help you fight the battle.

I'm glad you found this discussion board so early in your diagnosis. I've found the survivors here are so very helpful.

Take care,
Geral

chemoqueen1 · May 2003

I also had a 1.5 cm tunor, clean magins, clean nodes and no sign of sread from scans. I am her2+ and ER/PR +. I am in a study that includes the use of herceptine with standard chemo. My leg of the study involves Taxotere, Cyboplatin and Herceptine. My doc has great hopes with the Herceptine, it is thought that adding the herceptine will reduce the risk of spread or re-occurance. In my opion it is worth the chemo to have the chance of not having a reoccurance. Check with your doc. The study is being conducted by the US Oncology Group.

Help with Decisions Diagnosed

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