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Medical Forum / Diseases and Disorders / Breast Cancer / September 2004Newly Diagnosed
I'm a total newbie here, although not to the general subject, as I've had a radical prostatectomy this year for prostate cancer. A very close relative, age 61, has recently been diagnosed with breast cancer. Lumpectomy done last week. The intrasurgical lymph node biopsy came in negative, but the more complete pathology report a week later (today) showed spread to one node. The salient details as I understand them are as follows: 1. 1.8 cm tumor in extreme upper left corner of left breast. 2. Tumor completely removed; clean margins. 3. Estrogen receptive, and "urtu" (phonetic) negative 4. Five sentinal nodes biopsied, one node (#3 ?) positive with micromet The issues at this point as explained by the doctor are: Further surgery to remove/biopsy all lymph nodes? Radiation/chemo/hormonal therapy? We would be deeply grateful for any advice re prognosis, treatment options, odds, what to expect and when, etc. Thank you very very much. Paul > I'm a total newbie here, although not to the general subject, as I've had a > radical prostatectomy this year for prostate cancer. [quoted text clipped - 20 lines] > > Paul Dear Paul Welcome to the group. The prognosis in this situation is pretty good, at least 80% with this situation would be completely cured, in that they would not get a recurrence within five years. The further therapies suggested would be normal. If she is otherwise healthy with a good life expectancy then the risk-benefit of chemotherapy is significant. In the longer term, having once had a particular cancer is a risk factor for getting it again. So although the risk of this particular cancer recurring is fairly small, the chances are perhaps 30% that she will get breast cancer again sometime in her life, although most likely when she is so old that it will not be important. This may be because her breast tissue has demonstrated that it has the genetic and historical capability of getting all the "ducks in a row" needed to start cancer, so there is really no reason why it should not happen again to another part of the breasts. The word pronounced "urtu" would be HER2, a growth-factor receptor subverted by some cancers to produce their characteristic uncontrolled growth. This being negative usually means it is a less aggressive form of cancer, and probably mainly uses the estrogen receptors, so this indicates that hormone therapy would likely be effective in preventing recurrence. Tim Jackson > > I'm a total newbie here, although not to the general subject, as I've > > had [quoted text clipped - 52 lines] > > Tim Jackson Thanks so much. Re surgery, the doctor has recommended against additional surgery/node removal because of the presumed low risk of additional node involvement as compared to the potential side effects (e.g., lymphedema). Does this sound reasonable? If there are other nodes affected would those be "neutralized" in any event by the radiation and/or systemic chemo or hormone therapy? Would this systemic therapy also reduce the risk of recurrence in the future in another part of the breast? > > > A very close relative, age 61, has recently been diagnosed with breast > > > cancer. Lumpectomy done last week. The intrasurgical lymph node biopsy [quoted text clipped - 38 lines] > hormone therapy? Would this systemic therapy also reduce the risk of > recurrence in the future in another part of the breast? Hormone therapy would reduce the risk of further independent occurrences, as would prophylactic bilateral mastectomies (but a bit extreme in this case); chemo- and radio-therapies would only reduce the risk of recurrence of the present tumour. As regards node removal etc, it is all a matter of balancing risks. there are no hard and fast answers. Node removal reduces the risk of recurrence, but increases the risk of lymphedema. I can see why the doctor might suggest this. Chemotherapy will "neutralise" most small micrometastases, but there is no way of knowing how many there are and how large they are, as we are talking about clusters of cells well beneath the resolution of any imaging system. So it is a matter of educated guesswork on the available evidence, and that is the oncologists job. I would be inclined to trust his/her judgement unless you have reason to doubt it. To be fair we are probably talking about pretty small changes in risk, perhaps a percent or two. The same applies to 'skipping' chemotherapy: were she to have some other condition that meant her life expectancy was short, then the benefits from chemo would be reduced, and then it might make sense to enjoy life while it was around rather than spending it in the misery of chemo. However a healthy woman of 61 would normally enjoy a significant increase in life expectancy in return for losing a little quality life to chemo, especially if she intended to 'skip' node surgery. Tim The following was an email received personally on this thread from a WebTV subscriber who had difficulty posting to the group. As requested I am posting the thread. Perhaps a WebTV-er could give posting instructions. And of course any support for Becki's situation. Tim Jackson ------------------------- 19 September 2004 hello tim. My daughter 41 has recently been diagnoised with breast cancer in her left breast.So far she has had the bi-opsy and both the mass in her breast show cancer.This was done this tuesday./we saw a surgeon who tols us he need to have further tests.1. to find out if it is in the lym-nodes for 9/27 and than another for 9/30 for chemo..She was terrified so she didn't ask the questions she should of asked.This seems to be to far apart..She did not feel good about the surgeon.Her primary doctor is away to monday.I want to get a referral to a Special Hospital in Boston..Any and all advise will be so helpful..I don't know what to ask. Beverly J. Pires may you be blessed, always,BEVERLY ------------------------- 19 September 2004 Dear Beverly It is understandable and normal to be terrified at this stage. It is difficult to cope with the shock, the changes to one's thinking, the flood of information that comes with a diagnosis of cancer. Being in the UK myself, I don't know much about referral procedures in the US, perhaps a phone call to the hospital would elicit advice. The important advice here is "don't panic". The cancer has probably been around for the last 10 years slowly growing, and a few more days isn't going to make much difference to the outcome. You say she has an appointment "for chemo". Is this in introductory appointment to an oncologist, or is there a plan to start chemo before surgery? This is sometimes done if the tumour is rather large and advanced, to shrink the tumour and simplify the surgery. The key fact here is how big the tumour was seen to be on the mammogram. The process for a typical small tumour, once confirmed by biopsy, would be to schedule surgery, usually within about three weeks, which would include removal of the lump and of lymph nodes, either one or two 'sentinel' nodes, or of all the nodes likely to be affected. The lump and the nodes are examined in the pathology lab. At this stage the surgeon hands the patient over to the oncologist, who prescribes whatever therapies are needed on the basis of the path. results. Where radiotherapy is proposed this will usually be handled separately by a radiation oncologist. You might get some further information from our FAQ website at www.cancersupporters.com In particular that has links to extensive cancer information sites such as www.imaginis.com. Tim Jackson ------------------------- 19 September 2004 Thanks very much for your advise.. may you be blessed, always,BEVERLY ------------------------- 29 September 2004 Hello Tim, Thank you so so much for you advise and support regarding my daughter.We will get a 2nd opinion on 10/5..We are going to Dana Farber which is considered on the top 10 list... It very complicated what Becki will go through.She will have to lose both breast.She has genetic breast disease..Right now her left doesn't show from a mamo but a MRI will be done..She will have them removed and reconstructed at the same time...God is on our side... We discovered she has this history from both my side and her Dads...Years ago people kept this a secret,therefore we would have been on top of it.My granddaughters will have to be tested and counselled as well... We are able to embrace the new life that god has given us and every day we give thanks for this traumatic ordeal that women and yes even men have to go through... Thanks again this support group gave me alot of information...I do not know how to post,I am new at this so this is why I write directly to you.If you can forward this to the group I would love it... We must not be silent about cancer,it only kills if we remain silent to each other... Sincerely. Beverly J. Pires Mashpee,Mass may you be blessed, always,BEVERLY Tim, if the party who wrote to you is using and posting from a Webtv unit as I am, it is very easy to access the discussion groups from Webtv. All she has to do is the following: 1. Go to her homepage of MSNTV (Webtv) and in the left side corner she will see a list of things she can access. 2. Click on "Discussion Groups". 3. When it opens she can type in the name of the group she wants ex.: "alt.support.cancer.breast" and it should open up this group for her to access. 4. She can even type in the word "cancer" and it will give her a list of which other cancer groups she can access. Best of luck to her and her daughter who was recently diagnosed. Bea Let me just add here that once she does what the last poster told her to do...she should save this site to a "folder" and then she won't have to try and remember the "route" she took to get here. And my thoughts and prayers are with her and her daughter for a good outcome. Take care there/God bless annie Ultimately.....we know deeply that the other side of every fear is a freedom. "Courage"...is *fear* that has said it's prayers. |
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