treatment for recurrence - chemo or not?

mari3579

Hi.  I had posted this on the Second/Third Breast Cancer forum, but I think this is the right forum...I was first diagnosed at 35, Stage 2/3 IDC/DCIS combo, left breast, close to 3cm and positive nodes. ER+/PR-/HER-  I had neoadjuvant chemo (AC/Taxotere), lumpectomy, radiation, tamox and lupron shots.  5 1/2 years later; diagnosed again...same breast, ER+/PR-/HER-; 1.5 cm IDC/DCIS combo; Grade 3. Tumor was very close to original site. Have just done mastectomy (no addt'l nodes taken) with tissue expanders and thinking about doing DIEP reconstruction. Oncologist asked me stop Tamox, but continue on lupron shots as she'd like to switch me to an AI and may also recommend zometa infusions (2x per year).  I will also plan on taking ovaries out. As far as any further chemo, she tends to think there may be little benefit from it, but leaving it up to me to decide if I want to do chemo again. Ugh! She says I fall in a gray area, as far as chemo goes and will present my case to the tumor board to see what other onc's say. She thinks they'll also be on the fence. Hard decision to make...wondering if anybody else out there has/had a similar situation??  Thanks for any input!

lexislove

Mari,

I know the thought of having to indure chemo again is horrid but I think it might be wise. I see you did have radiation to the breast 5 1/2 years ago...so I don't think they will radiate again. You have already done the mastectomy. So chemo is all that is left. There is always that chance that a cell had escaped right?  Since your tumor is larger than 1cm and grade 3 I think it warrants chemo in my opinion.

You onc is right on with the removal of your ovaries and starting an AI. Also the Zometa infusions as well! Good for him/her for being on the "ball" regarding your treatment.Sounds like you are in good hands.

I hope some more woman can offer their opinions and maybe some have gone through something similar. You are still young and have many years ahead. If this was me....I would go for the chemo. I could not sleep at night knowing I hadn't done everything to fight it. The could of ..should of's would drive me crazy.

I wish you luck in your decision...

idaho

Get an oncotype test. Maybe chemo won't do you any good.   Tami

pitanga

Mari,

I am facing the same problem. I had a mastectomy for a local recurrence last month, adjacent to my old lumpectomy scar tissue, and I´ve also been diagnosed with a metastasis to my cervical spine. Weirdly, for the met my oncologist says just radiation and Zometa, but because the local recurrence was HER2 + she also recommends Herceptin... AND chemo. I am undecided about the chemo. My new tumor was a measly 7 mm and its growth index was really low (<10%). I am much more worried about the metastasis so if the chemo is not for that, why do it? My first bout with chemo was yucky... On the other hand part of me says, use all the weapons you have, imperfect though they may be.</p>

So, yes, my situation is similar to yours but unfortunately I am no further along than you, so cant yet offer any useful hindsight, 20/20 or otherwise. Except to ask about the growth index. My original tumor was only grade 2 but it had a really high index and my onc told me that chemo is more effective against tumors that are growing quickly. Yours being Grade 3, it may be that it was also growing fast.

About oncotype testing, no one has said anything to me about that... maybe I will ask my onc.

All my best to you in deciding. I´ll sure be thinking of you as I try to make up my own mind.

Lisa

mari3579

Thanks for the responses. The final verdict, after tumor board meeting and also after my onc (she is an angel!) also consulted 3 other colleagues outside Hopkins (in NYC and Boston), is that more than half of those consulted recommended to do chemo (CMF) followed by hormonal treatment (AI, ovaries out and ZOmeta). They are looking at this whole thing as if I had originally presented with this diagnosis, they would have done the chemo plus hormonal treatment. I start chemo on Tuesday;  six total treatments; every three weeks, so about 6 months. Sigh,.,..but, I think I feel at peace with this decision.