Radiation after Mastectomy and Chemo?

Sheedap

My Mom had 2 cm tumor, IDC. She didn't want radiation, so she decided to have Mastectomy. One of her lymph nodes was affected. 9 lymph nodes were removed in addition to the breast during Mastectomy. She went through 6 cycles of chemo which is what her ONC recommended. Now he is recommending that she do 25 days of radiation therapy. I thought they did radiation only after lumpectomy. Is this normal? 

My Mom lives in India where Doctors are not open to being asked about the basis for their recommendations. So she doesn't know why the doctor is recommending radiation. I'm hoping to find some pattern in any experiences you might have.

 Thanks so much. This is a tremendously useful website and forum.

lauri

Some of us are just lucky, I guess -- I also thought the mastectomy would mean no radiation, but I got it all.  For me, I think it was the number of involved nodes (11 of 12 sampled)  For others, it's how close the tumor was to the chest wall.

Radiation was, for me, no big deal. 

flopsy

Sheedap--I had a bilat mast and still had 35 rad treatments but I did have five very positive lymph nodes on one side.  My Rad Dr recommended the treatment to kill anything that surgery did not get.  Here is in the U.S. they don't always do rads with mast except when there are positive nodes so I guess that is why your Mom would be doing the rads.  I just completed my rads and they were not too bad.  Chemo was the bad treatment for me.  I hate to hear anyone has this horrible disease but I am thankful they can treat it and your Mom should do well. 

Post here and let us know how things are going and we will be here to answer any questions you should have.   GInny

climbergirl

Yes, I had Mx, Chemo and was very pressured to have Rads. A positive node = Rads. I found the rads has caused alot of tissue damage for me shoulder/back issues and am working through it but honestly I wish that I had never done it. I am very active so it really does not matter how much you stretch, it fries the healthy tissue and causes tons of scarring on the micro level in muscle. This is super apparent with people that have had Mx's.  Doctors need to be able to be questioned and if they can't take it, find a new one. It's your (your Mom's etc) body and you have final say on ALL things so please be her advocate it she needs it. 

I think it will prove to be overkill in the future and causes way more damage than it's worth. Then again who really can say?

Be Well and Good Luck!

~kd

weety

I had mastectomy and chemo and radiation.  As someone mentioned above, sometimes it just depends on the margins of the tumor--mine was too close to the chest wall for comfort, so rad onc recommended the radiation.

hymil

Climbergirl, I'm sorry you had such trouble after radiation. Thanks for the information, yes it can cause problems with mobility when you have surgery and radiation on top, and your explanation was really clear and helpful - im still working daily at the stretches nine months down the line, my excision undercut into pec major and my body's super healing (haha) has made it quite a challenge to get the shoulder open again. but then I was probably never as active as you to start! it's the old strength v flexibilty conflict, i have accepted to be weaker so long as i can get the movement back. 

Sheedap, It's a real shame your mother doesn't feel able to ask a bit more about her treatment. It is her body we are talking about and despite the tradition against women n the past, I'm sure educated men in India now would explain more about her individual lump - what grade aggessive was the cancer, was it near chest wall etc not the same as arguing with the doctors, but to find out why they think she needs it? I had radiation after mastectomy, because my tumour was large and close to the chest wall, not actually infiltrating the muscle but pretty darned close apparently. I didnt need (or wasnt offered) chemo, and I couldn't cope with tamoxifen so I'm glad i have had some extra treatment after surgery to reduce the risk of recurrence. I don't want to go through the whole cancer thing all over again, I really don't!

Sheedap

Hello Ladies,

 Thank you so much for your help.

About getting a second opinion in India, the short story about India is that, India is still a very tribal society despite all the technological and cultural advances. Doctors expect to be revered and never questioned. If you question, you are out of their care. There is no concept of independent opinion. No doctor will disagree with another doctor. The concept of getting a second opinion is just completely moot. Finding the right doctor and getting the right treatment depends on who you know. 

My Mom's ONC is rumored to be the best. There is no intellectual who will dare to challenge that for fears of repurcussions. The rumor is just simply perpetuated and everyone just puts up with it. Even though this ONC is considered the best, I sometimes wonder who gave him a medica degree. The man doesn't have basic courtesy, has zero listening ability, just constantly scolds his patients, verbally abuses his staff, and forces treatment by intimidation. My Mom loathes him but I can't talk my parents into finding another doctor. Because my Mom says they're all alike. She thinks it's unfortunate that she got the disease. She just wants to be done with the treatment and hopes that it goes into remission. Some day India will learn to teach their doctors to be good human beings as well. Until then, this is all my Mom has.

Looking over my Mom's biopsy reports, distance of the mass from the nearest surgical margins is 2 cms. I'm not sure if that is any indication of whether radiation is needed.

Thank you so much for all your responses. You ladies rock. Here's wishing good health to all.

-Sheeda

cbm

For what it's worth, I still go back and forth about whether I should have pushed for rads in addition to mx and chemo.  The radiation oncologists are starting to advance a case for considering rads in cases of 1, 2, or 3 nodes if certain other criteria are met. At 4 nodes you're in.  I had one, but it was large, and if I had to do it today, I'd at least have tried to get the choice and engage in the discussion. I didn't want rads, so I didn't argue for it; radiation can increase the likelihood of lymphedema, which I also didn't want.  

Incidentally, I know a lot of U.S. docs just like your mom's oncologist.   Arrogance seems to be a cross-cultural phenomenon :^)

Warmly,

Cathy 

redninrah

Why wouldnt chemo kill any stray cells in the lymph nodes?

I can understand why it might not in an area with no breast as there is no bloody supply to carry the chemo drug- but the lymph nodes still have a blood supply and can carry the chemo drug to kill stray cancer cells. Any other opinions n this?