Radiation after Chemotherapy-Is it neccesary

Tashfeen

 I hope you will not mind my coming on to your forum but I need guidance in my wife's case. I hope some one will be of help.

The details are:

The lump size detected during mammograph was 4.0 x.4.1 x.4.6  cm at 4 o- clock position in the right breast.

We were asked to do further tests including biopsy ( true cut was suggested but the hardness of the lump did not allow that so only FNA was done), CT Scan and Bone Scan. FNA was inconclusive and both CT Scan and Bone scans were clear.

The surgeon suggested that we need to  do a frozen section i.e do a biopsy at the time of surgery, if the tumor is found to be malignant, they will do a mastectomy otherwise they will do lumpectomy.

After due deliberations and opinions we went ahead for the surgery and the doctor called me and my son and told us that the tumor is malignant and he has to do a mastectomy. We were a little unsure but did the doctors bidding and the mastectomy was performed. well and good.

Chemotherapy was to be started after the wound healed and that took about 3 and 1/2 weeks to heal. The pathology reports when they came in said that it was a IDC cancer tumor but all lymph nodes were unaffected, no invasion into the skeleton or the lungs or anywhere else, as we had seen in the CT Scan and the bone scans also, the tumor was removed with clear margins without any tumor affect.

The oncologist and the surgeon my wife was being treated by had to leave the hospital for some reason and we moved to another hospital, 6 chemotherapy sessions have been completed but now the Doctor is suggesting Radiation.

We are worried and concerned. Keeping in view that there was no invasion, nothing in the lymphnodes, is radiation required. They diagnose the tumor as Grade 3, just because of the size of the tumor and for no other reason.

What should we do? Go for radiation for 6 weeks or not? I will appreciate as much input we can have on this matter.

Thanks and best wishes

starbeauty

Tashfeen - to the best of my understanding... what she did with chemo will impact any dividing cancer cells... despite the margins, despite the clean nodes - there could still be microdots of BC on the chest wall or some other local area.  That is why they are suggesting it... but you are right - the usual risk of nodes positive or margins unclear isn't there, but the tumor has a "grade" too... you need to understand if it was a more aggressive type tumor - and it it was that may also account for their caution.  Bottom line - it is going to be her decision.  Her choice has implications for reconstruction - so be sure you see a plastic surgeon to discuss the options before you make the final decision.  Whatever she decides - you need to agree together that you are not going to second guess the final choice.  It will be made with as much information as you have - and with the best of intentions... a second opinion from an oncologist is really valuable... that may be the first step toward getting some clarity on what is best.

Letlet

Hmm, being that she has clear margins and has no node involvement I'm not sure either why radiation is being recommended. I was told that if I had a mastectomy I would not have radiation, which is not true. I ended up with 6 positive nodes and this is the exact and only reason why I am getting radiation. What exactly was their reasoning? Is it because of the tumor size? You can always go and get a consultation with the rad onc to discuss all this and ultimately decide for yourselves. What the med onc is saying is not necessarily what the rad onc would recommend.

suzieq60

If the tumour is close to the chest wall (even with clear margins), they may recommend radiation - that would be the only reason.

Pegs

i had a similar situation, my tumor was 5.9cm lymph nodes were all clear, margins were good, everything was what you'd want it to be except the size.  i saw 3 different radiologists trying to get out of radiation and try to understand why, i did the chemo wasn't that enough?  i was told by all 3 doctors to get the radiation.  the size was considerably large and to make sure no recurrence its the best thing to do, i had a bilateral mast.  so i did it.  i wanted to be sure i would never doubt myself if this should ever return, i feel like i've done all i could do and now its up to god to decide if i am done with all this.

Bethie1

My name is Beth and I'm 3 yrs out from IDC breast cancer, the same type your wife has, but I had lymph node involvement, so I had chemo and radiation.  IDC I was told is the most common and most curable.  I'm not sure why radiation was suggested either being as in your case there was no lymph node involvement, but if its near chest wall that could be a reason to radiate.  I would suggest based on my experience to radiate after chemo.  These two treatments are the best line of defense against possible reoccurrence.  It's my understanding radiation gets what chemo may have missed, so protect your wife as best as possible.  if you so choose to radiate, get AQUAPHOR ointment to put on her skin to heal the burn

pattibear

well my breast cancer was stage 3  with clear margins then chemo,masectomy and now radiation, i think for myself that i want to do every thing i can tomake sure not one little cancer cell has escaped. radiation is time consuming but i feelbetter doing it. good luck with your wife and know all of us are here for her and you

Bethie1

Pattibear--how did you have chemo before the mastectomy? I had mastectomy, chemo, and radiation one after the other

cycle-path

Tashfeen, I had DCIS rather than IDC so my perspective may be skewed, but here's what I think.

Doctors want to really squash this cancer bug and hit it with everything they have. They don't want it to come back and they don't want it to weasel its way into other organs. IMO they sometimes take what I call a "belt and suspenders" approach to make double sure the pants won't fall down. (My son calls this a "belt and suspenders and cummerbund" plan )

I think one needs to educate onesself about the risk of recurrance or metastatization and decide how many belts and pairs of suspenders one wants to wear. A person who wants to be 110% certain the cancer is GONE may opt for more treatments than a person who's comfortable with a little risk.

There's also the issue of "quality of life" versus "quantity of life," and sometimes one trades a little of one in order to get more of the other.

So the answer to "is it necessary" depends on how much risk one is comfortable with. A treatment that one patient thinks is absolutely necessary may seem completely unimportant to another patient. Only the patient and his/her family can decide.