Confused and Worried about Prognosis for Mother

Ali126

My mother was diagnosed with breast cancer back in 1991 and was treated through a lumpectomy and radiation.  For 20+ years, she has been cancer free.  This past year, she was diagnosed with a recurrence of the same cancer and just about two weeks ago, underwent a mastectomy and a diep flap reconstruction.  We met with the surgeon on Monday, who gave off very negative vibes, telling us that the pathology showed positive margins at the chest wall.  She said that to have clean margins, she would've had to remove ribs, which would've been too difficult for my mother to recover from.  Since my mom already had radiation, it's not likely she'll be able to receive more, especially after the diep reconstruction.  Therefore, the surgeon recommended aggressive chemotherapy treatment.  When asked for a prognosis, she said, "Without chemotherapy? 3 months? 6 months? 1 year? I couldn't tell you."  So we left the appointment feeling as though my mom only has months to live.  A few hours later, we met with the oncologist who questioned whether or not chemotherapy would even be an option for my mom (She's 60+, diabetic, kidney issues, etc.) but stated my mom still is at Stage II and that neoadjuvant therapy might be sufficient for my mom.  

My question is - how worried should we be?  I know that radiation is typically used if positive margins remain after a mastectomy but with that off the table and the chance that chemotherapy might not be possible for my mom, how bad is her situation? 

aaoaao

Ali, the surgeon is not an oncologist.  She really shouldn't be given life expectancy regarding chemotherapy because that isn't her field.  There are many different treatment options for breast cancer and she probably isn't aware that chemo isn't always the answer.   The oncologist is the cancer treatment specialist, the surgeon does operations..truly not usually involved in long term cancer treatment.  There are hormonals than can be used to treat cancer before chemo is considered.  It is easier on the body and can keep cancer in check for many years.  There are Stage IV cancer patients who are only on neoadjuvant therapy for many years and they save chemo for later use.  However, I do recommend that everyone get a 2nd or even 3rd opinion if necessary.  Getting a 2nd opinion helps by reassuring you that your treatment plan is the right one for you or you might find an oncologist you feel more comfortable with. I can't tell you not to worry because it's your Mom and you're going to worry anyway.  However, I do want to reassure you that there are so many treatment options available and chemo isn't always the correct answer.  Keep us posted how she's doing and what treatment plan she decides on.  But get that 2nd opinion because you'll feel so much better.  The more info you have the better you'll feel about your choices.

Letlet

Ali, I am sorry about your mother's recurrence

Let me just put in my two cent's worth to that doctor's response. First of all no one knows how long everyone has. No one does. It's often quoted on the BC boards that we do not have an expiration date stamped on out foot. With that out of the way, you have to understand that there is a lot of research and data out there on patients regarding chemo and radiation. There is so much literature out there that doctors are able to give statistics or research based data because they did track and collect the data on patients who did chemo or radiation or surgery. . Compare that to research and study of patients who do not have treatment - the data may not be readily available or available at all. So when the doctor said he "couldn't tell you", he really couldn't tell you. I wouldn't immediately focus on getting "she only has months to live" from that meeting, rather I would focus your energy on researching and discussing what regimens that are available and advisable for her with her comorbities. I think getting a second opinion is always a good idea, not because you don't trust the first oncologist but it's always good idea to find out what another MD's thought is, it might be the same or not but it will give you more confidence of her treatment of choice if you are armed with information and going through this with your eyes open.

Ali126

Thank you aaoaao and letlet!  This is the second oncologist that my mom has seen and she was optimistic about my mom responding to the neoadjuvant treatment without any chemo.  We are waiting on the oncotype test results to make a more informed decision about additional treatment.  It's just easy to get stuck in the negative and the worry that we felt when we spoke with the surgeon, rather than focusing on the positives we heard with the oncologist.  Too, the surgeon didn't fully explain the implications of there being positive margins with the chest wall involved, which makes it difficult for us to really understand what's going on and what the next steps could be.