Wife finished treatment - still have questions

spudmctater

My wife (Stage 2B, Grade 3) was diagnosed in February and had a bilateral mastectomy in March. She finished up five months of chemo a few months ago and will be going back every three months for check ups.

A few questions:

- If the doctor doesn't run any tests or scans at the three-month check-up, how will they know if the cancer has come back or not? What is the purpose, then, of the three-month check-up?

- Does the fact that the tumor was Grade 3 mean it is more likely to recur?

- My wife's cancer had spread to the axillary lymph node but not further. Does that mean the cancer didn't spread through the lymphatic system elsewhere in her body?

- How/when do you find out that a patient was resistant to chemotherapy?

- If someone's hair starts coming back during chemo, is that a bad sign that the chemo isn't working?

- How can doctors tell that the cancer spread through the blood system?

Thanks for your help answering these!

breastcancerhusband

Hi Spudmctater

Sorry to hear your wife has had to go through this.  Mine is going through it too. She begins chemo next week. 

To try and answer your questions:

1) I would imagine it will be to check general health and ultrasound/mammo of the chest area. Even after full breast removal there is still a chance (although very small) that some breast tissue is left. Constant PET/MRI scans can cause excess stress and worry and I believe only detect tumours above 1cm (?). unless there are outward symptoms of something else they tend not to scan

2) grade 3 means the cells were very aggressive and yes in theory more likely to have broken away from the tumour and spread. However that doesn't mean they have, multiple factors dictate how cancer cells spread not just cell grade. Also even if cells have spread very few cancer cells are actually able to survive in the vascular system and are able to form a new tumour.

3) Grade 3 cancer cells are in general more susceptible to chemo. Chemo drugs target fast growing cells. However the only real way of knowing is by performing chemo first before surgery.  That way the doctors can see how much the chemo shrinks the tumour and any affected lymph nodes before surgery. However the overall outcome isn't affected by chemo being done first or after surgery.

4) Not at all. Some people are lucky and don't lose any hair during chemo!

5) At the moment there isn't a conclusive test for cancer cells in the blood system. They can look at tumour markers, and while useful, false results can occur. A number of studies have directly measured circulating cancer cells, but again this is open to error and isn't in clinical use.  When the tumour is removed the path report should say if lymphovascular invasion is present or absent. If present it means that cancer cells are seen in the blood vessels surrounding the tumour. But again even if it is present it doesn't mean the cancer  has spread and vice versa.  A recent study did suggest that LVI should be used as a prognostic factor. 

Remember that everyone is different and every case of breast cancer is different. All the stats are based on huge numbers of patients,  but your wife is not a statistic.

Triple negative can be scary,  but any cancer is. I think the lack of treatments after surgery, chemo/radio  is the worst part. But research has shown that exercise and a low fat healthy diet can reduce the risk of recurrence. Although hard, try to put the negatives to the back of your mind and enjoy your wife being past treatment and take each day as it comes and try to enjoy each day!

I wish you both the very best and will say a prayer for both of you.

Moderators

Hi spudmctater, and welcome to Breastcancer.org!

Sorry to hear what your wife is going through... As you can already tell, you're not alone, and we hope you'll find the information and support you're seeking here. If you are interested, there is another topic under the For Caregivers, Family, Friends and Supporters forum called The Husbands Corner(for family, friends, boyfriends, ect.) where you may want to read or post also.

We hope this helps!

The Mods

jenjenl

- If the doctor doesn't run any tests or scans at the three-month check-up, how will they know if the cancer has come back or not? What is the purpose, then, of the three-month check-up? Every doctor is different unfortunately, some do routine labs for a year, some do scans and some do nothing only visual and verbal check up. My doesn't do anything unless i cause a stink and pursue tests I feel are needed. So far it's been an OK compromise and when I really needed a scan it was ordered with little fuss.

- Does the fact that the tumor was Grade 3 mean it is more likely to recur? Grade 3 doesn't necessarily mean it's more likely to recur, the fact it's TN makes it more likely to recur. Grade 3 also responds better to chemo than lower grades.

- My wife's cancer had spread to the axillary lymph node but not further. Does that mean the cancer didn't spread through the lymphatic system elsewhere in her body? True, but there are many woman who had no positive nodes and recurred elsewhere.

- How/when do you find out that a patient was resistant to chemotherapy? if they had chemo before surgery they will know if the chemo worked. if you had surgery 1st then chemo, you just won't know unless you recur.

- If someone's hair starts coming back during chemo, is that a bad sign that the chemo isn't working? Mine did the same thing but then it all feel out and then regrew. Lot's of wacky things happen during the process.

- How can doctors tell that the cancer spread through the blood system? the path report would indicate if there were signs of that.

In the end you just do the best you can and hope that by following all the steps in the process and being aggressive that you've paid your dues. Once your a year out from treatment things get better - at least the mental torture game. I just had my 2 yr since dx and I forgot on that day....never thought that would happen!

Luah

spud: The first 12-18 months following treatment is an anxious time. You are not alone! My best advice, is to try to manage that anxiety and go on with life. As the months and years go by, it gets a whole lot easier, trust me! Here are some answers to your questions:

- If the doctor doesn't run any tests or scans at the three-month check-up, how will they know if the cancer has come back or not? What is the purpose, then, of the three-month check-up? It's true, they won't, but it's also unlikely to have occurred, and scans don't indicate circulating tumour cells anyways. It's an imperfect world. My onc referred to studies that show that symptoms often show up between visits anyways. So many docs order scans only if you're symptomatic. That can be way less stressful too.

- Does the fact that the tumor was Grade 3 mean it is more likely to recur? Grade 3 is a measure of how abnormal the tumour cells and the tumour tissue looked under a microscope. It is an indicator how quickly a tumor is likely to grow and spread; however, if treatment is successful at eradicating the tumour, it's kind of irrelevant after the fact.

- My wife's cancer had spread to the axillary lymph node but not further. Does that mean the cancer didn't spread through the lymphatic system elsewhere in her body?Not necessarily. Having 1/15 nodes is a good sign, but unfortunately, there are no guarantees. But then again, there are many women who had no lymph node involvement who recurred. So the importance of LVI is thought to be less of a prognostic factor with TN.

- How/when do you find out that a patient was resistant to chemotherapy?You can't know unless chemo was done prior to surgery. (And unfortunately if BC recurs shortly after treatment, it would be a sign that it didn't work.)

- If someone's hair starts coming back during chemo, is that a bad sign that the chemo isn't working?I don't think there's any evidence to support that, no.

- How can doctors tell that the cancer spread through the blood system? This may be shown on the path report. My BS said that with lymph node involvement, it's highly likely there would be vascular invasion too, so no point is overstating this risk. However, it is what chemo is designed to address.