asking help form China

RoseBAI

my friend just diagnosed of breast cancer，but didn't undergo the mastectomy， instead，the doctor suggested to have her only remove the tumor. However，she is confused about the follow-up treatment include chemotherapy and radiotherapy. The main concern is that if she needs both therapies or either of it？ and the duration of each. Because the answer she got from different hospitals are vary（and this is always a problem for us and the reason is complicated. In one word，the trust issue never end between patient and HCP in China）. Here is some basic information about her case： malignant tumor in right breast，1cm×2cm. pT2NO（SN）MO. CK5/6（-），ER（90%），PR（70%），Her-2（1+），P53，TOP-II（10%+），E-cadherin（+），Ki-67（20-30%）. she had finished chemotherapy for sometimes and seems everything goes well, she does not want to continue anymore chemo nor radio，and one doctor suggested the same，while the others recommended for further treatment. She asked me about how this works in western country, and thats why here I am. Hope I could get some ideas from here.

Thank you for helping！

Nancy2581

hi Rose-glad you're helping your friend. As rose50 said your friend had a lumpectomy which is what I had. I also did chemotherapy and radiation. Radiation is always done with a lumpectomy. Chemo sometimes is too and sometimes not - depends on the diagnosis. I had one lymph node involved so that's why I had chemo. I would encourage your friend to finish her treatment. That way she will know she has done everything possible to keep the cancer away. Since she is ER+ she would do hormone therapy after chemo and rads. Hormone therapy can last from 5 to 10 years. I will be on tamoxifen for 5 years and then femara for 5 years.

Nancy

BarredOwl

Hi RoseBAI:

" . . .she had finished chemotherapy for sometimes and seems everything goes well, she does not want to continue anymore chemo nor radio, and one doctor suggested the same, while the others recommended for further treatment. . . ."

This is my understanding as a layperson (no medical training). Please correct me if this is wrong:

She had a lumpectomy for invasive breast cancer. After the lumpectomy, she began chemotherapy, and is tolerating treatment reasonably well. But for some reason, she wants to discontinue the chemotherapy regimen and decline (not do) radiation treatment. One doctor said it was okay to stop all treatment in the middle of chemotherapy. However, "others" (more than one) recommended that she complete the full chemotherapy regimen and radiation.

In the US, we generally follow the National Comprehensive Cancer Network (NCCN) guidelines for treatment of breast cancer (Professional Version, 1.2016).

Under the NCCN guidelines, following lumpectomy for node-negative (N0) invasive breast cancer, the guidelines provide for a course of radiation: "Radiation therapy to whole breast with or without boost to tumor bed or consideration of partial breast irradiation (PBI) in selected patients."

Clinical trials have demonstrated that lumpectomy plus radiation is comparable to (or possibly better than) mastectomy in terms of overall survival.

The specific radiation regimen and duration is a more complex question.

The NCCN guidelines provide information about what is usually done. However, it is possible that in a particular case there may be sound medical reasons to do something different in view of particular clinical factors (e.g., some special pathology findings, family history) or patient presentation (age, other medical conditions, etc).

NCCN guidelines differ regarding chemotherapy and endocrine therapy by histological type. For example, tubular and mucinous histology tumors may be treated differently from [EDIT: ductal], lobular, mixed or metaplastic histology tumors. The guidelines also differ if an OncotypeDX test was performed, which is now very common in the US for hormone-receptor positive, HER2 negative, T2N0 invasive disease.

If she initially started the chemotherapy regimen on trusted medical advice, and is tolerating it, then I think it would be best to finish the chemotherapy regimen completely.

Some patients wonder why they need additional treatment if the tumor was removed and the sentinel biopsy was negative. Many patients do not understand that lumpectomy plus breast irradiation are local treatments only. They only address the problem in the breast. In contrast, chemotherapy and endocrine therapy are systemic treatments (they go throughout the body), and can address the possibility of distant spread.

Even though she is node negative (N0) and she is thought to be M0, the possibility of distant spread remains. The tumor was in there for a while before it was removed, providing a potential opportunity for cells to escape the breast either by the lymphatic system or via the blood stream before surgery. If any cells moved away to distant sites (laying the groundwork for a distant recurrence (i.e., metastatic disease)), these can be reached by chemotherapy and endocrine therapy (and reduce the risk of distant recurrence).

BarredOwl

[Edited to correct the spelling of "ductal"]

RoseBAI

Thank you for that Nancy.

RoseBAI

thanks a lot everyone！

RoseBAI

I found myself not only get ideas from you guys but also learn a lot.

In addition， I do feel sorry for our medical system. Hope we could establish a more clear guideline for every treatment.

Again a great thank you to all of you.