Does my mom get right treatment?

purrr

Hi! I'm not sure if its right place to ask such a question... forgive me if I made a mistake

Problem is, medicine in our country is not super reliable, so it's better to double-check treatments offered by doctors. Also there is a problem of corruption resulting in inadequate treatments. So I try to collect as much information as possible.

My mother (53 y.o.) was diagnosed with breast cancer on 29-Jan-2016.

Preliminary diagnosis: T2N2M0 or T1N1M0 (different opinions - because of biopsy taken from tumor, the tumor has grown twice its size during a week - so you see, already no clear opinion. also some say there is one node affected, others say its conglomerate with more than one node).
I'd be grateful for any opinions of proposed treatment strategy! Especially, about neoadjuvant therapy.

Tumor has been found in the right breast with a size of 1.2cm, lymph node next to it (arm pit area) is oversized (3cm) and the opposite node is also slightly big (2cm).

Biopsy detected invasive ductal carcinoma, with lymph node affected by metastasis.
First IHC: ER: +, PR: +, HER2: 2+, Ki67: 50%; G2 (2+3+1)
Second IHC (revised, with FISH): ER: + (95%, 8 ball), PR: + (80%, 8 ball), Ki67: 60%, Elston&Ellis: (2+2+2)=6
FISH: negative (no amplification of her2/new, for 20 cores of tumor cells: chromosome 17: 25 signals, her2: 50 signals, rate: 1.42)

As for other tests:
- mammography: didn't detect tumor itself, but detected lymph node problem
- ultrasound: detected tumor and possible metastasis in lymph node (further biopsy confirmed that on right side nodes are grouped in conglomerate, 1 or 2 nodes affected with metastasis)
- osteo scintigraphy: ok (there were some suspicious places on ribs near the breast side, on shoulder, at the back of skull, but repeated scintigraphy and x-ray didn't show anything bad)
- CT scan (with contrast): same as ultrasound, detected tumor and lymph nodes
- blood tests: ok
- BRCA: one mutation detected (BRCA1 5382insC, others were negative: BRCA1 2080delA(insA), BRCA2 6174delT, BRCA1 4153delA, BRCA1 185delAG, BRCA1 3875del4, BRCA1 3819del5, BRCA1 T300G)

what treatment plan is recommended in this case?
- what kind of neoadjuvant therapy? chemo/hormones?
- what kind of surgery?
- what kind of adjuvant therapy? chemo/hormones?

if neoadjuvant chemo fails, what would be plan B for neoadjuvant period?

Next week my Mom is scheduled to have first chemo, some kind of platinum. as I understand BRCA-1 mutation was the primary cause of this decision. Do you think its right type of chemo?

some say platinum is hard chemo, what can we do to make it less aggressive for health? any special meals? any other practical advice?

thanks in advance!

Anton

Moderators

Dear purrr, Welcome to the BCO community. We are sorry about your mom's diagnosis but glad that you reached out. We hope that you find some support and information here. Here is a link to information about Carboplatin on our website. We hope that this helps. Keep us posted. The Mods

BarredOwl

Hi purrr:

As kayb noted, we are just other patients with no medical training.

You noted that the tumor has roughly doubled in size in one week, but did not specifically state which clinical staging result was made first:

"Preliminary diagnosis: T2N2M0 or T1N1M0 (different opinions - because of biopsy taken from tumor, the tumor has grown twice its size during a week - so you see, already no clear opinion. also some say there is one node affected, others say its conglomerate with more than one node)."

If the first clinical staging was T1N1M0, and then after that the tumor doubled in size (and possibly the clinical presentation of the nodes changed), it is formally possible that at a later date, a clinician evaluating your mother would perceive clinical staging as more advanced T2N2M0 disease. In other words, if the first opinion was T1N1M0, but disease burden rapidly increased and this increase manifested clinically, then the opinions may not necessarily be in conflict (the situation changed).

In contrast, if the first opinion said T2N2M0 and the later opinion said T1N1M0, then there would seem to be a difference of opinion.

It is a good idea to ask for the exact names of the drug or drugs she will be receiving so you can ask specifically about them and find people here who may have received the same drug regimen.

With ER+PR+ disease, endocrine therapy will likely be recommended at some point. There are a variety of different approaches / interventions, and some are more intensive than others. The recommended options generally depend on menopausal status (including whether the patient has already received oophorectomy, or receives a recommendation to consider bilateral salpingo oophorectomy), and related risk/benefit considerations, such as the magnitude of the risk of recurrent or new disease, the potential benefit of the proposed intervention(s), the side effect profile of those, and patient age and medical history (including certain known health risk factors). In your mother's case, the recommendations may also take into consideration the BRCA1 mutation (if it is known to be a pathogenic mutation).

Has your mother received Genetic Counseling? If available, through consultation with a Genetic Counselor she can learn more about the types of cancers that may be associated with the particular mutation she has and the estimated life-time risks for such cancer(s). She can obtain advice regarding appropriate options for managing risk in her case, as well as whether genetic testing would be recommended for her children and other blood relatives.

BarredOwl

purrr

Wow guys thanks a lot for you support! such detailed and helpful replies... this really means a lot to me!

While I realize that there might be no doctors here, often times patients know very much especially if they had similar diagnosis.

kayb, thank you for these links! as for tests and scans, not all of them were proposed by doctors, I had to read some info over the internet, and for example, we did some scans which doctors said "optional", and specifically BRCA test was almost overlooked, and should we not ask, it won't be done... but once BRCA-1 mutation was discovered it has changed treatment type. in the end, they suggested platinum therapy, as I expected after reading some studies, but I wanted any kind of third opinion... for example, I wasn't sure if platinum alone is ok, maybe somebody got some additional treatment at the same time in similar case. also, I wasn't sure if its common practice in other countries, or just some experiments.

BarredOwl. thanks for your answer! initially the tumor was more like T1N1M0 (judging by ultrasound scan), but after biopsy the tumor has grown twice its size over the week or so. So some doctors said it has become T2, while current ultasound (after 2 weeks) says that tumor's core hasn't changed, and the growth is just some side effect from biopsy. current CT doesn't clarify things. As for nodes, different doctors say different things even now, some say its conglomerate of nodes, with 1 of them affected by metastasis, some say more than 2, thus N2. As for drug names, it seems we will know better near the day of chemo. there is some kind of organization mess in the clinic these days... thanks for the tips about endocrine therapy and genetic counseling! I'll try to collect more info about that.

thanks again for your kind words and support!

purrr

kayb, thanks for your reply again! now I know a little bit more

I'll try to follow your advice and ask in different threads!