Timeline of treatment

Zhawn

Hey my girlfriends mom has recently been diagnosed with breastcancer. I am worried as it seems like quite a bit of time has passed with very little to show. My GF and her mom are not the best with handling stressful situations and I am fearing that the mom is not fully leveraging her time and no one in her family (including my gf) has the emotional fortitude to discuss it with her. I am writing this post to get an understanding of what others experience has been in terms of length of time of initial detection, biopsy, diagnosis, surgery, and chemo/radiation.

Background:

Gf's mom is very strong headed and does not like doctors. Went 5 years without ever seeing doctor; current age 50s.

Initial detection: 2/1/16 (on cruise; self screening)

Dr. Consult: 2/14/16 (told may be cancer mri)

Oncologist consult: not sureally (biopsy scheduled)

Cancer confirmed: 3/4/16 (biopsy results recieved)

Now past this nothing else has happened. We have other info and not for lack of asking; that is literally all she is able to tell us. All we know is she does have cancer but no treatments have been scheduled nor any info on size of tumors or staging. The mom has said that she is seeking a second opinion at Stanford for next Tuesday 3/22/16 but I am getting the feeling that something is off in terms of this timeline. One month to even get confirmed and another 2-3 weeks without any treatments planned sounds like my GF's is being avoidant.

Can someone please just give me an idea of the timeline for this while process as I have found few details?

Moderators

Hi Zhawn-

That timeline actually sounds pretty normal. Appointments and tests take time, unfortunately, and a lot can determine how quickly everything goes, like doctor availability and insurance. A second opinion is always a good idea if she has unanswered questions or concerns, and she's chosen a great cancer center. Once she does that, she'll most likely see a breast surgeon next to decide what, if any, surgical path she should take, and then back to the oncologist, where (once the doctor has her full pathology report from biopsies and/or her surgery), a treatment plan will be developed.

We know it seems to move at a snails pace, and everyone is anxious to begin treatment, but at this point, there is no rush, and it's more important to get ALL of the information about her cancer to develop the best treatment plan as possible. If you or your girlfriend have questions or concerns, it may be a good idea to accompany her mom to one or two of her appointments, and make sure the right questions are being asked! That way everyone is on the same page.

We hope this is helpful, please keep us posted!

The Mods

Kicks

There is no exact timeline that is followed with all of us - for some it is longer, for some of us shorter. Based on what you wrote - it sounds quite average for most.

The appropriate time frame varies a lot with the different types of BC (Ductal Carcinoma In Siru/DCIS, Invasive Ductal Carcinoma/IDC, Invasive Lobular Carcinoma/ ILC, Inflammatory Breast Cancer/IBC), the suspected Stage, the Grade, ER/PR and HER2 status, size, possible node involvement, possible metatises are some of what goes into the appropriate time frame for starting TX (treatment), the needed TXs or the order of TXs. There are other tests/Scans needed to get the 'bigger picture' for the Team (Surgeon, Chemo Dr, Rads Dr and Board) to come up with the best TX plan prjor to jumping straight to surgery (which may be the correct plan for her). Genetic testing may also need to be done in deciding on the TX plan. In other words - nothing is as simple as just saying 'breast cancer' and always going straight to surgery first. Overall health comes into play also with TX plan.

My suggestion would be for you to keep coming back with your questions/thoughts and to encourage you GFs Mom (and GF) to come here to 'talk' for support and knowledge as to what 'we' have been through. There is a 'world' of experiences/knowledge here - though very diverse as all are very unique with there being NO "One Size Fits All"!

Zhawn

Thank you for the response; this gives me some piece of mind. I guess I let my bias of my own experience from battle with illness (not cancer) cloud my judgement.

I probably didn't word my initial question well with the words "emotional fortitude". My GF's motger rules her family; 100% heads the show. It's very difficult to give her input in a normal sense. My GF's mom dominates my GF and her relationship (not in a bad way; trading strict Catholic sense). Moreover, my GF has been very affected by the whole circumstance. Anyway, I apologize if I came off chauvinostic.

More symptoms:

Additionally, I found some more info about what's going on. So, the mom has tested positive "Her-2" as well as "Triple Positive". They also suspect that an additional tumor exist behind the primary one biopsied. I just thought there would be more urgency being that the mom is over 50 years-old and was not receiving regular exams prior to her diagnosis (5 years since last doctors visit)?

ElaineTherese

Hi!

If GF's Mom's cancer is HER2+, she will probably get chemo, the meds few want or desire. She may get chemo before her operation or after her operation. She may get targeted therapy (Herceptin) for a year. HER2+ cancer is a marathon, not a sprint, but targeted therapy has greatly improved outcomes.

Kicks

At 50+, age is not something to be concerned about. Younger at DX, with any type of BC, is 'worse' than 'older' for prognosis. (I was 63 at DX 6 1/2 yrs ago.)

'Triple positive' means that she is ER/PR + ( Estrogen Receptors and Progesterone Receptors) so the cancer 'feeds'off of estrogen so after other TXs she will be on an estrogen blocker for several years. HER2+ means that part of her Chemo will include probably Herceptrin. Others can explain HER2 better than I can as I'm HER2- so didn't have to deal with it. It is better to be Triple Positive than Triple Negative.

There will probably be more tests/scans (CT/MRI, Bone, PET Scans) to determine the extent and if there are mets. There can be other test depending on what the TX plan will encompass. There is a lot more than just saying 'breast cancer' and immediately jumping into TX without more information.

To me, your initial wording came off as being condescending in regards to the rest of the family for not having the "emotional fortitude" to deal with/confront 2 women (your GF and her Mom) who "are not the best at handling stressful situtations". Not chauvinistic (in my mine) as most families include men who it would seem have no "emotional fortitude" either from your post. More likely, Mom 'rules the roost' and won't tolerate others who do not follow her dictates. ("GF's mom is very strong headed." "My GFs mother rules her family; 100% heads the show")

Your GF/you know only what her Mom has told her/you - that is not necessarily all that she has been told - just what she wants to be known by others to maintain control.

It is good she is getting a second opinion especially if she has no more information than has told her daughter.

Kicks

Forgot to mention - it is becoming more common in TX plans today to do neoadjuvant (pre- surgery) Chemo for some (it's SOP for IBC).. The idea is to shrink the cancer, get better margins so surgery has a better outcome. Some will do 2 different Chemo neoadjuvant, some will do 2 different Chemo but 1 neoadjuvant and 1 adjuvant (post surgery) which is what I did. Of course, there is what most think of - just adjuvant Chemo (1 or 2 different Chemos).

Rads come after Chemo.

So many different possibilities for TX.

BarredOwl

You've received good information and advice above. I note that actual TNM stage cannot be determined from minimally-invasive biopsy and imaging alone, because more information is required regarding actual size of tumor (T), lymph node status (N), and evidence of distant spread (M).

That the mom arranged for a second opinion at a center of excellence is not consistent with being "avoidant." Please keep in mind that the question of when, with whom, and how much confidential health information one shares with others is a personal decision, and that those receiving such information may be asked to hold all or part of such information in confidence.

If one has not been highly diligent in health screenings, there may be a fear of being judged. Keep in mind that many women receive concerning diagnoses despite having been diligent in annual exams and screening mammograms. This is because clinical examinations and screening are imperfect (some tumors are not screen-detectable and/or palpable at first or ever), and because some tumors suddenly appear as "interval" cancers that only become apparent between annual or biannual screens (not keyed to be apparent at an arbitrary exam interval). She acted on the lump promptly, and it cannot be known whether more frequent exams or screening would have led to either earlier detection or a better outcome or not. One must look forward.

A breast cancer diagnosis can be extremely upsetting, the impact is highly personal in nature, and it can be difficult for some recently diagnosed to talk about it, even with close family members. It is also extremely time consuming and draining. The diagnostic process likely included more tests (e.g., mammogram and/or ultrasound), and more consultations than you are aware of. Keeping others fully apprised of every step and all details can be challenging, and some choose not to do so. It seems formally possible that the mom may be limiting the amount of information she is sharing with her daughter at this time, by choice or by need (to conserve resources). She is likely considering options such as neoadjuvant treatment (chemotherapy plus HER2-targeted therapy) followed by surgery, versus a surgery first plan, as well as types of surgery (lumpectomy versus mastectomy), and perhaps reconstruction, and is taking time to think about what is right for her. She may choose to be more forthcoming about aspects of her diagnosis and treatment plan after the second opinion, as a plan solidifies.

Sending good wishes.

BarredOwl