Treatment plans for stage 2 grade 2 er/pr+ her2-

GwennyMD

My family has a significant history with BC so I had long ago decided to have it cut out asap if I was affected. Thus after my positive biopsy I went straight to a surgeon. Based on the sonogram, it appeared that identical small tumors at the back of each breast. They were small I nor my doctor could feel them. Therefore we decided to do lumpectomy. The testing done with the lumpectomy showed that I also had tumors in 2 nodes on my right side. The tumors in my breast were 1.6 cm but both of the node tumors were over 2 cms. I was told that chemo was necessary. I did not know about oncotype test at that time. After 6 months of chemo I decided to have BMX. MO was considering need for radiation. Radiation doctors said that I could skip radiation because tumors were smaller than 3 cms, margins were clear and I was doing BMX.

bravepoint

I went with surgery first, right breast lumpectomy followed by chemo, 4 cycles of AC and 12 weekly treatments of Taxol. I'm 1/3 of the way thru the Taxol. Then I'm looking at 30 radiation treatments. The only thing I am second guessing at this point is whether I should have gone for a mastectomy rather than just the lumpectomy.

MamaOz

I am currently going thru chemo first , I am stage 2  grade 2 er/pr+ and her- as well

however my tumor is invasive and into the pectoral muscle   and was positive in a lymph node and would be a difficult surgery

 so my drs felt it was neccessay to do chemo first to shrink it and hopefully stop from spreading. I will do round 3 tomorrow

 I am doing 4 rounds of A/C then 4 rounds of Taxol

stephilosphy00

I am also doing chemo first. I have finished 12 rounds Taxol and started DD A/C last Friday. My tumor (2.5cm) has shrunk a lot but I can still feel it. I am afraid I won't get PCR in the end which actually is normal for my low ki67 I think.

bcincolorado

When my final pathology came back my mass was 5 cm. Did mx on left side. Due to OncoDX score of 17 oncologist said benefit of chemo would outweigh risks for me so no chemo. Did 5 years on Tamoxifen and now on Femara for another 5 which I've done 8 months down at this point.

runor

I am stage 2, grade 2, no LVI, clear lymph nodes, 2.5 cm tumour, had lumpectomy.

My reading tells me that for my situation AC-T is the most common chemo. But I see some people get CT, which is the way I think I want to go. And I'd like the T to be nab-paclitaxel if I can swing it. But when I told my onc that I'd like to skip the Adriamycin because I already have a wonky heart and long line of family heart problems, he ordered a stress test. He seems to think if my heart is good I'm good to go on the Adriamycin.

My question: what determines who gets AC-T, AC or just CT?

I have tried to find valid information on the absolute recurrence and survival rates with the different chemos, but can't find anything too clear.

Radiation is a given. They are going to nuke me!

Kath1228

I was diagnosed November 2013. Stage 2 (2.1 cm), grade 2, Oncotype 11 - so no chemo. Lumpectomy with clear margins, clear lymph nodes, no LVI. Canadian protocol for radiation - 16 whole breast, 4 boosts to tumor bed.

Rumor - did you have the Oncotype test done? Based on your stats alone, not sure why chemo is a given unless you are choosing to do it - or had a high Oncotype score Oncotype would tell you what benefit you would get from doing chemo.

runor

Kath1228:

Oncotype has just been requested in the last 2 days, so now I wait. I don't know where you are in Canada, but so far the WAITING has been one of the worst parts. I had a mammogram Dec 5, 2016 and it took until March 23rd to get a diagnosis of cancer. Almost 4 months. It seemed like forever. But now waiting for Oncotype...

From what I've read (poorly educated at the school of Dr. Google) the size of my tumour puts me at high recurrence risk and pretty much expect to have chemo.

Kath1228

hi runor,

I am not in Canada, I had my treatment at Sloan Kettering in NYC. My RO thought I was a good candidate for what they call the Canadian protocol. It involves fewer treatments with a higher dose of radiation per treatment. I tolerated it very well - just skin looking sunburned for a while but it recovered very well.

I don't think the size of your tumor alone is a guarantee of chemo (ours were very close in size). At least that's not what I have been told. Many more factors come into play including your age at diagnosis, proliferation rate, aggressiveness of your particular tumor, location of the tumor, presence of LVI, node involvement,etc... The Oncotype test will take most of those things into account. I waited about 10 days for my Oncotype results - I'm not sure where you are so it may take longer...so don't bank on chemo for sure until you discuss those results with your doctor...

Your stats say stage 2b but you indicate no nodes were involved. As understand it, that should put you at stage 2a - almost stage 1a. Stage 1a would be 2 cm or less no nodes involved. I was 0.1cm away from being stage 1a.

You may want to double check with your doctors about the stage 2a vs 2b....just to clarify for yourself. That could affect your treatment decision....

Being ER/PR+ hormonal therapy will be a big factor in your ongoing treatment. I am on letrozole.

runor

Kath 1228:

When you said the Canadian protocol I immediately imagined chemo involving beer and maple syrup. Not too stereotyped, eh?

I have also been reading about shorter duration radiation. Sounds good to me!

I think my onc said my tumour size (2.5 cms) put me in 2b, but I could be wrong about that. Had I been a stage 1, I would NOT have qualified for the oncotype test. Here, it is only offered to certain women (at least as I understand it in British Columbia). I guess people with different profiles might be able to get it if they are willing to pay for it themselves, but my profile fit the criteria of perhaps benefitting from this test.

Weird... you'd think that no chemo would make me jump for joy, that I'd be so happy. I always thought that's how it would go. I do not want chemo. It sounds diabolical and scares me to death. Yet I worry that I am missing the boat if I don't cover all my bases. So I wonder if I will feel extra vulnerable if I DON'T have chemo?

Cancer has made me stupid.

Kath1228

Beer and maple syrup - love it!😊

You can look up the definitions of stage 2a vs 2b on breastcancer.org. According to those definitions, without nodal involvement, your size tumor puts you at stage 2a.

If you look at it purely fromnumbers standpoint, the Oncotype test will tell you whether your particular case will benefit from chemo or not. If the Oncotype score is low enough, there are even some instances where the risks and side effects of chemo (hair loss, neuropathy, heart damage, etc.) could outweigh the benefits for your particular tumor. In other words, chemo might just carry a risk of doing more harm than good. It all depends on the score.

Your doctor needs to explain this carefully to you once you have the score back. Risks of chemo vs benefits....

All that being said, peace of mind is invaluable - that is something you will have to decide for yourself when the time comes and you have all information available to you in order to make the most informed decision possible. There are never any guarantees with cancer. Some people do chemo and still recur - others don't do chemo and don't recur - we just never know for sure. That's the part that is so hard to deal with.

I hope you get the results soon and they are what you are hoping for!!

ShockedAt48

I had a lumpectomy on my right breast within 2 weeks of discovery. The surgery was on June 22, 2017. I was diagnosed with stage II-A with a 3 cm tumor with clear sentinel node biopsy and clear margins. I am 48 years old. My first visit with my oncologist and she said I would benefit from HT treatment, radiation, and possibly six rounds of T/C chemo if my oncotype score was not low. Waiting on pins and needles to find out my score. The way she described T/C chemo sounded horrible. Very stressful, I didn't realize how serious breast cancer is! Life changing.

Hokster

I was diagnosed in October 2016 with a 1.6mm ILC tumour and 1/3 nodes involved. Although my incotyoe score was low (13), and ULC responds better to hormonetreatment, chemo was recommended given my age and node involvement. All scans at the time were clear and I began chemo. I have done Acx4 and 8x Taxol so far. The remaining 4 Taxols are lending and the plan is tend to move to endocrine therapy.

I have been experiencing shoulder and arm bone pain consistent with mets. The thinking is that it is likely due to the treatments but it was felt that another scan was in order. Given I was diagnosed at stage 2. Had a scan performed in January and have been in chemo, I'm can't but feel that it's highly unlikely it would jump to stage IV with bone mets so quickly!

Would love to hear from anyone who may ha be experienced this and/or who has an opinion on feasibility of this occurring so soon after diagnosis. Thanks!!