TNBC with margins free of tumor

Meer

dear friends,

Kindly suggest me what to do in my mother case as she had suffering from TNBC, Lumpectomy done and 1st chemo also done this Tuesday. She is also suffering with triple vessel disease as the lump was on left side. Can you plz suggest what to do next..

Moderators

Dear Meer,

Welcome to the BCO community. We are so sorry to learn of you mother's breast cancer. We are glad that you reached out on her behalf. It might be helpful for our members if you could say a bit more about what kind of help you are looking for and more details about her treatment. Do you have specific questions? Are you unclear about her treatment protocol? We are sure that our members can be of help but they will need more detail in order to most beneficial. Let us know if you need any help. The Mods

Meer

actually my mother is also suffering from heart disease as triple vessel are almost block. Doctor had advised that mastectomy is required with huge risk as on table or for next three days after post operative pateint can get the heart attack. When I asked about the alternative he suggested me as it is a triple negative breast cancer we will do chemo than after radiation. I want to know from you all that how long this treatment will proceed and what I actual I have to do in coming days to win this battel

BarredOwl

Hi Meer:

How long chemotherapy will be depends on the particular drug regimen used, the amount of time between each treatment cycle, and the total number of treatments ("cycles"). Her medical oncologist should give her information about the specific drugs included in her regimen, the time between each treatment, and the total number of treatments.

Depending on local recurrence risk profile, radiation regimens may differ in type of radiation, the fields of radiation (areas irradiated), and the number of treatments. Her Radiation Oncologist should be able to advise her/you regarding the particular radiation regimen recommended in her case, including the type of radiation (e.g., external beam?), areas (e.g., whole-breast, axilla?), treatment interval (e.g., daily), and total number of treatments. Here is some general information about the most common type of radiation from the Main Site here:

http://www.breastcancer.org/treatment/radiation/types/ext

Hoping she tolerates treatments well.

BarredOwl

Meer

She is on TC treatment, first cycle completed. Doctor had advised for 4 cycles then radiation. My question is after 4 cycles of chemo is it possible to stop the treatment without radiation. By which test we will come to know that still cancer cells are remain in the breast. As the lump was 3x2 size and it is removed. When lump was went to frozen section the duct carcinoma was detected. But the margins are free from tumor. Now what is the possibilities that cancers cells are in lymph nodes. What will chemo results in this???

BarredOwl

TC is typically cycled every 21 days for 4 cycles, but please confirm it with her team.

With invasive breast cancer, usually a "sentinel node biopsy" is performed to check one or more lymph nodes in the underarm for the presence of tumor cells. Please inquire whether she had such a procedure and the results.

Even with negative nodes, there is still some risk that tumor cells have broken off the tumor before surgery, and traveled to distant sites via the blood stream or lymph channels. Such "micrometastases" at distant sites cannot be detected by available methods. The main purpose of chemotherapy is to kill off any such cells that may have left the breast, reducing the risk of suffering distant recurrence (an incurable relapse of disease at distant sites). This distant risk is increased if there are positive lymph nodes, larger tumor size, and/or aggressive tumor biology.

Radiation is primarily a local treatment, designed to reduce the risk of same in-breast local recurrence. With a large (3 cm?? x 2 cm??) triple-negative tumor, the risk of local recurrence is probably not small, even with good surgical margins. Please consult her Radiation Oncologist for a case-specific estimate of her risk of local recurrence and an explanation of by how much radiation can reduce that risk. This will help her to weigh the risks and benefits.

BarredOwl

Meer

Dear BarredOwl

Thanks for you valuable comments, her lump is removed and ER PR HER 2 came negative. First cycle of chemohas been done. TC is the prescribed dosage. Doctor had advised 4 cycles and after that radiation for 5 weeks. Can you plz let me know is this a right treatment to beat the cancer. Plz help me out.

BarredOwl

Hi Meer:

I am sorry I don't know the answer to your question. I am just another patient. Members here can provide support, share our personal experiences, and general information, but we cannot provide case-specific medical advice. We are not doctors. (A doctor would need copies of all pathology reports, related test results, and medical records before providing any advice.) Also, there are sometimes differences in practice between countries and under different health care systems.

"Triple-negative" breast cancer is ER-negative; and PR-negative; and HER2-negative. We have local treatment guidelines applicable to triple-negative disease, but they vary according to Stage, and then by tumor size and lymph node status.

If you are just interested in other people's experiences (not medical advice), it is possible that if you provided information about her age; stage; the actual tumor size ("3x2 size" with no units is not clear), and lymph node status, then others with a similar diagnosis may come along to share their experiences. (I do not have a similar diagnosis.)

Meanwhile, here are some very general comments. Selection of a particular chemotherapy regimen entails consideration of all relevant clinical and pathologic factors, including disease features, age and co-morbidities. It requires medical training and the expertise of a medical oncologist, and exercise of their clinical judgment.

Advice about various treatments entails a personalized risk/benefit analysis, in which recurrence risks are estimated and the potential risk reduction benefit of treatment is weighed against the risks of serious adverse effects. Certain co-morbidities may increase certain risks of some treatments.

With early stage breast cancer, the potential benefit of radiation therapy is proportional to local recurrence risk, and the potential benefit of chemotherapy is proportional to distant recurrence risk. Greater local recurrence risk tends to warrant more intensive local treatments. Greater distant recurrence risk tends to warrant more intensive systemic drug treatments. Lower risk disease and/or increased risk of bad side effects due to certain co-morbidities may lead to a recommendation for less intensive regimens.

No treatment is 100% effective. However, appropriate local treatment can reduce the risk of local recurrence, and appropriate systemic therapy can reduce the risk of suffering incurable distant (metastatic) recurrence. Again, age and co-morbidities may factor into what may be considered appropriate in the individual case.

One of the best ways to probe medical advice is to seek an independent second opinion from another institution. Seeking a second opinion is usually done before treatment is initiated, but you may still find a second opinion helpful for some peace of mind if it confirms the advice received. There is general information on the Main Site here about the second opinion process:

http://www.breastcancer.org/treatment/second_opinion

In any case, you can ask her Medical Oncologist for a reasoned explanation (with reference to your local treatment guidelines) for the selection of docetaxel-cyclophosphamide X 4 in her particular case, and can ask her Radiation Oncologist to estimate her local recurrence risk, the risk reduction benefit of any proposed radiation regimen, and how that benefit compares with risks of serious adverse effects of radiation.

BarredOwl