Outlook for my mother.

Neon55

Hello,

My mother recently/last tuesday had a lumpectomy to have a lump removed from her right breast the doctor also removed some nodes from her underarm. Shes 62 years old and also suffers from stage three chronic kidney disease and mental health problems.

The doctor didn't do a biopsy because he didn't feel my mother would tolerate well so he said he would just do the surgery and biopsy it then I was in the waiting room at the hospital when he came out and said good news the surgery was a success but it is cancer but it didn't spread anywhere and he took three nodes from her underarm.

I was then told by staff at the hospital to schedule a follow up with the surgeon for pathology report. Today the doctor calls me and said everything is fine clear margins and no lymph node involvement but he still wants her to have some radiation and take some meds.

My mother is very stubborn when it comes to treatments and plus with the kidney problems make it very stressful decision. My question is how important is it for her to get these treatments even though the doc said he got it all no lymph involvement clear margins. What is the recurrence if she doesn't do the treatments?

Also what questions should I ask during her appointment.

Thank you.

molliefish

i suppose how important the treatment is is a relative term based on what your Mom wants. The radiation is not hard,but can be painful in the end and takes a month to 6 weeks to complete. When you say he wants her to take some meds I suspect AI, or Tamoxifen. Unless he actually said chemo. Are you caring for Mom through her treatments due to her kidney and mental health issues? Your doctor can provide you with survival rates with and without treatment, or with only rads or only estrogen blockers. If you would be able to tell us if the tumour is er pr positive that will shed more light.

Neon55

He didn't really go in to to much info hes a very calm mannered guy all he said was the pahtology came back everything looks good clear margins no lymp node involment and I asked him does she still need treatment he said she will probabbly need some radiation and take some meds he didn't say what type of meds didn't mention anything about chemo and that after she saw him he would prob have her see a couple more doctors for consultation.

And yes I live with her and take care of her administer meds makes sure she goes to doc appointments mentally she doesn't get the grasp of what's going on. I'm trying to be as postive as I can about all this and tell her shes gonna be fine and just wait till we see the doc in person.

moth

I think the thing to understand with breast cancer is that while surgery remains the primary attack - and breast cancer is a 'good' cancer in that sense because there is something that can be surgically removed - it can come back. "Although more than 90% of patients with breast cancer have early stage disease at diagnosis, about 25% will eventually die of distant metastasis" (Hamer & Warner 2017)* . If it comes back again as just a lump in the breast with no spread, then you can cut it out again. But it can come back as metastatic breast cancer - which means it has spread to other parts. Metastatic breast cancer is unfortunately not curable right now.

So all the additional treatments are to reduce the risk of recurrence.

The doctor should give you numbers if you ask for them. You can also run some numbers in these validated calculators, print them out & discuss with your doctor as the prognostics can vary with each individual and the oncologist will be able to take that into account.

Radiation benefit https://www.tuftsmedicalcenter.org/ibtr/ (radiation usually follows lumpectomy; it's the 'price' you pay for having a smaller, less invasive surgery. Lumpectomy + radiation has essentially the same outcomes as a mastectomy. Without radiation, there's greater risk of recurrence)

Predict (for benefit of endocrine therapy - which I agree is probably the 'meds' the doctor mentioned) http://www.predict.nhs.uk/predict_v2.1/tool

best wishes

*http://www.cmaj.ca/content/189/7/E268

ktab96

The radiation is to kill off any remaining cancer cells that may be lingering around the surgical site. Sometimes the cells can flick off from the tumor when it was removed during surgery. I would opt for the radiation. I had savi radiation which is a 5 day targeted radiation treatment. It required, however, a device to be implanted in the breast. My side effects were very minimal.

I would get more information out of the doctor regarding the type of breast cancer it is and what are her chances of recurrence. They can perform further tests on the tumor without disturbing your mother.

If the cancer is a hormone receptive positive cancer, they will recommend hormone suppression treatment. Some of side effects are hot flashes, joint pain if taking Femara or Anastrozole I found Tamoxifen to have less side effects which is hot flashes. If your mother is HER2+, they will recommend herceptin. If they recommend herceptin you will have to discuss the pro and cons of her taking it given her medical condition.

Neon55

I have yet to read the pathology report appointment is on Monday so I will request a copy of it.

Any particular question should I ask the doctor when I'm there my mind is just in a funk right now with all this going on I'll ask what stage the prognosis what is the recurrence any other important things I should ask? Much appreciated.

Beatmon

Has your Mom seen an Oncologist? I am concerned that the surgeon is planning her care without input from an oncologist. You are a loving daughter to take such good care of your mom

Neon55

She has not yet but the doctor will refer her to one I beleive when we see him Monday.

ktab96

The oncologist will have all the data and should recommend a course of treatment.

You will want to know

What type of breast cancer she has?

What is her risk factor for recurrence - (Oncotype score)

If HER2+ what is the risk of taking Herceptin to her heart and kidneys.

What impact will chemo, if recommended, have on her kidneys ?

Does she qualify for targeted radiation vs full blown radiation? (5 days vs 6 weeks)

What are the treatment options given her medical history (mental health as well as kidneys)

Neon55

Thanks these are good questions.