Some advice pls- chemo a must?

IsMe

I had my mastectomy last week on left breast. The lump size is around 5mm, 4 lump found with two cancerous. Similar size range. But micro invasive area is up to 5cm. CT scan and lymp node are clean.

I have er-, pr-, her2+. Age 42, oncologist suggest chemo 4cycle follow up radiotherapy 15 rounds. Main concern there may have leave over cell from operation. I will also advice to go for herceptin parallel with chemo TC for 18cycle for a year.

I am looking for second opinion from another oncologist as soon as possible. Waiting for reply from hospital side.

Anyone have similar scenarios? Is chemo a must or I am over doing it?

ElaineTherese

Hi IsMe!

For HER2+ cancer, chemo is almost always recommended. Yes, your tumors are small, but HER2+ cancer is very aggressive. There are a range of chemo options, some harsher than others. I did Adriamycin + Cytoxan (4 cycles), then Taxol + Herceptin + Perjeta (12 cycles), then a year of Herceptin. My lump was large (5 cm with a lovely satellite), I had one positive node, and my cancer was Grade 3. AC + THP is a pretty harsh regimen, and isn't recommended for women with heart problems.

Another heavy duty regimen is Taxotere + Carboplatin + Herceptin + Perjeta. Some women do 6 cycles; your oncologist may be proposing 4 cycles for you because your lumps are small. (My neighbor was scheduled for 6 cycles but only ended up doing 4 because she has heart problems. Her heart problems were exacerbated by the Herceptin.)

For someone with smaller lumps, Taxol + Herceptin might be all that's required, though it's usually given in 12 weekly doses. I'd think you'd be a good candidate for that regimen. I found Taxol to be easier than AC chemo, that's for sure.

You should definitely get a second opinion. ER-/PR-/HER2+ has slightly worse outcomes than what I have (triple positive -- ER+/PR+/HER2+). Chemo + Herceptin is the only systemic treatment for your kind of cancer since it wasn't being fed with estrogen. Triple positives, however, can take hormonal therapy as well as chemo + Herceptin, so we have more options.

Good luck!

Beesie

IsMe,

I don't understand your diagnosis.

If the lump is 5mm, how can the microinvasive area be 5cm? By definition, a microinvasion is at most 1mm. So do you have several 1mm microinvasions spread over a 5cm area, or do you have an invasive tumor that is 5mm, along with some microinvasions? Or something else?

That aside, if you have an HER2+ invasive tumor that is larger than 5mm, chemo will always be strongly recommended. And chemo will be discussed as an option for any HER2+ invasive tumor above about 2mm. In your case, since your tumor is ER- and PR-, endocrine therapy is not an available treatment, which reinforces why chemo would be recommended even for a tumor smaller than 5mm.

One note: I noticed that you've posted in the DCIS-Mi forum, so I assume your tumor includes some DCIS. Because DCIS is non-invasive, the amount and size of the DCIS isn't counted when determining the size of the tumor - only the invasive component is factored into the chemo decision.