Why not skip radiation for chemo?

Waves2Stars

I’m sorry I’m ignorant about all this. I’m trekking across country on a family road trip, back home to Texas. I’m trying to quickly learn what I need for my appt with oncologist and geneticist two days after I get back.

My onco surgeon recommended lumpectomy (with plastic surgery), radiation, and tamoxifen. I was cool with surgery and radiation, not so much about tamoxifen, until reading some of the sage advice here. TBH, I thought I only absolutely had to be alive for another five years, until my kids were settled adults. I even have this set up with my medical power of attorney. But now that this has forced my hand, I’d like to make it 10, lol! So if it’s going to suck anyway, can taking chemo now help? Why not pull out all the stops?

I’m Actually pretty ticked off I consented to a biopsy. They all knew just by looking. I should’ve said, forget it, just cut it out. Now all I can imagine is little cancer jelly from the core biopsy floating around my blood stream. I have a suspicious fibroid with necrosis that my gyn suggested was a leiomyosarcoma. She said I needed an abdominal hysterectomy because even disturbing the uterus could cause mets. I couldn’t even get a biopsy because of it. Further imaging showed it to be regular fibroid. But all that imagery stuck with me, and it’s what im thinking about every hour. I’ve done the stupid magic 8 ball calculator, and things looked rosey, but I want to increase my odds. And I’d rather do that now while im younger and in decent condition.

So can I ask for chemo also? Should I? I never thought I’d be balls to the wall with any medical treatment, but today I am.

ElaineTherese

Why would you want chemo if you don't need it? Don't get me wrong; I did "the works" -- chemo, targeted therapy, radiation, surgery, ovulation suppression, and hormonal therapy. However, I had Grade 3, triple positive breast cancer (ER+/PR+/HER2+) that was 5 cm + and had invaded a lymph node.

It sounds like you will be getting surgery first. Your oncologist will look at the surgical pathology report and will discuss options with you then.

Let's say you have the most common form of breast cancer, ER+/PR+/HER2-. In such cases, your lump would be tested via the Oncotype Test to determine whether or not the benefits of chemo outweigh the risks. If you get a low oncotype number from this test, your oncologist would probably not recommend chemo.

Let's say your cancer has spread to your lymph nodes. At that point, your oncologist might consider doing more surgery (axillary lymph node dissection) or just radiate the lymph node area. Or, the oncologist could recommend chemo, if enough lymph nodes have been compromised.

It all depends on the kind of cancer you have, how quickly it is replicating (grade), and whether or not it will be efficacious for you.

Remember, chemo is not a risk-free treatment. My neighbor had to stop after four treatments because chemo (+ targeted therapy) had reduced her heart function. She spent several months feeling breathless and low-energy before her heart function bounced back. ((Hugs)) Chemo isn't as bad as many people think, but it's best used when it's medically-recommended.

Waves2Stars

I guess I’m concerned because the part of my report I’ve gotten so far said Stage 1, Grade 2. ER+ PR+ HER2?? I had a clean mammogram two years ago. I’m afraid going from undetected to 1.8cm in two years is fast, which is not really that fast compared to what happens to women on this forum, I guess.

It sounds like you’re telling me to let the experts recommend appropriate treatment, lol! I will calm down for a few! Thanks! I’m so glad to see your treatment and dates in your signature! I feel like a Padawan and you’re Luke Skywalker

AliceBastable

There's nothing unusual about the size of your tumor. I had a thorough breast exam by my PCP a few days before my mammogram and she felt nothing. My tumor was about the size of yours. And genetics and family history is relevant in a surprisingly small amount of cancer patients. There IS something extremely weird about any doctor or technician saying "That's cancer" before you had any imaging (per your other post). I'd give serious side-eye to any professional who did that.

As far as chemo goes, if you're Er/Pr+ and Her2-, and have a low Oncotype score, chemo not only isn't necessary, it would be like putting a bandage on your hand when your foot is what's bleeding. In many ways, the anti-hormonals ARE similar to chemo in that they're a systemic preventive treatment; chemo kills any stray cancer cells wandering through your body, and anti-hormonals starve them so they can't develop. And it's not either/or, some women with aggressive cancers do radiation, chemo, and anti-hormonals. A lot of women have no side effects from tamoxifen or whatever anti-hormonal they're on - it's usually just the ones having problems who post about it.

exbrnxgrl

Waves2stars,

This is a time of great uncertainty and yes, there is a breast cancer learning curve. Take a deep breath, work with what you know and try not to dwell on the “what if's"

- Ticked off that you consented to a biopsy? Why? No responsible doctor would perform surgery for bc based solely on imaging. Additionally, despite what was said to you, no one can see or feel breast cancer just by touching or observing an area on the breast. They can make an educated guess but a biopsy must be performed. Breast cancer can only be confirmed by biopsy which can actually “see" the cancer cells as well as determine hormonal status.

- Cancer jelly? Are you thinking of seeding? Yes, theoretically seeding is possible but doctors have found almost no evidence of it. This is not a reality based worry so let it go! Here is an article on seeding:

https://community.breastcancer.org/blog/what-my-patients-are-asking-can-getting-a-biopsy-spread-the-cancer/

- Although you don't know your post surgical stage, if a lumpectomy is being recommended it sure sounds like early stage. The chances of you making it 5-10 years? Pretty darn good! Remember, no one dies from early stage bc confined to the breast. It is also quite unlikely your bc has spread beyond the breast at the time of initial dx. This happens in a very small percentage of cases. Don't put your foot in the grave yet!

- Why would you want chemo if it was not medically necessary? Chemo is definitely appropriate for some but we are talking about very strong drugs which can have negative consequences for some. Again, great when needed but something you want to avoid if not needed. Your signature line is not public but it sounds as if your biopsy found DCIS. If, after surgery, it turns out that you have pure DCIS, then chemo is never recommended and I don't think a responsible oncologist would agree to such serious treatment if it was unnecessary. More treatment, stronger treatment does not equal better treatment. Having unneeded chemo will not decrease your odds of recurrence, since DCIS does not merit chemo. DCIS is confined to the ducts and is not invasive so cannot metastasize so chemo would do no good.

-Skipping rads for chemo? You are making the assumption that they are interchangeable treatments, which they are not. Radiation is a local treatment which is recommended for pure DCIS. Chemo is a systemic tx, however if you only have DCIS then cancer cells are confined to the ducts of your breast and cannot “escape”. Why subject your whole body to a harsh txthat will serve no purpose?

There are different tx possibilities for different types of bc (yes, bc is not one single disease!). You can't look at treatments that others have had and decide that you should have that too. After surgery, your pathology report will be what ultimately drives treatment. Your doctor has a fairly good idea based on biopsy pathology but surgical pathology will be the ultimate driver of tx decisions.

BTW, I have lived with stage IV for 10 years. I retired from teaching in June (first grade). I worked for almost all of those 10 years with only 3 1/2 months on medical leave. I have only been on aromatase inhibitors, no chemo, and I have had no progression. Yes, I am an unusual case but the point is that breast cancer is not one thing.Don't be afraid to ask you oncologist why she is recommending certain tx after you have your surgical pathology report. It makes things much easier when you understand why certain treatments are being recommended or why not. Take care

exbrnxgrl

Hello my friend,

Thank you for making your signature line public. You may now ignore everything I said about DCIS as it’s no longer relevant to your diagnosis. Take very good care of yourself.

moth

your surgeon will not be making the decisions about further treatment. Your medical oncologist will. They will make recommendations regarding chemo based on the Oncotype test (or similar like mammaprint etc) and likely a sentinel lymph node biopsy. They usually make these recommendations after surgery because they run the test on the surgical sample.

btw, staging can change after surgery as well This is the phase of a lot of unknowns - hang in there. There treatment plan will be clearer after surgery.

In addition to the info on this site, the NCCN pt booklet has excellent info and will likely prepare you for your appt https://www.nccn.org/patients/guidelines/content/P...