After-surgery Decisions to Make

Jos645

Hi, I'm Jo. 72 yrs old and already a lung cancer survivor (segmentectomy, no rads or chemo and follow up scans are clear so far).

Diagnosed with invasive ductal cancer, hormone positive, HER negative in November. Lumpectomy three weeks ago removed 9 mm tumor; path report good - no cancer found in the margins.

Since stopping my estrogen & progesterone after diagnosis I've gained weight (that was a battle to lose in the first place) and have menopause symptoms all over again. I take meds for depression and have for years.

Healing well from surgery. Met last week with Radiation Oncologist who recommends 5 week course of rads. Meeting with medical oncologist next week, then will have some decisions to make:

Oncotyping - yes or no
Radiation - yes or no
Hormone (suppression) therapy - yes or no

I've been reviewing info on this site but would appreciate any specific experiences that might help with my decisons.

Thank you.

AliceBastable

Have you consulted with your lung doctor about undergoing radiation? That would be the first consideration.

The Oncotype is just a test on the tumor tissue and doesn't really involve you; it's to determine if chemo would help you or not. It's pretty routine for most tumors to be sent for testing. You need to talk with your MO about the various hormone blockers, which ones would be most effective and the various side effects.

Rah2464

I concur with Alice. I would consult my lung doctor about the radiation aspect. The tumor should definitely be testing using Oncotype , directed by your MO. Hoping that is already in play and you will be discussing the results with your MO at your appointment. Glad to hear tumor was small and you had clean margins that is excellent.

metooat71

Look into Proton radiation if you live near a Proton Center.

ThreeTree

Good point about looking into proton radiation if you can. It's supposed to be less likely to cause heart and lung problems. I was able to do it and have no regrets. Good luck to you!

RatherBeSailing

Were you lymph node-negative? More recent research is questioning the need for radiation in early-stage women over 70 with no positive lymph nodes. Links to a couple of articles below. Of course there are many factors involved, but given your lung status I would question your physicians, and possibly get a second opinion on any radiation, photon or proton.

https://www.usnews.com/news/health-news/articles/2...

https://www.health.harvard.edu/cancer/women-over-7...

Jos645

Hi. Thank you for all the informative and helpful responses. I really appreciate the "voices of experience" and the time you take to help me.

My breast cancer journey is approaching a "semi-climax." I met with the MO and received good information as follows:

1) Oncotyping is recommended for my parameters only if the results were to show the need for chemo, which I doubt I would buy into anyway. So, no oncotyping.

2) Radiation is an option I could consider; a risk calculator is available to detail chance of recurrence. MO believes I'm low risk for recurrence. I'm opting out of rads.

3) I'll be off hormone supplementation forever. Suppression may be required in the future, but for now I need to get through this "second menopause" I'm experiencing. My list of symptoms is too long to mention, but I feel I must wait a few months to see if symptoms subside, disappear, or get worse. Estrogen suppositories have been prescribed for the most important issue - my sex life. High hopes for positive outcome.

4) The MO had good dietary recommendations. I normally weigh 135, but have gained 8 pounds since November when I stopped hormones. Right now I'm trying out some suggestions.

Beesie

Jos, I was 10 years younger than you when diagnosed, with a tumor of about the same size (mine was 8mm). It was my MO who made the "no Oncotype" decision because he said that he would not recommend chemo for me even with a high Oncotype score. His explanation was that my age (higher than the average in the Oncotype studies), the tumor size (smaller than average) and the tumor grade (grade 2 but barely, with grade 1 mitosis) were all factors that would counter a high Oncotype score, bringing my risk down.

I was skeptical so he pulled out a computer model that Genomic Health, the Oncotpye company, make available to MOs. This model takes your Oncotype score and readjusts your recurrence risk by factoring patient age, tumor size and tumor grade. Since I didn't have an Oncotype score, my MO ran the model using several different scores, up to a 40 score. The model (called RSPC at the time, now updated and called RSClin) proved to me that even with a 40 Oncotype score, my personalized risk, when factoring in my age and pathology, was low enough that neither my MO nor I would agree to chemo. That confirmed that there was no need to get an Oncotype score.

I wanted to share that because it's similar to how you made your decision to not get an Oncotype score, although in my case, it was my MO who made the decision and had to convince me.

Good luck moving forward!

Cowgirl13

Jos, there is a shorter radiation protocol that I was able to qualify for. It was about 19 rounds and was a piece of cake. I would definitely consider it, especially with your lung issue.