Follow-up After Chemo

I am her2+++ and had a micromet to one lymph node, but after AC/TH and a bilateral mastectomy, I saw my surgeon every six months, my radiation nurse practitioner every six months and my oncologist every three months. My radiation nurse practitioner says I no longer need to see her at all if I don't want to (I actually like seeing her, and she's the only one who measures my arms for lymphedema, so I'll continue to see her once a year), and my oncologist says I can beginning increasing the amount of time between appointments with her, so I'm stretching out to four months now. In the past, I've had blood tests with tumor markers when I saw my oncologist, but at my last visit, I was told that tumor markers were no longer being done, since they seemed to confer no survival advantage. I haven't had a PET/CT since I was first diagnosed, but because I have slightly high liver enzymes, I am occasionally sent for an MRI of my liver just to make sure there are no mets there.

This is interesting to me - we are all aso different in how we approach things. I would be upset if no follow up scans were ordered for me, I would think the oncologist was being remiss. I am reassured by getting scans, they can often spot problems before symptoms occur, when they are more treatable. I always refuse to worry about scan results until I get them in front of me and can see they are problematic, so there is no extra stress added by getting them. I tend to worry more if there is no due diligence taken.

Nancy 

My story is similar and treatment similar.  I had DD A/C to shrink tumor (it did), followed by surgery (lumpectomey) wih SNB, also all clear, followed by Taxol, then radiation, and finishing up with Herceptin.  I go every 3 weeks for the Herceptin until July.  I see my onc every 6th week, and my radiation person every 6 months.  I finished my radiation the end of October, have had a mammogram already (no active disease) and go for a MRI of both breasts in February.  No mention on additional PET scans yet.  I too figure I have gone this far and done well, what the heck to a few more tests.  Thank goodness for insurance.  Merry Xmas all and I hope we all have a better 2009!  I am so looking forward to it!  Deb

It may have something to do with medical coverage, shelley.   My experience shows me that Muga scans are done to monitor the heart function because chemo and Herceptin can cause heart problems.  Here in the USA there is usually a heart scan (MUGA) or an echocardiogram to see if there is any change in the heart.   I also do not think a follow up with the radiation oncologist is the usual.  Once radiation is done, that is it.   SNB = Sentinel Node Biopsy to check the lymph nodes for cancer cells.   Did you have a breast MRI?   Blood work is very routine to monitor white and red blood cells.   A bone density scan (DEXA) is used to see if the bones are weakening due to chemo and highly recommended for osteoporosis screening at age 40 or pre menopause as a base line to monitor as one ages and goes thru menopause.   

May I ask your age?   I am 62 and have had no other serious health issues ever.   30 years ago I had multiple reconstructive surgeries on my wrist due a car wreck - which puts me a a higher risk for lymphadema (swelling of the arm).  I am hoping that exercises will help prevent that.   A MUGA and MRI of the breast are done with dye injections to see things better.   Some are allergic to the dye, but it is very rare.   

This does not answer your question directly, but as with any kind of treatment, some doctors are more in favor of one thing than another.  Some patients also insist on certain things.  One friend had chemo before a single mastectomy and is having more chemo after, then radiation.    Another refused any chemo or radiation after bi lateral mastectomies.  I cannot say what their "cure" rate is , as their surgeries were only this year.  Your doctor should be able to tell you why such and such a treatment was done for you.   

Shelly, I had 4 pages of questions for my first surgery appointment...  And another 4 pages for the oncologist..  This was after reading on this site, checking goggle for all sorts of definitions and Susan Love's book.   I ask questions and if I am challenged, I then ask WHO should I ask - if not you, who are the expert...    

I have to add that I go to a hospital with a cancer center and then a sub division for only breast cancer.  My oncologist is a professor and my surgeon has published some on the subject.   I feel they are up on the latest treatments and they did target MY treatment.  Chemo zapped the tumor and I had clear margins.  The first time  it was only 1 mm, so she went back in and got the "Usual" 2 mm.  

Happy Belated Birthday.  Here's hoping for another 50 for you.  Keep on top of it, get yourself checked regularly and dont'  be afraid to ask questions.