treatment after mastectomy: diagnosis jumped from stage 0 to II

I was also a II with one node positive.  My feeling is, if it's traveled to the lymphatic system ist's become mobile.  Cancer can travel through the blood stream as well.  HER2 is a more aggressive form of cancer than mine was.  I wouldn't hesitate to do chemo if I were you.  Ask yourself how you would feel if your cancer came back two years from now?  Would you feel regret?  Will you have the added daily stress of worrying about metastasis?

This is a personal decision and your onco should be able to show you stats to help you make your decision.  You can also check out one of the treatment calculators too.  There is a section that allows you to change your treatment.

http://www.lifemath.net/cancer/

Best wishes.

It's my understanding that Herceptin -- which is a MUST for Her2 positive -- is more effective when given in concert with a standard round of chemo.  I am HER2 positive and had AC x 4 Dose Dense followed by Taxol x 4 Dose Dense (with Herceptin every three weeks starting on day of first Taxol).  I have read that TCH (which is the same as what I had but minus the Adriamiacin, which by the way is the drug that most causes hair loss) has also been a very effective combo.  IMHO what you should be looking at is whether to do ACTH or TCH.  Ask your Oncologist and certainly get more than one opinion if it helps.  I agree with Boobee -- Her2 is an aggressive cancer and you must be aggressive in treating it.  It sounds like your DX is similar to mine (though my tumor was smaller -- but that is irrelevant): DCIS which has become invasive, 1 node and HER2 = chemo and Herceptin for best prognosis.

For what it's worth, my initial diagnosis also was DCIS -- they did not discover that it was invasive until they opened me up.  And the HER2 diagnosis, as well, came at that time.  So I too went from a Stage 0 to a Stage II... at the time I felt tricked.  In retrospect, it was just the best they could tell as they went along.  I am grateful to have gone through chemo (even though I lost my hair, which is now growing back) because I feel that chemo, along with the Herceptin I am now getting, has given me the best chance to survive BC.

Lilah

Mine was the same - DCIS diagnostic at biopsy, changed to DCIS, LCIS, ILC &+ SNB positive  after MX. Treatment TC x 4 rounds + more lymph node removal afterwards and then we'll see.

Ask your BS or oncologist for your pathology report. The have to give you a copy.

My situation is like yours, except the SN was negative during surgery and then turned out to be positive, leading me a second surgery for another 18 lymph nodes (which all turned out to be negative, thank god).

I've seen 3 different oncologists and they all have told me the same - to do the chemo, essentially because of my age (I'm 28). I'm still oncologist-shopping but they've told me what I think is true - that even if other treatments like tamoxifen and herceptin (though not for me - I'm HER-) may be way, way more effective on my cancer than chemo, they would not recommend that I take the risk. I'm starting to accept that. I don't want to skip any treatment now that might reduce my risk of recurrence down the road, even if I think it's overkill. I think the mind game is the worst part right now, and I certainly don't want my my future burdened by a "should've". 

Still, if oncotype comes back low, it will be much harder decision.

Good luck! 

You only count the invasive part of the cancer in determining the staging, not the DCIS, though.

c100,

It would appear to me (as I was also DCIS mx only to find out I had invasive after the surgery but no lymph node involvement) that although you have DCIS, there is/was an invasive portion to your tumor.  They may not have been able to find it in the pathology.  Pure DCIS will not leave the ductwork of your breast.  It is the invasive portion that has left the ductwork and went to your lymph node.  Please read the posts from Beesie as she is the expert on DCIS.  I'm sure you will find wonderful information there.  Remember that it was posted on the DCIS forum and that some may not pertain to your situation any longer since you are now considered stage II.

http://community.breastcancer.org/forum/68/topic/727963?page=3#idx_85

Hugs,

T.

c100 -- I don't know the difference in terms of side effects except for one thing: adriamiacin has a risk of heart damage and the other chemos do not; so it's possible that THAT is the chief difference in terms of SEs (or potential SEs) or the main reason why there is a choice of ACTH and TCH.  I also know that TCH is a newer protocol and that ACTH is the standard (for the last 10 years anyway).  I was not given a choice (though I did not ask for one either).  My doctor said ACTH and described the SEs and the percentages (post chemo and surgery, etc) re: recurrence and I said: OK.  I do feel I've done everything now (still getting the Herceptin til next fall) and that is a good feeling.  I also had my MX after chemo (2 lumpectomies before it) and there was no cancer found in the final pathology of the tissue (which also was a relief).

Your situtation DOES sound different than mine (because no IDC)... so you might very well be a candidate for TCH (and skip the risk of heart problems that Adriamiacin adds).  Herceptin also presents a risk (very low) of heart problems but the risk from Adriamiacin is apparently worse.  (The risk is a risk, in both cases, of developing congestive heart failure).

Also to clarify: I did AC x 4 followed by Taxol x 4 -- so 8 cycles in all.  Herceptin, which I get every three weeks, was also started when I started Taxol (I think they delay the start of Herceptin with ACTH to the day you start Taxol because of the heart issues, by the way, so if you do TCH it's possible you start all together -- but I don't know that for certain, just guessing).  What do your doctors recommend?  I realize your case is unique... but they must have a recommendation. 

Lilah

My mother had Wide local excision with right mastectomy Infiltrating duct carcinoma NOS(
Grade II BRS Modified) measuring 1.4X1.3X1 cm wit tumor metastasis to one of
seven axillaries lymph node with tumor size 1.4 cm size,Nipple areola, Deep margin , Free of tumor. Six cycles of chemo and tamoxifen taking. No radiation taken before or after surgery.

Due to the suspicion of malignancy, she was planned for wide local
excision followed by frozen section. Wide local excision and frozen was done
and was reported as infiltrating ductal carcinoma and posterior margin was
involved. So modified radical mastectomy was done.

After completing the last follow up with doctor two weeks later she started
having cough with scanty expectation breathlessness and left sided chest
pain it last for another two weeks. She went to a doctor and he did some
clinical testing like CT scan and chest examination and confirmed the
metastasis spread to lung and small lesion in the liver. Lung almost right
full and left 3 forth was affected. She went her regular doctor oncologist
and they did some pulmonary medical support for 10 days during their
investigation later she was given Inj.Docetoxel one dos. Later discharged
from the hospital and after within ten days she passed away.

The surgery done two and half years back.last one year she used to have tamoxifen.

please advise is this treatement  was ok for her. what could be the reason  that she could not prolong her life.After the metastasis to lung and liver she had 15 days left to treat.The oncologist were not sure how much area was invoolved in the lung cancer cells because they were suspecting the TB, and confirmed the spread bur said can start treatment only after TB test.

Was this treatement given in the begining for  Ductal carcinoma is currect. Any mistake done during the follow up. During folllow up no chest extra and CT done in last one and half year . But altra and mammo done.

Please advice yours opinion.