Treatment for Triple Negative and very small tumor

Hi MS1:

First of all hugs~!!! Sorry you have to make this decision.

I am TN too and the standard of care is chemo. My tumor was 1.2 cm and I took 6 rounds of Cytoxin and Taxtoere(?). I know the choice is personal but I would struggle and go through the chemo to give yourself as much protection as possible.

Good Luck...

Hi MS1:  Sorry this happened to you, but good to hear your tumor is small. I am sure you have been told chemo works well for TN..If I had a TN breast cancer, I would do chemo. if I had a very small tumor that was ER/PR+.  I would not..Best of Luck to you!

Hello, I recently joined and was about to post this very question, since I am having a hard time making a decision.  I  am 42 years old and I had a lumpectomy on Jan.20, 2011 for what they thought was an area of DCIS (from stereotactic biopsy), first seen as calcifications on a mammogram.  When the pathology came back, it was 90% DCIS with a very small tumor of 3 mm of Triple Negative invasive ductal carcinoma.  My surgeon left it up to me to decide what to do next.  There were positive margins on 3 sides (<1 mm) so I need a re-excision or mastectomy.  I have pretty much decided to go with the re-excision (after cancelling my surgery date for mastectomy) and would then have 7 weeks radiation with a boost at the end.  We had went for a second opinion at Roswell Park Cancer Institute and they were astonished that I would want to lose my breast for such a small tumor and negative genetic testing.  It was my surgeon who made it seem like it would be risky (and my oncologist kept suggesting bilateral mastectomy), but I would actually feel safer to have the radiation than not, which brings me to the chemo question.  My first oncologist gave me the figures for a 1 cm tumor which were 20% relapse after 10 years (80% cancer free), 7 people helped by chemotherapy.  She then decided to send me to the cancer institute (I'm guessing because she specializes in Hematology?).  Two oncologists there said this small of a tumor would not warrant even consideration for chemotherapy because the risk would far outweigh the benefit (I could have permanent heart, nerve, or bladder damage) and if I would have a local recurrence (which would be more likely) I couldn't have this same chemo again because the body remembers it. I guess a 1 cm. tumor is a whole different ballgame, and she should not have been using this information for my case (and she is a friend of a friend too).  Another thing they found was my pathology was wrong.  The original pathology was grade 3, but when their breast cancer pathologist redid it, it came out grade 2!  Thank you Irr4993.  I checked out Cancer Math and the information kind of agreed with what I was told.  The risk for dying of other causes in 15 years is greater than the risk of my dying of breast cancer.  I am going in for another appointment with an oncologist there to find out more and then having a third opinion at another reputable breast center.  Anyone else run into this same issue out there?  I'd love to hear about it.  Thanks for listening...

Oh and btw for anyone going through the beginnings of treatment, get at least two, if not three, opinions! You mayget more confused, but it will give some peace of mind.

Thank you, Luah.  I had come across this article, but upon rereading it, it clarified a few things.  I guess the big question for me to find out is whether a tumor of 3 mm. is at risk for distant recurrence.  I had negative nodes.  It sounds like it is very difficult to detect a tumor of my size, and in my case this is what happened.  They only detected my DCIS.  I think maybe they feel a tumor of my size may have such a slim chance at metastasis that in my case, a local recurrence is statistically more likely (I believe I read 14% for local in the article).  I definitely need to speak to more doctors!

SusanHG, Do you have a link for these guidelines or is it not accessible to public? Just wondering if the grade of tumor matters, especially if grade 3. Also wondering about the stages listed. I have been told I am 1A, based on a tumor smaller than 2 cm, with no node involvement. This matches what is listed on breastcancer.org website under "stages of breast cancer."   

I will see two different oncologists for two opinions...one Wed and one Fri. Anxiety rising. Am trying to prepare for the chemo news. I 

Huskerkkc: Did you mean 2 cm or 2 mm?

The tumor was 1.9 cm, not mm. Diagnosis 1A. BC.org doesn't distinguish A & B stages at stage 1, although ACA does, and my surgeon did I guess. 

I did not have the "credentials" to get on the website, although I found what you referred to. You're right, I am doing lots of research-probably more than I should-but it seems mostly to help. I will try your link as well. The oncologists will obviously shed light on my never-ending list of questions!

I hope they will appreciate that I've done some homework and not be offended that I question what I've read. If so, I guess that will tell me something useful too!

And Go, Fighter_34!! Celebrate! You have the same dx as I do, except for nodes. I was 0/3. Congrats. 

Thanks Susan...I will try to see if I can log in again. When I first tried it was asking my specialty, etc. Figured I had to be a doctor! But maybe I was not looking closely at other options. If not, I'll PM you and have you email it. 

I am trying to get all my piles of paperwork in order. Had done it sporadically but with three appointments this week it is time to get serious I guess. Oncology #1 on Wed; Surgeon (just post-op visit) on Thu; Onc #3 on Friday. All in different towns, from 60-120 miles away. SIGH.

Oh, and I am seeing a counselor prior to my surgeon visit. Husband insisted  and he is right. I'm a school counselor myself so I really should practice what I preach, so we'll see how that goes. I feel like I need it. But she is 120 miles away so that isn't gonna work for weekly support. Maybe phone follow-up? Anyone done that?  

Do you mean you are 1C?  1.9 cm is at the top of limit for stage 1C, not 1A.

MsBliss...1A is what my surgeon wrote on my path report and what matches with the info on staging on this site and National Cancer Institute...tumor less than 2 cm and no node involvement. Where do you get the limits of 1C that you refer to? 

Titan...I'm pretty sure chemo is in my future. Just trying to prepare myself and really understand my options. Onc visit tomorrow will be enlightening and hopefully not too depressing.

I think Titan is right regarding chemo. I had 2 areas in right breast 1cm of IDC and .7cm of DCIS. My path report says 1b. I had  a mastectomy and four rounds of Taxotere and Cytoxan. I was told because of the triple negative there was no escaping the chemo whether I had a lumpectomy or mastectomy. If it helps any, chemo was not absolutely horrible for me.

So sorry you are going through this, but will we will help you as much as we possibly can. I am 8 weeks Post Final Chemo.

Tiffany

I finish my antibiotic Wed and see dr Thursday, so hopefully all is clear. Then I can schedule port placement and chemo. Tired of all the waiting! And coughing! And people asking at work-although I know they mean well.

Huskerkkc: 

Ms. Bliss is correct.  I am triple neg - Stage 1c, grade 3, no nodes, no vascular and 1/2 cm nodule.

Titan, 

I have asked to start March 31 (I asked a week ago and still waiting for an answer!) because my 73 yr old mom is having knee replacement surgery on March 24 and I would like to be there. However, if they think I need to start sooner then I will do what they say, probably the 17th if I have to. Then the 24th would be my "off" week and I should be feeling okay. I should know more on Monday. I hope!