Plse help am I stage 4?

Oh My Gosh, I am just floored by this.

There is no way of difinitively knowing if a small lesion in the liver is a met unless it is biopsied!  Also it's gone so you have no visceral ( organ ) metastasis You have had what is called a Complete response to Chemo which is Excellent!! It is not unusual for something to show up;  liver or lung, but it does not necesarily always equate to mets.

if this was me,  I would RUN to to another Oncologist, I totally agree with  the dble mastectomy as you are  BRAC1 pos.

Relax and enjoy your good news, Find yourself a Onc that will be your advocate.

I think your Onc is thoughtless and Insensitive. I was " written" off 6 years ago and I am NED. Only God knows what your course will be.

God Bless.

I'm so sorry you're feeling so confused right now.  I'd get a second opinion b/c she can't say it was cancer without a biopsy.  At my last PET a small <5mm spot on my liver was found also, it didn't light up but was told I could do a CT/MRI to investigate it.  I asked would I then recieve more chemo if it was and dr said no, I'd continue with AI's and watch it.  Right now it's to small to biopsy anyway so I'm still IIIc and so are you!!  I'm also BRCA1+ and had a almost complete response to chemo.  I don't see why you couldn't continue with your BMX.  Hugs and prayers going your way and I hope you get some real answers soon. 

EshLou, I'm not Stage IV -- but the topic of mastectomy in women who are Stage IV has come up on this board previously, and I thought I would post some of the research links that have been posted here previously, a lot of it gathered by members English Major and rkt (Becky).

Even if you actually are in Stage IV (which is not clear at all ! ), the idea that mastectomy is of no use to women who are Stage IV may be outdated.  Recent research seems to show improved survival for some women.  I apologize for the length, but thought this may be helpful -- even if you don't go back to your twit-onc, maybe she should read some of this!

http://www.ncbi.nlm.nih.gov/pubmed/16614878
Babiera GV, et al. Effect of primary tumor extirpation in breast cancer patients who present with stage IV disease and an intact primary tumor.  Annals of Surgical Oncology 2006;13(6):776-782.
Reviewed the records of all breast cancer patients treated at M.D. Anderson (Houston, TX) between 1997 and 2002 who presented with stage IV disease and an intact primary tumor. Of 224 patients identified, 82 (37%) underwent surgical extirpation of the primary tumor (segmental mastectomy in 39 [48%] and mastectomy in 43 [52%]), and 142 (63%) were treated without surgery. The median follow-up time was 32.1 months. After adjustment for other covariates, surgery was associated with a trend toward improvement in overall survival (P=.12; relative risk, .50; 95% confidence interval, .21-1.19) and a significant improvement in metastatic progression-free survival (P=.0007; relative risk, .54; 95% confidence interval, .38-.77). CONCLUSIONS: Removal of the intact primary tumor for breast cancer patients with synchronous stage IV disease is associated with improvement in metastatic progression-free survival. Prospective studies are needed to validate these findings.

http://www.ncbi.nlm.nih.gov/pubmed/17522944
Gnerlich J, et al. Surgical removal of the primary tumor increases overall survival in patients with metastatic breast cancer: analysis of the 1988-2003 SEER data.  Annals of Surgical Oncology 2007;14:2187-2194.
A retrospective, population-based cohort study by using the 1988-2003 Surveillance, Epidemiology, and End Results (SEER) program data. Overall survival in women with stage IV disease was compared between women who underwent surgical excision of their breast tumor with women who did not, controlling for potential confounding demographic, tumor- and treatment-related variables, and propensity scores (accounting for variables associated with the likelihood of having surgery). RESULTS: Of 9734 SEER patients with stage IV breast cancer, 47% underwent breast cancer surgery and 53% did not. Median survival was longer for women who had surgery than for women who did not, both among women who were alive at the end of the study period (36.00 vs. 21.00 months; P < .001) and among women who had died during follow-up (18.00 vs. 7.00 months; P < .001). After controlling for potential confounding variables and propensity scores, patients who underwent surgery were less likely to die during the study period compared with women who did not undergo surgery (adjusted hazard ratio, .63, 95% confidence interval, .60-.66). CONCLUSIONS: Analysis of the 1988-2003 SEER data indicated that extirpation of the primary breast tumor in patients with stage IV disease was associated with a marked reduction in risk of dying after controlling for variables associated with survival.

http://www.ncbi.nlm.nih.gov/pubmed/17687611
Fields RC, et al. Surgical resection of the primary tumor is associated with increased long-term survival in patients with stage IV breast cancer after controlling for site of metastasis.  Annals of Surgical Oncology 2007;14:3345-3351.
Chart review (Washington University School of Medicine, St. Louis, MO) identified 409 patients with stage IV breast cancer treated from 1996 to 2005; 187 received surgical excision of their primary tumor and 222 did not. 102 patients had bone-only metastases, 281 had metastases to other organs +/- bone, and 26 had no metastases recorded. RESULTS: After controlling for age, comorbidity, tumor grade, histology, and sites of metastasis, patients who underwent surgical resection had longer median survival when compared with patients who did not undergo surgical resection (31.9 vs. 15.4 months, p < 0.0001; aHR 0.53 [95% CI 0.42-0.67]). CONCLUSIONS: Surgical excision of the primary breast tumor was associated with significantly longer survival in this cohort of stage IV breast cancer patients, even after controlling for other factors associated with survival. Randomized clinical trials are needed to validate these findings.

http://www.ncbi.nlm.nih.gov/pubmed/17687611
Blanchard DK, et al. Association of surgery with improved survival in stage IV breast cancer patients. Annals of Surgery 2008;247:732-738.
Using a large database (Baylor College of Medicine, Houston, TX) of women who presented with stage IV breast cancer, we compared outcome of patients who had resection of their primary cancer to those who did not. METHODS: Of 16,401 patients, 807 had stage IV disease at presentation, and 395 survived >90 days and were included in this analysis. Clinical and tumor characteristics, surgical treatment, and survival were compared for the surgically versus nonsurgically treated patients. Two hundred and forty-two patients (61.3%) had definitive surgery for their primary tumor and 153 (38.7%) did not. Patients who underwent surgery were significantly older, were more likely to be white, more often had hormone receptor positive disease, had small primary tumors, and had fewer metastatic sites and less visceral involvement. The median survival of surgically treated patients was 27.1 months versus 16.8 months for patients without surgical resection (P < 0.0001). In multivariate analysis, which included surgical treatment, age, race, estrogen and progesterone receptor status, number of metastatic sites, and presence of visceral metastases, surgery remained an independent factor associated with improved survival (P = 0.006). CONCLUSION: Patients with stage IV breast cancer who had definitive surgical treatment of their primary tumors had more favorable disease characteristics. However, after adjustment for these characteristics, surgical treatment remained an independent factor associated with improved survival.

http://www.ncbi.nlm.nih.gov/pubmed/18357493
Rao R, et al. Timing of surgical intervention for the intact primary in stage IV breast cancer patients. Annals of Surgical Oncology 2008;15:1696-702.
BACKGROUND: Recent studies demonstrate improved progression-free survival (PFS) and improved overall survival (OS) with extirpation of the primary tumor in breast cancer patients who present with metastatic disease at initial diagnosis. The subset of patients who would most benefit from surgery remains unclear. This study evaluates the pathological attributes and optimum timing for surgery in patients who present with stage IV breast cancer and an intact primary. METHODS: Retrospective, single-institution (University of Texas Southwestern Medical Center, Dallas) review of all breast cancer patients between 1997 and 2002 presenting with an intact tumor and synchronous metastatic disease. Information collected included: demographics, tumor characteristics, metastatic sites, type/timing of surgery, and radiation/systemic therapy received. Patients initiated treatment within 3 months of their diagnosis. Patients were divided into three groups based on time interval from diagnosis date to surgery date. Disease progression and vital status at last follow-up were evaluated. Analysis of metastatic PFS (defined by progression of systemic disease) benefit in relation to surgical timing was performed. RESULTS: Multivariate analysis revealed patients having only one site of metastasis, negative margins, and Caucasian race had improved PFS. Further analysis revealed non-Caucasian patients more often underwent surgical intervention for palliation versus surgery for curative intent, possibly explaining their worse outcome. Patients who underwent surgery in the 3-8.9 month or later period had improved metastatic PFS. CONCLUSIONS: Surgical extirpation of the primary tumor in patients with synchronous stage IV disease is associated with improved metastatic PFS when performed more than 3 months after diagnosis. Resection should be planned with the intent of obtaining negative margins.

Oh, I am just speechless.....seems your quality of life would be vastly improved by removal of this idiot onc.  How insensitive.  And how on earth can she know that without a biopsy?  She's shooting with blanks.

Enjoy.  Celebrate.  Fine a new onc with a heart and some compassion.

Good for you, and no none can tell you you are Stage anything without any proof of it.

You are Stage In Remission .

god bless

You are so kind EshLou. You do not deserve a doctor to treat you that way.

just another voice chiming in the chorus to find a new onc ASAP. You deserve so much better!

we all face the spectre of cancer's recurrence. your doc was thoughtless to the point of being cruel.

good luck - let us know how you are.

xo

janyce

The following is my editorial comment: Wow, I have to say that you ladies ROCK! I always get the best info from this site. AnnNY I think it's amazing that you found those articles. I've been going through my periodic self-doubt about my proph mastectomy and I read these posts and realize that there is a strong rationale for the course of action I have chosen. I worry that I might have been too aggressive. There are so many pitfalls it seems in this journey. I think that has been the hardest thing for me. For instance: take zometa, but um it might make your jaw crumble, adrymiacin, but no might give you heart problems, take tamoxifen, but no you might get uterine cancer,... It is really effed up.



Then you here experiences like Eshlou's and they say well don't do this because of your QOL- well EXCUSE ME I think QOL left the building a long time ago!,, seriously, I am a big believer in fighting - working every tolerable angle. and, for me the truth is the ms wasn't really that bad (although I do have my expanders in after 2 hrs -but that's another story).



Anyway, sorry to go on and on. But, I just need to throw it out there how much I appreciate this forum. even when a post is addressing someone else's issue it can resonate for others. thank you, thank you. Jeez I think I'll shut up now.



Amanda

Ultrasounds are not as conclusive as CTs, Which basically means CTs are better at picking up lesions.

From your CT report, the result of an isolated " dot" does not mean mets. I think your good.

Once you sit down with  your new Onc, your old Onc's words will have far  less power. You will feel better.

Congrats, I'm glad you were able to get some clear answers and reassurance.

EshLou, this whole thing just sucks, doesn't it?  So sorry to hear you had such an inconsiderate onc...but really glad you got a second opinion!  And congrats on how far you have come!!  I have days like that too, where the fear just eats away at me, and rather than dwell on it, I try to find the positive, which can be really hard!  I was dx in Sept. and am HER2+, so I was told that Herceptin would work wonderfully for me and they thought that my survival rate was 90%+.  Then I had a PET scan and they found a spot on my liver.  I, like you, was told this is extremely rare...ususally people are either covered on their liver, or have no spots at all.  I was a bit of a medical mystery also.  I went to see a top onc at the University of Pa and he agreed totally with my onc here at home that this was rare and in his 20+ years, he only knew of 8 people who went thru this.    After recieving my first tx of chemo, all tumors had either shrunk or melted away totally.  They were a bit confused about the met on my liver, because at one point it looked solid with liquid in the center, which made them think that it possibly was a cyst instead.  But the fact that it was shrinking made them think it was cancer.  They also found some other tiny spots but said that is not surprising, most everyone has cyst-like spots on their liver.  So now that I finished radiation yesterday (yea!)  I will be having a PET scan next week followed by a liver MRI.  If no other spots have shown up, I will be having a liver resection in a month or so.  I saw the top liver surgeon at U of PA and although we want answers and someone to tell us all will be fine, even she couldn't do that for me about the surgery.  She said that it would be a difficult surgery, but well worth it if no other spots have come about.  Some people's cases can be kind of cut and dry, and other's, like ours, are extremely confusing to not only us, but the dr's too.  I was told back in Feb. that they found a spot on my sternum that was hidden by a positive node that I already knew would be getting rads.  One Dr. was saying he is almost positive that it was a met, and another saying he doubted it.  It was the only spot that the chemo didn't shrink.  I had a sternal bone biop done to see, since I would need it radiated if it was a met, and it came back negative.  They said that we will never really know if it had been cancer at one time or not.  Could just be a discoloration on my bone.  So...long story short...sometimes even the Dr's don't know and yes, we need to be our own advocates during this crazy time.  Hang in there and trust your gut.  Wish I could give you a hug to help calm your worries.