Radiation after Mastectomy?

pp729 · May 2011

Hi all. Still searching for info for my mom. Excisional biopsy in Jan, 2011: Right breast mass. Skin/associated soft tissue involved by Moderately Differentiated Infiltrating Ductal Carcinoma measuring up to approx. 1.7 X 1.5 X 1.4 cm. Focal dermal lymphatic involvement noted. ER positive 99%; PR positive 98%; HER-2/NEU Negative 1+; Ki67 = High 80%; Bloom-Richardson scale grade = 9/9 = Grade III.

Started on Anastrozole a few months ago. Oncotype score = 36 (high)

Unilateral mastectomy in April 2011 - 2 lymph nodes remove - benign,. No residual carcinoma; no additional malignancies; no metastatic disease. So she is clear.

Recommendation to see oncologist again regarding chemo after surgery and/or radiation oncologist regarding radiation treatment. I am confused -- it the cancer had not spread anywhere in her breast outside the original margins which are clear. why would she need to consider chemo or radiation after mastectomy?

peggy_j · May 2011

I think it's unusual but not unheard of to have rads after MX. Maybe has to do with the location of the tumor (close to the chest wall, so they aren't sure if they got good margins) ???

pp729 · May 2011

Thanks Peggy -- I thought of that, but her tumor at about 10:00 on her breast, more to the underarm area. Is that considered near the chest wall?

She's very small and had a very small breast -- A cup at most. She did have involvement of the dermal lymphatics and skin but all margins were clear. Could it be related to the location and the skin? I am so confused about this.... would have expected the recommendation for chemo due to her high Oncotype score, but not sure why radiation is being considered????

Leah_S · May 2011

pp729, your mother should ask her onc why rads are being recommended. It could be that the involvement of the dermal lymphatics puts her at a higher risk of local recurrence without rads.

Best of luck to you and to your mother.

Leah

peggy_j · May 2011

I agree with Leah that it would be best to ask the doc. Perhaps the doc referring her to the RO is just being thorough, wanting the RO to make the call whether rads are needed or not. I know that when tumors are closer to the chest wall (right next to the rib cage, vs. closer to the skin) that it can make it harder to initially diagnose treatment. (because it's harder to see?)

pp729 · May 2011

Hi ladies, thanks again for your insight. Rad onc said both chemo and radiation is recommended due to involvement of the dermal lymphatics and skin, plus a high (36) oncotype score. Not sure that mom is willing to do either, due to other health related issues and she seems to be lulled into a sense of security that her lymph nodes are clear and there is no additional indication of cancer spread. But she understands that her chance of recurrence is 24% with hormone therapy only -- I'd be rushing to start chemo/rads but that's just me.

LindaKR · May 2011

I had MX and had chemo and rads. My margins were clear, but a little closer than the RO liked and I had 5 positive lymph nodes, that threw me in to the group to have rads - BS told me that if you have 4 or more postive nodes then rads. Both the rads and chemo decrease your risk of recurrence considerably. How old is your mom?

pp729 · May 2011

Hi LindaKR, my mom is 67.

Luah · May 2011

Not to be alarming, but no known node involvement does not put one in the clear. Cancer cells can still be floating about and lead to metastatic disease later. I'm sorry to say that there have been too many women on these boards for whom that has been the case. It would be wise to have a good heart to heart with the onc, who can review your mom's risk factors and concerns in relation to her expected benefits of chemo and hormone therapy.

pp729 · May 2011

Hi ladies -- thanks for your advise, and you are all so correct. And no, you are not being too alarming....However, my mom is seeing her medical onc this week and she tells me that she has decided to decline both chemo and radiation. She will continue on Anastrozole but she feels that the side effects for chemo and rads will be too much (mainly concerned with the fatigue). I still believe that she is being lulled into a false sense of security that she was node negative and no evidence of cancer having spread. Despite very direct conversations with her breast surgeon, the rad onc, and the med onc and despite two second opinions with the strong urging by them all to proceed, she's declining. I talk with her daily and said many times that I think she is making a HUGE mistake, but have tried unsuccessfully for months now to convince her otherwise...Frankly, I think she does not want to fight and I feel like I can't continue to push her... so sad to see someone you love make such a poor decision.

Luah · May 2011

Ah heck, pp729, I'm sorry you and your mom are going through this. The important thing is that she gets good, solid information on which to make her decision... and it sounds like she has. Is it possible she might be willing to try a round or two of chemo and see how it goes? Fatigue can be managed if you listen to your body and don't overdo.

In the end, it's her decision of course. It's just so hard on others to accept one that seems wrong. I'm sure you're a great support to her though, and let's hope the hormone therapy does its job and she lives to a ripe old age.

LindaKR · May 2011

pp729 There is a lady in my womens cancer support group that chose not to have chemo or radiation, against the advice of her oncologists, and that was 11 years ago, she had a recurrence in her other breast a year after the first one, and only had surgery again. She's doing great.

mammalou · June 2011

I also had involvement of the dermal lymphatics and am undergoing radiation and chemo after mastectomy. Once it is in the lymphatic system there is a higher chance of recurrance, thus the extra precautions. It is scary, but you just have to weigh the risks and benefits.

Radiation after Mastectomy?

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