Treatment for Triple Negative and very small tumor

Huskerkkc: Sounds like you're ready, just need to get away from all those viruses! Isn't the hardest part about breast cancer "keeping calm and carrying on"?  The fear is always there that if you do start to calm down and move on, it will just stab you in the back yet again...that's why I love the quote so much because it is the hardest thing to do, yet the most important because life does go on.

Keep strong and good luck as you start your treatments.  We'll be here for any venting you need to get out along the way or for even sharing any good days too.

Susan

I know this thread is a bit old, but I wanted to comment in case anyone else out there ever looks for info on such a small sized TN tumor.  Mine was 3 mm, grade 2, all taken at stereotactic biopsy.  Had tissue retested to make sure how large it was and saw two oncs, both of whom recommended chemo because we're dealing with TN AND because I was 43.  Age really plays a factor into it.  So anyway, I had 4 rounds of TC.  No lymphovascular invasion and no nodes.  We believe it had just become invasive.  The only thing left at mx was a small amount of DCIS.  I think this would be a good thread to try to keep alive.  Wish others would comment about their treatment who had such small tumors.  The line seems to be drawn at 5 mm... many people under that choose not to do chemo... but the thing is, we don't know which of us needs it in order not to have a recurrence and personally I would have never forgiven myself if I hadn't thrown everything I had at it and then had a recurrence.  We have one shot at killing it....

I just joined and have the same question concerning very small TN tumor. I posted a separate thread before I saw this one. Once I saw all the valuable information here, I am very grateful to all of you for your postings. I was advised against chemotherapy and will accept that since benefit is very minimal. I am three weeks into Tomotherapy and starting to get a few rashes similar to heat rash. Hopefully I will finish in three weeks without further side effects. After that close monitoring.

Hi ladies - I agree with cc4npg....it would be very helpful to newcomers if we can keep this thread alive.  I know it's meant a lot to me connecting with others with a similar diagnosis.  I hope everone is having a nice evening!

I just had surgery on Friday and am facing the same dilemma. I have a bizarre situation though. I had 1 tumor that was 5mm and a second that was 7mm (located very close to each other).  My surgeon had a radioactive seed implanted in me the day before surgery and when she went in the following day the 5mm tumor was gone....  The only present tumor was the 7mm.  She said I had clear margins and the preliminary reports said no lymph node involvement.  She says chemo is not necessary, however, I think the medical oncologist and radiologist both want me to have chemo because I am only 40 years old.  I am Triple Negative and do not have my BRCA results yet. My initial biopsy gave me a grade 2...  Any thoughts--I am very scared of chemo, but if I have to do it I will. I have 2 children--a 7 year old daughter and a 13 year old son..

kll22: The hard thing is, things won't be normal for your kids. And that's okay. They will surprise you with their resilience and support... and they will live through a life-lesson and be stronger for it.  All the best.

The kids will be fine... and I agree, although you can try your best to make things as normal as possible, cancer is not one of lifes normal bumps in the road.  Nothing about it is normal.  We just get through it.

Chemo scared me... until the first infusion.  Much like everything else about cancer, the anxiety leading up to the "unknown" event was worse than the event.  After the first infusion, I knew what to expect and I was fine.  It's not as bad as it sounds.  And cancer scares me WAY worse than chemo.  My 3 mm tumor was well below the line for chemo, but many onc's are doing away with the old thinking that there is a safe size with triple neg tumors.  The fact is, it's a more aggressive cancer that responds better than the others to chemo which is why they encourage even tiny triple neg tumor people to have chemo, especially those of us who are younger.  I was 43 and my child was only 2 when I was dx.  I knew the chemo might make me feel bad, and I knew we might have some days during the week that I wouldn't feel like doing much with my child, but I was eager to trade those few days for my life.  Losing hair was very hard.. mine was long.  That was the worst thing I remember.  The other side effects fade after it's done.. kinda like having a baby.  You forget the pain and morning sickness after the baby is here, or it fades to the point where you can't quite place how bad you really felt.  This is the best comparison I have to how chemo was for me... it was no walk in the park, but I got through it and the worst thing I remember was losing my hair.

I forgot to add that rads was not easy for me, at least at the beginning.  I came down with two bouts of cellulitis, the second started the first week of rads.  So, my breast was beet red from the first week, i had inflammation of the chest muscles for the first 3 weeks, and eventually I had a black armpit and very, very dark breast with some small blisters.  I count myself fortunate that my skin never opened up, but it looked bad.  Right now, most of the dead skin has peeled off and am almost back to normal.  So glad that's over and I can start my life!

hi friends,

small TN tumors and chemo appears to be an area of controversy.  my MO said that they have less understanding of such small tumors, and now with intensified screening, they are seeing more.  They are also pushing the boundaries of when to offer chemo - it used to be none unless 1cm or more, now they tend to offer for 0.6-1cm and for some at 0.5cm or less- the cutoffs are/have been somewhat arbitrary.

I had a 0.5cm IDC TN at Mx (I am BRCA1+ and thought I had DCIS) and researched the chemo question a lot and got opinions.  I have opted for chemo and start tomorrow!  I am 44 btw.

Some of the numbers I found:  example -  6-8% risk of death at 10 yrs versus 2.5-3% with chemo... thats a reduction in risk of death by half with chemo, but you can see the numbers are small.  Some studies show recurrence up to 15% (not death) with St 1A TN tumors...but TN is actually a heterogenous group and is only beginning to be adequately characterized and studied, in fact there are some TNs that are more agressive than others and we don't know which group we are in with the current clincal practices.

my particular pathology had all the "bad" signs - grade 3, TN, necrotic etc (though thankfully LN was neg).  this also influenced me to go for chemo... I am having DD AC.

Bumping to keep alive

Sugar77 your story is almost like mine.  I too am 45 and have one daughter 11 years old.  Just got married.  Found out about the BC a month before wedding.  My husband stands by my side and encourages me every day.

Can't hurt to check in with an MO, right? If it were me, I'd want at least one MO opinion if only to put my mind at ease. There's some evidence that chemo, if it's to be given, should be given within 12 weeks of surgery.... (which is not say it's not effective at all if given a litttle later.)  

Hello-I'm new to this and have been searching for as much info on mastasis for those of us TN. had a scare last week with a "spot" on my chest xray. it has made me look for more info and have discovered this site.

I finished my chemo in Sept. 2010 after my surgeon and onc. both agreed there wasn't any choice in chemo. was MISERABLE but i made it. I was stage 2b with a 2.2 cm and1/13nodes. tested positive for the BRACA 1 gene.

want to learn more so I can help my daughters be informed when they are older- ages 6 an 14.

New here.  I was diagnosed last year.  August mammogram left no doubt in my breast specialist's mind, and her convictions were confirmed by biopsy at the beginning of September.  In all the tests and imaging that followed, I was found to have "something" on one ovary.  At age 62, I'd forgotten I even had ovaries!  GYN oncologist recommended a total hysterectomy even though she was sure the cystic mass was going to be benign, citing stats about the possibility of needing additional surgery in the future.  So...first a total vaginal hysterectomy, and then, a week later, the lumpectomy.  By the end of October, I was uterus/ovary/invasive cancer free, and one breast was a little smaller and much more attractive than its healthy counterpart.  Pathology showed that the invasive disease was so small (2mm) that the biopsy in September had removed all of it, leaving just 3 mm of ductal CIS, with 4cm of clean margins all the way around it.  The sentinel node was negative.   A second pathology opinion (done under the table through "connections") suggested that the invasive disease might have been closer to only 1mm. 

After several months of hearing "all we have to treat this form of cancer is chemo", with my wig at the ready, I learned that because the invasive disease was so small, I did not meet the criteria for chemo.  I was floored, and felt that I had been left marooned up the well-known creek in a small row boat...with no paddle.   I moved on to the standard 33 radiation treatments, which were annoying but tolerable, and left me feeling tired toward the end of them; six weeks later I had my former energy level back.  (Too bad...I was hoping for something better than what I started with.  )  

The "no chemo" edict still gnaws at me a little, though my daughter, who is - get this -  a breast cancer nurse practitioner (don't you love farce?) tells me that the best breast cancer oncologist at her facility agrees completely with my oncologist's determination.  She said that chemo that would have been "used up" this time would be available to and effective for me in the future if I ever need it.  My oncolologist released me from his care, calling me "so low risk" that it would be of no medical importance for him to follow me.  And I admitted to him that an online cancer calculator had suggested that the chances over the next 15 years that I would die from this cancer episode were 2-3%; there's a 23 % chance that something else will get me during those years. I'm hoping it's a gelato overdose. I continue to be followed closely - perhaps too closely - by my breast specialist.  

 Has anyone else been told "Yes, it's triple negative and no, you can't have chemo?"

Louise,

My tumor was 3 mm. and I was advised against chemo for the very same reasons your doctor gave.  She said it would be overkill and would use up my chemo option.  Also, she emphasized that it isn't always necessary to join the "chemo camp".  She gets it a lot from people that they feel shorted out by not doing chemo.  She gave me the distal recurrence rate of 1-2%.  I keep repeating these numbers to myself whenever I get scared (which is often).  Chemo would only reduce these odds by half, so there would still be a risk, and there there would still be worry(the hardest part about cancer).  I have the attitude now that I will just go about with my life and live it to the fullest.  If something bad happens, I don't want to feel that I was hanging around waiting for it to happen.

Take care and keep us posted.  Nice to hear about another non-chemo case.  Makes me feel better :-).

Susan