chemo vs radiation HELP?!

The reasoning behind the recommendation of chemo is based on the fact that even if one cancer cell got into the bloodstream it could turn up years later as a metastasis in the bones, brain, lungs or liver - the places where breast cancer metastasizes.

Radiation will not erradicate that one cancer cell that is hiding elsewhere in the body where it can thrive and grow.  Radiation will only take care of any existing cells in that node - not cancer cells in other parts of the body.

Also ER+ cancer cells grow in the presence of estrogen which is produced in the ovaries, adrenal glands and fat cells.  Tamoxifen acts on the receptors of the cancer cells so that the estrogen cannot get into those cells so they can multiply.

Chemo tries to make sure there aren't any of those cells left in the body!  So chemo destroys those cells and Tamoxifen is insurance that if there is an ER+ cell elsewhere in the body it will not receive estrogen to allow it to multiply in the body.

I had a lumpectomy, chemo (also due to one micromet in one node) and radiation.  My onco score was 20 - in the intermediate range and my onco said the choice was mine, my BS said no - and I went ahead and did the chemo because I needed peace of mind -that I did EVERYTHING I possibly could to erradiate the cancer. That was last year and I am confident that I made the right decision FOR ME.

Judy

B123 - Check out NCCN guidelines - it validates what Beanpole is saying above even with a larger tumor or grade.  You have to pretend you are a doctor to sign in but we all do it.  I think the page you want is 16.

I did lumpectomy, partial chemo  (about half) and then read NCCN and stopped, followed by radiation and arimidex.  It was actually my rad onc who suggested I look at guidelines more closely, noting that I had a luminal A, low Ki67 tumor and that he really didn't believe chemo was benefitting me as much as it was damaging me.  You will likely get that info, the Ki67, from your oncotype.  My score was 23.

Best wishes -

D

Thanks for opening this discussion.  So many of us need to make this choice with the oncotype tests being done more often for Stage 1.
I am in the decision making dilemma.  I had a lumpectomy 8/30 with clear margins and 0/2 nodes.  My tumor was grade 2, ER PR + and HER2 - with oncotype score 13.  My oncologist uses a lower threshold for defining "low scores" which puts me at the low edge of the middle group.  I assume this reflects the ongoing Tailor study which uses these numbers with hopes to refine the outcomes for the middle group.
So, my body says do the radiation and hormone therapy.  My mind says do the chemo to better my chances against a recurrence which would make me Stage 4.
It is disrupting my sense of well-being and forcing me to face the seriousness of BC.
Anyone else have this decision?
I was asked to give my decision 3 days ago.

Rocky,
Thanks for finding my post here...yes, you did respond on the August 2011 thread.
I hope you are doing OK - you had your first chemo...I hope you are recovering and feeling better this week.  You are right about my age (PM 62) and that chemo is probably not significantly beneficial for me.  I let myself get so confused over it that I couldn't function for 2 days.  My body says "no" but my mind says "shouldn't I do everything to avoid recurrence?"
My onco uses the Tailor scale which puts me as low end intermediate range for my score.  That really threw me. Most of what I read on the web indicates that ladies with scores up to 20 or even higher are bypassing chemo.  I called for my test result so that I can see the variables just to be sure I am comfortable with my decision. 
Sometimes I have this weird feeling that if I didn't have to give up a breast and if I didn't have chemo, then I really haven't experienced breast cancer...but I have -- I've had so much stress and loss of control...and I still have to do rads and Arimidex. 
I do feel blessed -  my surgical  recovery was easy. It breaks my heart to read what women are going through. I know that if it recurs I could face more surgery. If I were younger or had young children, I would do chemo. My last kid is in college, so they are mostly independent now (6 kids).
For now, I wish you well and that your SEs are bearable and few......you have really helped me move closer to the path that works for me.
Thanks.
Joan

B123 - I had an undiscovered Grade 2 cancer in my right breast while I had chemo for the nasty Grade 3 HER2+ve one in my left breast. The grade 2 one did not go away and looks the same size as it did on my mammo the year before (it wasn't reported). The chemo may have stopped it growing and spreading, but as someone above said, lower grade cancers do not respond to chemo as well as the higher grade ones do. Who knows, the chemo might have lowered it's grade but it didn't kill it. My onc said that was possible. Both of my cancers were very highly ER+ve.

Sue

I had the second one removed via another lumpectomy. The chemo was for the HER2 one but it was interesting to see when they finally found the second one that it hadn't been killed off by the chemo - it was a totally different pathology.

It's a difficult decision to make regarding chemo, I know, in my case I had no choice for the first one because of the HER2. The second one was node negative too. The thing is, we can never know. One sweet lady on here had DCIS with a microinvasion, clear nodes and no chemo as that is not recommended for DCIS - 2 years later she had mets.

I've always thought that any nodal involvement meant chemo, but these days that opinion is changing especially with the oncotype scoring. The thing is, it did spread to your nodes, so it is capable of spreading further even being grade 2.

I hope you can make the right decision.

Sue

Joan - you should still do rads even if you decide against chemo especially if you had a lumpectomy. I had rads both sides. The chemo choice is your hardest one. Your cancer was small and you had clear nodes, so I don't understand why anyone would suggest chemo, my onc told me that I would not have had to have chemo if I hadn't been HER2+ve. Then again the oncotype test is not available here. This test is really changing things for everyone. I only hope it's proven to be accurate as time goes by.

Sue

Joan, I have to agree with ICanDoThis.  You will be doing RADS and Arimidex (maybe even 5-day brachy rads) and those two treatments, based on science, are the "standard of care" for where you stand.  We are all going to be concerned about a recurrence from this day forward.  I sucked it up to do the chemo based on my age, nodes and original tumor location (way too close to the axillary with my cancer possibly getting a free ride to somewhere else in my body).

Listen to what you said about chemo, My body says "no" but my mind says "shouldn't I do everything to avoid recurrence?" Sometimes our bodies know things before our minds do.  Unfortunately, our minds can get in the way of decisions all too often.  Avoid the recurrence by eating right, exercising, being careful of the plastics, estrogen related products and all the other things they say we should do.  This chemo gig is not easy on the body.  In fact, at 47, I'm doing this now so I WON'T have to revisit this in my 60's.

BTW, like I mentioned before, the MO you saw is talking overkill chemo with you.  8 treatments WTF??  My stats, etc. only brought me to TCx4... chemo light if you will.  Why the hell would you be more chemoed up having with better pathology results then myself (I'm not a doctor, just a scientist).  Think about it.  Get the 2nd opinion, you'll be glad you did.  You're in NY.  Many, many impressive MOs there.  Good luck and let us know what you finally decide.  We will all be around here for sometime now... good or bad.

Joan, was thinking of you yesterday.  I'm so glad you've got he 2nd opinion lined up.  This should help a lot in getting the ball rolling for you.  You are very smart taking your time because when all as said and done, YOU will feel you did the right thing and not have what I call "boob remorse."

My first dx = 6/9, surgery = 8/10 and chemo = 9/19.  I think these were big spreads compared to others around here, but no regrets now.

Icando - Sue
I signed a general release to have my medical records made available for research.  I believe in that.  And the clinical trial is "random" selection; therefore I do not have to do anything except what I would have done anyway. 
Today I had a highly recommended oncologist call me back and tell me that she would not prescribe chemo for me; and that I should take hormone therapy.  No guarantees either way, chemo or no; but she afirmed no significant benefit from chemo.
So I am ready to move forward with the rads and take it from there. 
Life feels kind of faster-paced than I want it ... I still need time to digest all that has happened in the past few months.  I feel grateful so far...but when I hear of how many ladies are dealing with more difficult surgeries and treatments, I don't rest easily. 
I hope that after treatment I can give back to someone who needs information or reassurance.

Thanks, Sue...I think I am feeling the peace I've been seeking. It's a good thing I like to drive.....already do  40+ miles RT commute, so what's another 15-20 added on for M-F?
I think I'll live for week ends....speaking of which, it's here  
Happy week end to all.

Joan, I started with my BS since I knew him from a past life (so to speak) and trusted him.  As for my RO, my best friend in Washington was trying to convince me to go to L.A. or come back east for the best of the best.  I thought she was being extreme, but I did listen.

I work at a library and we have a magazine that lists the best doctors in our state and why they have been chosen.  I picked my RO who was a key figure in the creation of brachy therapy.  Never thought I'd be anywhere near chemo.  She was as excellent as they come and helped with some of my decisions.  Even convinced me it was time to tell my younger daughter back then.  Anyway, my BS agreed that she was good so there was the beginning of my "team."  I asked both my RO, BS and OB/GYN for MO recommendations.  I met with two and picked the one who was closest to me and had the nice, healthy looking nurses.  I'm not a fan of unhealthy medical personal ;-).

Later on when I met with my RO again to tell her it looked like chemo was coming my way and that we will meet again in a few months, I mentioned to her that sometimes I felt strange for creating my own "team" and that I wasn't at any of the Canter Centers we have in my state.  She assured me that I was getting better care doing it the way I was and that the "centers" don't always have the best of the best.  My three people communicate when needed, but overall I am way happy with how this turned out and I feel like they are all working for me as opposed to following some protocol and doing their own thing.

Just my 2 cents for you.  P.S.  Glad you got the 2nd opinion and happy you don't have to do chemo.  RADS will take care of local recurrence and the hormone therapy is probably what will keep it from coming back.  Good luck.  Let us know what happens.

Joan --

Sometimes I have this weird feeling that if I didn't have to give up a breast and if I didn't have chemo, then I really haven't experienced breast cancer...but I have -- I've had so much stress and loss of control...and I still have to do rads and Arimidex.

I had almost these exact thoughts, especially when I "compared" myself to a close friend who was diagnosed even younger than me. But, recently we attended a breast cancer awareness program and met three other women who were diagnosed at about the same age as me (40 at first mammo). All three, plus my friend, told me in no uncertain terms that it wasn't "cancer lite," it was cancer, and just because I didn't have to do chemo doesn't make it any less a cancer.

Yes, I got "lucky" b/c it was found in stage 1, and I had all the best possible results in my tests, but I still had to have surgery, and I still had to have rads. I advocated for myself and followed my RO's suggestion for Mammosite, even though my BS said it wasn't "standard of care" for someone as young as me.  And now that I've started my Tamoxifen, it turns out that I'm one of the not-so-lucky ones who ended up with ovarian cysts, but then again, my ovaries went into overdrive after I started Tamoxifen this summer, so I just started Lupron too. So, even without chemo, I've gone through my fair share.

All of this is just to say, don't feel like you had to suffer through more than you did in order to feel like you really experienced BC. You did, I did, we all did.

I hope you were able to put together a good medical team and maybe have already started your rads. It's rare to find everything under a single roof unless you are in a closed HMO like mine (Kaiser) or seeing your doctors at a major cancer center. I'm in a big city, and my docs are actually spread out over 3 locations, but as they work together all the time, they are amazing at staying in touch with each other, and they all have access to all of my info. I wish for you a similarly cohesive group.

sorry for rambling -- feeling the insomnia tonight,

Joanne