Calling all TNs

Hi everyone just an update im 25 and was diagnosed at the end of January with breast cancer then had a right masectomy on valentines day ... After surgery found out I have stage 2a no lymph nodes involved but triple negative ... Met with oncologist last week and will be starting chemo. I will be given FEC for 3 treatments then DOX for three treatments .. Just was wondering if anyone else was on anything like this for treatment..

Any responses would be great

Thanks

That's what I was wondering like I do know my mother has the braca 1 mutated gene but other then that I have no clue why I'm on this treatment .. I'm seeing a lot of people with the same treatment you are on .. I guess I will have to ask on Thursday when I go for my first treatment.

Well the thing was I just found out about my moms genetic thing ... And know knowing this my oncologist has already sent out urgent genetic testing for me to see if I have the gene and if I do he wants to talk about removing my left breast .. So once the testing and chemo is done we will talk about other surgery ..

Titan  hip hip hooray.  You made it to four years.  Congratulations girl.  I bet you will be around for the next forty years or so.  So go party and have a ball.  Luv yer. Annie 

Michelle ~ you're right -we could have sung duets during that year!

Take good care of yourself, bosum buddy ~ Shar

TasiaB, hi, diagnosed in jan. also. Are you in Canada or Australia by any chance? I'm in Canada and FEC D is pretty common from what I've read-that is what I'm on. Wishing you minimal SE, I have found the FEC part very doable. I start next segment next wed so can't comment yet. Make sure you hydrate before during and after and keep smiling!

Congratulations, Titan!  Wishing you many more years!!!

Slv58 thank you for the response and the heads up on fec I Amin Saskatchewan .

Luah thanks for the response didnt know it was common.

Tasia..welcome to the tn bco family...I am so sorry you had to join us here at such a young age. You sound strong...go conquer!



Titan :D ♡♡♡so happy to celebrate your 4 yrs...party on girl..and open up a nicebottle of cabernet!

Lady Miz...def push and be your own advocate!

Maggie

argynnis -

I really don't know what goes into the decision to do adjuvant v. neoadjuvant chemo.  I had my surgery and sentinal node biopsy first and then started chemo but I have known others who have done the opposite.  Had i known more beforehand, I definitely would have asked this myself! This is something that you have every right to ask your doctor before everything starts and make sure you feel comfortable with ALL of the answers.  with an aggressive tumor, sometimes we have a tendency to just "go with the flow" and do what we're told without asking why certain methods are being used as opposed to others.  I congratulate you for wanting to know the "when, where, why, what and how" behind your diagnosis and subsequent procedures and treatment.

Plenty of amaxing women will be following my comments shortly, I'm sure, and maybe they will know about why one is chosen over the other.

Blessings to you and I will keep you in my prayers!

Stay strong and vigilant!

Arginnis,



I've looked into this a lot since it was my situation. It's a little complicated.



Re: "survival rates are the same...". : I believe you are referring to a study that showed there is no difference in survival between these two groups: 1) women with MICRO disease (ie less than 2 mm), or isolated cancer cells, in ONE positive node, only; and 2) women with ZERO positive nodes (ie node negative). Based on that study, in some cases surgeons are doing a sentinel node biopsy (where they take 1-4 nodes) and NOT doing an axillary dissection if only one node is positive.



It's tricky timing-wise, though, because while the surgeon gets some idea of sentinel node status while the patient is still on the table (they use a blue dye to see whether the sentinel node is positive), they don't know for sure until days later when a pathologist has had a chance to look at the nodes under microscope. In my case, while on the table they thought sentinel node was negative, but pathology then showed 8 mm cancer in the sentinel node. This is a "macro" deposit, not micro. The other 3 nodes removed were negative. So I then had to decide whether to have an axillary dissection later, when I did my mastectomy. I chose not to.



Chemo: From what doctors have told me and what i have read, you want to know your true nodal status before chemo starts (ie before chemo shrinks or changes the tumor) which means doing the sentinel node biopsy before chemo starts. If you do the biopsy after chemo, then you don't really know what stage you were. Stage affects other treatment decisions, including radiation. MRI does not definitively tell you the node status; only pathology of the nodes.



Chemo: yes, it makes sense to me to have your sentinel node biopsy (ie surgeon takes 1-4 nodes) and see how many are truly positive, then do chemo. You would not be able to see how the nodes are affected by chemo because they will have been removed. But doing the sentinel node dissection/biopsy before chemo will tell you your number of nodes and whether axillary dissection is warranted when you have your mastectomy. And maybe the remaining cancer in the breast (positive margins) can be tested at mastectomy to see how it responded to chemo? Not sure whether such a small sample would tell you anything meaningful. My tumor shrank from 3.1 cm to 7 mm from the chemo and the ki 67 (proliferation rate) dropped from 70 to 17 percent.



With a grade 3 tumor, I'm also a fan of starting chemo quickly. I did as well. Get the systemic treatment underway to kill any cells that may have escaped, then deal with local situation.



Radiation: Given that I had a positive node, in order to skip the axillary dissection, I definitely had to do radiation. Radiation helps kill any cancer in the nodes. Chemo does, too, but radiation is the extra help that in effect substitutes for the axillary dissection. I'm starting radiation next week and they'll zap 3 levels of nodes.

argynnis: placid has provided an excellent reply. I second everything she has said. 

(I had micromets and chose to have an ALND after much consternation. Research was just emerging then showing the efficacy of rads, I might choose differently now....although I was relieved to KNOW -- through surgery -- that no other nodes were positive. I have not had any problem with LE, luckily. But be aware too that rads heighten risk of LE too.)

Hello & Welcome argynnis,

I, too, came up with negative BRCA1/2 testing. There is a second test called BARD that they do if the BRCA results are negative. BARD is more intensely focused on certain areas of the BRCA genes to see if any positivity is picked up. When you filled out your paperwork for the testing, did they ask you about having this additional test, if needed? It is optional, and costs about $750 or so, and since insurance usually doesn't accept it, you have to agree to pay for it, if insurance denies it. Luckily, my insurance did pay for it. It also turned up negative, so barring any other genetic mutations that are not tested at this time, I do not have a gene mutation to pass on. That makes my BC "sporatic/spontaneous". One of the benefits of going through this testing is that you are kept in their database, and if any other genetic mutations are discovered (and surely there will be), you supposedly will be notified. Being so young with TNBC, insurance should be required to pay. I lucked out, because I was under 60 yrs old (57+11 mos) with TNBC, and therefore considered at "high-risk".

 ~ Shar

argynnis - Hooray on the other tests being clear! 

Ask your surgeon if your sentinal lymph node biopsy (SLNB) will be sent for frozen section during surgery, or just sent to pathology for later diagnosis. After the SLNB tissue is obtained, it is rushed down to histology/pathology (or in larger centers, may even be performed next to the surgical theater) in a fresh state, immediately flash-frozen, cut into extremely thin slices and placed on glass slides, stained so that the cells are visible, and viewed at the microscope by the pathologist, with the results called to the surgeon, while the patient is on the table.  This whole process is supposed to be accomplished with a 15 minute turnaround. If the SLNB is positive, then the surgeon would probably want to do the ALND with the mastectomy. If negative, then that should be all they need. Of course, as others have said, the final word comes from the pathology report done afterwards, which involves exhaustive examination of all the tissue submitted.

If the SLNB is to be viewed after the surgery, it is placed in a preservative solution, and processed the same way as other surgical specimens. The report comes out at a later time, although biopsies always take precedence over other surgical specimens.

Oh, the memories...and adreneline flow! ~ Shar, aka former Histotechnician and Frozen Section Cryostat Operator