My oncology doc said chemo shows little use with ILC??

hollyboo
hollyboo Member Posts: 89

I had uterine cancer surgery last fall 2012 with 3 radiation treatments.  

Then in March 2013 my "calcium deposits" showed up in ultrasound and biopsy as IDC.  Breast MRI found more cancers.  Mastectomy surgery pathology found NO IDC but ILC instead and one of the tumors was pleomorphic.  

Oncologist has presribed 25 radiation treatments due to positive margins on the pleomorphic tumor (positive margin due to it being right on my chest muscle---fascia of muscle removed but no muscle).  Oncologist said that chemotherapy has shown to provide no benefit for ILC and therefore I am having no chemo.  Not that I WANT chemo, but from what I have read on here, many with ILC have had chemo.

Estrogen and progesterone positive.  The scary thing, HERS?, is negative.

Anyone understand about this chemo question with ILC, particularly pleomorphic?

Thanks.

Holly

Comments

  • toomuch
    toomuch Member Posts: 901
    edited August 2013

    Hollyboo -I was diagnosed with PILC in July, 2010. I have read studies that show that patient's with ILC who are treated with neoadjuvant chemo are less likely to have a complete response then patient's with IDC. I have never been able to find a study that looks at chemo response of PILC, either the type isn't mentioned or classic ILC present. There are many women on this board that had neoadjuvant chemo and had their tumors shrink so I don't think that it's a fact that chemo is of no benefit for patient's with ILC. If you are not entirely comfortable with your treatment plan, you should seek a second opinion, if possible at an NCI designated cancer center. I'm a firm believer in second opinions, even if for peace of mind!

  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited August 2013

    HER negative is a good thing! Since you are also ER positive, I would request the Oncotype DX test which would give you additional info with respect to whether the risks of chemo would outweigh the benefits. While the Oncotype DX test is more validated for traditional IDC, patients with rarer types of tumors, like ILC and mine, mucinous, are having the test. Good luck!

  • Momine
    Momine Member Posts: 7,859
    edited August 2013

    Hollyboo, I am not sure what your onc means with that. As far as I know, the statement is not backed by the literature. I would definitely get a second opinion.

    Did you have any positive lymph nodes? Did you have a mastectomy or a lumpectomy? Was there lympho-vascular invasion? Did they do the oncotype test?

  • mary625
    mary625 Member Posts: 1,056
    edited August 2013

    In my case, it was a must-do because they knew I had a positive lymph node upon diagnosis. You didn't mention your lymph node status. If they were all negative, then you can have the Oncotype test as mentioned above and it should help to make a decision. Because I had chemo before surgery, I was able to monitor for myself that the tumor and lymph node shrunk. However, I did not have anywhere near a complete pathological response. What I heard from my onc was that the ER+/PR+ tumors do not respond as well to chemo, but that they have the additional endocrine treatment like aromatase inhibitors afterwards. I never heard anything about ILC itself not responding as well except unofficially.

  • hollyboo
    hollyboo Member Posts: 89
    edited August 2013

    TooMuch (Great name!), What were your treatments?  And how have you fared with them and on the other side?

  • hollyboo
    hollyboo Member Posts: 89
    edited August 2013

    So I misunderstood my oncologist.  No chemo due to ER/PR+.  

    I am HERS-, no lymph noded involved, positive margin at my chest wall muscle.  PILC there and 3 ILC tumors.

    It is the pleomorphic type plus the positive margin that is scaring me re: no chemo.  But if it will not help, why do it. Plan: 25 radiation txs plus hormone blockers.

    Will get second opinion.

  • hollyboo
    hollyboo Member Posts: 89
    edited August 2013

    Oh, and I will find out if I had an Oncotype DX. If not, will ask.   And I had mastectomy.  Forgot to say that.

  • Gitane
    Gitane Member Posts: 1,885
    edited August 2013

    Hi Holly,  I had almost a complete response to neoadjuvant chemo.  I had AC.  My onc told me at the time that in his experience pleomorphic lobular responded well to chemo.  Chemo was also recommended by my second opinion at an NCI center.   I had almost a complete response to neoadjuvant chemo.   While classical ILC may not have a pathologic complete response as often as IDC, chemo can still be of benefit to ILC patients.  You are getting good advice from the ladies above.  Glad to hear you have no lymph nodes involved.  Hugs, G.

  • toomuch
    toomuch Member Posts: 901
    edited August 2013

    hollyboo - I saw 3 medical oncologists, 2 at NCI designated cancer centers, who all recommended chemo for me despite my low oncotype score, 12, and my small primary tumor, 0.9 cm. I had 2 large positive nodes with extracapsular extension. I received DD (Dose Dense) AC x4 followed by DD Taxol x 4, radiation, an  oophorectomy and Arimidex. I just reached the 3 year mark and so far so good. I had a BMX and reconstruction I have some hip pain from the the Arimidex or secondary to chemo but not every day and it's nothing that Ibuprofen doesn't take care  of. I've been back at work FT since I finished radiation. It's sounds cliche but I do many things now that I would not have done before cancer and I am enjoying life!

    I think that the most important thing is to be confident in your treatment plan. Wish you the best.

  • melmcbee
    melmcbee Member Posts: 1,119
    edited August 2013

    My breast surgeon wanted me to have chemo before surgery to shrinkbthe tumors but my oncologist said no to that. He said ilc doesnt respond as well as idc to chemo prior to surgery and wanted to do chemo after surgery. Once it was determjned that i had eight positive nodes with extra capsular invasion than i was told that i had to have chemo. After i had a bmx i ha chemo than i also had radiation.

  • gavinsgrandma
    gavinsgrandma Member Posts: 407
    edited August 2013

    Melmcbee, I feel like I will be following in your footsteps, being a ILC girl and my surgery was 7/18 with 15/15 bad nodes and my PET showed more node involvement and maybe even an incapsulated invasion as well, but everything else looked good on pet all normal😄I start 8 months of chemo next week 8/15 then rads so if I follow your lead maybe I will be starting my recon next May or June. My PS did not put my TE'S in during surgery because of + nodes and he did not want any infection to delay my treatment, hard to swallow at first but in my heart I think he made the right decision.



    Shary🌞

  • Momine
    Momine Member Posts: 7,859
    edited August 2013

    Shary, I know it feels weird to be boob-less at first, but give it time. I did not have immediate recon for similar reasons. Now that I am 2 years out, I am not sure I ever will.

  • hollyboo
    hollyboo Member Posts: 89
    edited August 2013

    All you wonderful women,



    Thank you so much for your feedback and sharing your own experiences.



    I have a name now for a second opinion. Got copies of my path reports and the plan is not filled out, despite the fact I start radiation on 8/20. I will ask the chemo questions.



    I have been quite upbeat and strong through all this for the most part. But it is the little things that add the breaking into tears point. Diagnosed w bladder inf yesterday. And at today's one year follow up to uterine cancer and hysterectomy w radiation, a tag of skin at the surgical site was taken and will be biopsies.



    And then I find out looking at the path reports that the docs knew I had pleomorphic ILC BEFORE my surgery. When I went in to surgery, I thought I had IDC and if no nodes were involved, I was done due to ER/PR+ status. I dunno where the communication broke down.



    Is breast cancer diagnosis and treatment EVER straight forward?



    Also, I misunderstood positive margin. I thought they did not get enough clean tissue margin around the cancer. But it means they did not get all the cancer. I thought the cancer was out of me. It is still there in my chest wall. So scared.



    Today has been one of those everything is in my face days and hard to see and feel refreshed by the sky, the water, the trees, my amazing friends, my young adult kiddos who are thriving.



    As my friend said, this is the place of feeling sorry for yourself....with ATTITUDE!



    Thanks all.

  • Colette64
    Colette64 Member Posts: 25
    edited August 2013

    I had not heard about that fact, is there an article somewhere about the benefits of chemo for ILC versus IDC. I did read that for any cancer with a low oncotype, even with node involvement, (albeit 1-3) , chemo is not beneficial.

    I am debating that myself right now. My onc does not WANT to do the oncotype for my cancer because he is afraid that if it is Iow I will hesitate to get chemo. I prefer to know what my oncotype is, and then make an informed decision. Therefore I am getting a second opinion.

  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited August 2013

    Colette...lobular breast cancer often behaves like slow growing cancers. Chemo is usually more effective on fast growing tumors. So, it's not uncommon to see a low Oncotype DX score with slow growing rarer cancers. Remember though, the Oncotype DX is just one tool of many in deciding if chemo is warranted. Check out the NCCN 2013 breast cancer treatment guidelines while also getting several opinions. And by all means, if you are ER + and your insurance pays for the Oncotype DX test... Then get it. Furthermore if you are premenopausal, ask about the SOFT trial. That study is looking at whether or not ovarian suppression is an alternative to chemo.

  • Colette64
    Colette64 Member Posts: 25
    edited August 2013

    Wow! Thanks voracious !

    Everything you wrote really resonates. In my Nottingham score, the mitotic rate is very low, which seems to confirm the cancer is a slow growing one. I had that thought in the back of my mind that since chemo attacks fast reproducing cells, it could actually miss my cancer, and just kill my hair :-)

    I am not against chemo, but I am trying to make sure I really need it.

    I will check the SOFT trial, thanks for the info.

  • edwards750
    edwards750 Member Posts: 3,761
    edited August 2013

    Agree voracious about the Oncotype test. FYI I had it done and it saved me from chemo. Insurance paid for it but Genomic Labs who conduct the testing will work with you on a sliding scale if you cant afford it. I heard they have come down from the initial cost of the test. I also agree dont rely solely on the results of that test but I have to admit aside from not having chemo having such a low score - 11 and an 8% chance of recurrence gave me a dose of optimism. Of course there are no guarantees but it is reassuring that this test was done on the biology of your cancer irrespective of family history and other factors. The results, for me, came back in 10 days. Good luck...diane

  • Colette64
    Colette64 Member Posts: 25
    edited August 2013

    Thank you Diane. I got a call from genomics, and they said my insurance okayed the tests. I had two tumors on the same breast so the onc wanted both of them checked.

    Unfortunately, in the meantime, I got started with chemo, first cycle was this morning.

    My onc said that all studies about not giving chemo to low oncotype apply to study groups with one tumor only, so I should be careful about applying those findings to my case.

    I will get my two oncotype scores nevertheless, because if they are low they will give me some optimism for my future, and if they are high, it will give me more motivation to pursue the chemo.

    Hope it is low ....

  • Deborahanne
    Deborahanne Member Posts: 181
    edited September 2013

    Hello everyone! I'm just now joining the forums. I appreciate all the information. I'm 57 years old, diagnosed in June, had my surgery in July and am starting chemo tomorrow. My oncotype score was 22 (intermediate range) and since my tumor was 3.5cm my oncologist recommends light chemo. He really left the decision up to me to have chemo or not, and he said that even if I just have one treatment and quit then that's better than no treatments. So I'm going to give it a try. Colette, I hope you are doing well after your first chemo treatment and that your Oncotype scores are low.

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