confused 2 very different opinions on treatment

Sssonia · February 2015

Hi I have IDC that invaded my beast tissue with local lymphatic involvement as well as skin involved . My MRI noted an abnormal 1.2cm lymph node. Have seen 2 different oncologists with very different treatment plans.

Plan 1: total skin sparing masectomy with same time reconstruction then chemo + herceptin (my Bx was HERS 2 positive ) for 6 to 12 months no radiation then antihormonal therapy (ttumor marker + estrogen and progesterone )

Plan 2: neoadjunctive therapy (chemo before surgery ) then total masectomy most skin removed and possibly muscle due to size of the tumor and because I already have implants which surgeon said makes my pectoral muscle thine more likely making muscle tissue involvement ) then more chemo then radiation (he said cause my skin was involved andlymph) then reconstruction surgeries at end.

Dr. In plan 1 wants to schedule surgery next.

Dr in plan 2 wants to send me for neneedle BX of lymph node and get chemo started ASAP .

These plans are 365 degrees in different . Anybody out there what TX have you done. Anybody was in a similar situation ????

Meow13 · February 2015

I would ask both doctor's why the treatment suggested is so different. Maybe they could consult with other Mo's. Remember in the end it is your decision.

ml143333 · February 2015

Can the MO's take your case to their tumor board to get more input?

Sssonia · February 2015

Yes these 2 different opinions are from 2 different Dr. I went for a second opinion because of a friend advice (she didn't choose or told me who to go with for second opinion )

SpecialK · February 2015

I am thinking that the doctor who is recommending neoadjuvent chemotherapy wants to use Perjeta in addition to the chemotherapeutic agents and Herceptin for the Her2+. I don't know if your cancer is considered early stage because of the suspected size, nodal status and possible skin/muscle involvement, but Perjeta is FDA approved to be given prior to surgery only. Some oncologists have been successful with getting insurance to pay for it after surgery, but those seem to be exceptions. I would be wary about sparing skin if there seems to be skin involvement, and also not radiating if there is skin, muscle, and lymph node involvement. If you opt for the neoadjuvent treatment I would inquire about having a SNB (sentinel node biopsy) done when you have your port placed, prior to starting chemo so that you have a more clear idea of stage.

YoungTurkNYC · February 2015

sssonia,

I did not have her2+ cancer but from what I have read Plan 2 appears to be more in line with cutting edge treatment for this type of cancer. I believe skin involvement makes you stage III. I would definitely ask your doctor exactly what drugs she/he plans to use as a neoadjuvant therapy prior to surgery. Also, if you have surgery first, you have to wait for a few weeks until you can start chemo which delays it. In addition, if you have chemo/Herceptin/Perjeta first, you will know first hand whether your tumor responds to these treatments.

Hopeful82014 · February 2015

I think regardless of whether it's a sentinel node or not, that abnormal node should be biopsied. Otherwise, I second what YoungTurk and SK have posted.

Kicks · February 2015

Neoadjuvant chemo is SOP for IBC and is becoming more used with other types. Neoadjuvant will, in the case of IBC, get it to form a 'lump' and shrink it along with getting margins. From what I have read with other types the idea is to shrink so less invasive surgery may be needed.

It is possible to do neoadjuvant and adjuvant Chemo.

confused 2 very different opinions on treatment

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