Micro Metastic tumor

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Hi Everyone!

I am 43 years old with two children (12 & 10), married, I work, very healthy, super athletic!

Just had a lumpectomy, "infiltrating ductal carcinoma is 2.6 cm." There is now no evidence of carcinoma or involvement beyond the cyst. I also had a sentinel node biopsy. Just two nodes taken. Pathology report says one node is negative tumor the other node says "one lymph node with Micro-metastatic tumor" is 1.5mm. I'm considered stage IIB. Estrogen receptor positive, progesterone receptor is positive, Her2neu is negative, score +1. Tumor is grade 3.

My Treatment plan given by my Oncologist:

"A/C" = Adriamycin/Cytoxan once every other week x 4

"T" = Taxol once a week x 12

Then, Radiation for approximately 6 weeks

Lastly, will take hormone therapy for approx 5 years. Most likely be put through early menopause.

My question to the group is the chemo part. Trying to find a way out of chemo and get a second opinion. Is this the best plan for me? The side effects of chemo seem pretty serious. Why not just radiation and hormone therapy, why all three? Will I ever be able to do a triathlon again?

How do I know if I go through all three treatments that it won't come back again? So many unknowns!

Thanks Everyone!!

Comments

  • Beachbum1023
    Beachbum1023 Member Posts: 1,417
    edited March 2015

    Hi canderson, Welcome to our club! I would ask the MO with the plan for answers to those questions also. And a second opinion would be beneficial as well. The MO may be concerned with the node with the micro-met, but ask to be sure why the AC/T. I am not a medical professional so best to check with the MO. I did have AC/T, and many women have it as well. You can also find the info for chemo at chemocare.com, check the drug info. Note the various side effects etc. to discuss with the MO. The good thing is the + status, you can have hormone therapy. So more treatment options for you.

    Usually it seems that rads are done after the lumpectomy, I am just finishing with 3 more days to go. Being an athlete and super active note any specific side effects that would be important to you. Quality of life is very important, and you are already aware of that. I don't think we can ever know that it won't come back, but I do know that we control what we are going to do stop it. But there are alot of unknowns on this path, and self education is key! Visit the American Cancer Society site, they can be helpful. Stay away from Dr. Google, the info is usually outdated or wrong from mystery sources. Your hospital may have a site as well.

    Ask questions, info is power! Good Luck!

  • Moderators
    Moderators Member Posts: 25,912
    edited March 2015

    Hi Canderson,

    Welcome!

    Beachbum has given you some great advice so far, you may also find the links below enlightening regarding whether or not chemotherapy is the right choice for you.

    This one explains the oncotype testing and how it can be useful in determining your risk of recurrance as well as how likely you are to benifit from chemotherapy http://www.breastcancer.org/symptoms/testing/types/oncotype_dx

    This is a brief outline of common treatment options for IDC patients. http://www.breastcancer.org/symptoms/types/idc/treatment

    Sending you hugs and warm wishes

    The mods.

  • muska
    muska Member Posts: 1,195
    edited March 2015

    Hi Canderson, chemo is quite doable especially if you are healthy and young as you are. And with a positive node you need a systemic treatment. You will read a lot of horror stories about chemo but please remember that most people tolerate it well, especially with preventative anti-nausea and other meds that are now part of the protocol.

    Are you sure AC would be every other week? In my case, the interval was three weeks. BTW, I worked through 6+ months of chemo, never experienced any nausea and I was a dozen years older than you are now. I am not saying it was easy but it was doable. No significant long term side effects so far. Good luck!

  • SelenaWolf
    SelenaWolf Member Posts: 1,724
    edited March 2015

    The recommendation for chemotherapy comes from 1) your relatively young age; and 2) the positive lymph node. As my surgeon explained to me, if the average woman in North American now lives to the age of 84 years, at 43, you have 41 years to get through disease-free. Chemotherapy (radiation + hormone treatment) will increase the odds of being able to do that in your favour. Unfortunately, once you have invasive breast cancer with positive nodes, you will always be at risk to develop it again. So, it is possible that you can go through all three treatments and, somewhere down the line, it may still come back. But, then again, it may not.

    Many, many women struggle with the necessity of undergoing chemotherapy and, for some, the benefits may not outweigh the risks. Our first instinct is to avoid it if we can. But the truth is, that - under certain circumstances - it can make a difference for long-term survival. The hard part is deciding whether- or not you think that difference is worth the short-term side effects.

    I - like you - had a lumpectomy for a Stage 2, hormone-positive breast cancer with one positive lymph node. I had a left-sided lumpectomy, followed by dose-dense AC+T (every two weeks) for four months, 6 weeks of radiation, and am, now, into my third year of tamoxifen. During chemotherapy, I followed the MO's instructions about the anti-nauseants meticulously and did not suffer any nausea or vomiting, although I did - towards the end - get very, very tired. Radiation passed uneventfully and I have had very few side effects taking tamoxifen. Because I was 50 years old at the time of treatment, chemotherapy threw me headlong into menopause and I had an uncomfortable two weeks, then, poof! Gone! I've not had any further issues.

    Absolutely, get another opinion if you are not sure about what you are being told, but - if you are basing your decision as to whether- or not to have chemo on the certainty of never getting breast cancer again - I would suggest, instead, that you look at it more along the lines of what will increase your odds of long-term, disease-free survival instead.

    Good luck.

  • inks
    inks Member Posts: 746
    edited March 2015

    Your only way out of chemo might be the Oncotype test. It would show how likely your cancer is to recur with just hormone therapy. But I have a feeling your doctor did not even mention it because of your age, they prefer to treat anyone under 50 agressively. I was 36 and had 2 micromets in the lymphnode, chemo was for distant metastasis, radiation for local recurrence. I had my lymph nodes radiated instead of the full axillary node dissection. I think because grade 3 tumor chemo might be avoidable. Some young women with small grade 1 tumors have done just radiation and hormone therapy, but that's only stage 1 and grade 1. You'll do fine with chemo, just keep up your exercise, it helps with muscle and bone pain. I did the AC every 2 weeks as well, it goes faster that way and you get back to your old life quicker.

  • dltnhm
    dltnhm Member Posts: 873
    edited March 2015

    Canderson -

    So sorry you have to go through this - but glad you found BCO.

    I'll address this portion of your question. Yes - you will almost assuredly be doing triathlons again! Although each person's response to his/her individual chemotherapy is specific to him/her - there are lots of us who do just fine all through chemo.

    I had the same dense dose AC 4xs over 8 weeks and then 12 weekly Taxols. I ran once I was cleared by my BS & reconstruction surgeon following a unilateral mastectomy (with DIEP reconstruction) at the 6 week mark.

    I ran throughout my chemo months ....ran throughout my radiation treatments ...& even did a Firefly Run in Chicago the day after my rads ended.

    There are threads on BCO for runners ... I happened to be involved with a thread for Chemo February 2012 & we had another runner (a male pediatrician & grandpa) in our group. He and I encouraged each other along.

    He actually flew to Boston to do the marathon in 2012 - it was the one where the heat sidetracked everyone. The better course of valor was for him to wait until 2013. And so he did. He was about a mile - mile & a half from the finish line (if memory serves correctly) when the bomb went off. He wrote up his story & it is on the running thread that year.

    Forgive my getting sidetracked.

    I just want to encourage you - if you do end up having the chemo - it doesn't take everything ;-)

    Feel free to private message me if you have any questions. Or ask right here.

    Diana

    I'll try to post a link to the 2015 running thread. If it doesn't work for you - put "2015 Running Thread" in the search bar. You will find links to the thread which is in the "Fitness & Getting Back into Shape " category.

    https://community.breastcancer.org/forum/58/topic/827338?page=5#post_4327388

  • muska
    muska Member Posts: 1,195
    edited March 2015

    Quick comment about Oncotype test. I don't think it is routinely offered to those of us who have positive nodes.

  • snorkeler
    snorkeler Member Posts: 145
    edited March 2015

    My IDC was smaller than yours, 9mm, but like you I also had one lymph node with a 1.5mm micromet. My MO ordered the Oncotype type test which came back low, so she did not recommend chemo for me. She explained that before the Oncotype test was developed, I would have automatically been given chemo based on my relatively young age (41 at diagnosis). There are no guarantees against recurrence, but I will have done the standard of care for my situation, and I'm comfortable with that.

  • Leighrh
    Leighrh Member Posts: 317
    edited March 2015


    Just wanted to chime in on what the other gals have said.... I have almost the exact same situation as you.. Lumpectomy got clean margins of my 2.5 cm IDC.  Had a very small amount 3.5mm in 1 of 3 nodes taken.  My MO says that I am the poster child for chemo.  ACT works best on me (Lucky me) :)  I too am 42 have two active boys (8 and 9)  I am a crossfit junkie and super active!  I also work.  I have the same regime.. 4 rounds of AC followed by 12 weekly Taxol then 6 weeks of radiation.  I start March 26 and am super nervous but I am praying I am one of the lucky ones that can make it through with little  side effects.  I plan to go to my gym everyday that I am able!!! I really hate to have to do chemo( the hair part is really what I can't get past) but I know it's my best chance to not have to worry about this pesky cancer coming back!!

  • inks
    inks Member Posts: 746
    edited March 2015

    Muska - Oncotype is for node negative and for those with 1-3 positive nodes.

  • muska
    muska Member Posts: 1,195
    edited March 2015

    Hi Inks, you are right, the test is marketed to node positive patients too. Here's the link: Oncotype DX Assay

    The test quantifies the 10-year risk of local recurrence - with unclear accuracy especially if one is node positive. Have you seen any studies indicating how accurate it is if patients are node positive? I saw this on NCBI website but this is not recent: Use of Oncotype in Node Positive Women

    Editing to add that a trial is currently under way that might answer the above question: Trial

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