When I chemo required?

Hi Snowflake67:

It would be helpful if you could fill out your profile, with tumor type (e.g., IDC, ILC), estimated size, and ER, PR and HER2 status.

Sometimes, people have a mixture of non-invasive DCIS plus some invasive disease. In that case, the DCIS needs to be removed, but the features of the invasive disease and lymph node status drive the treatment plan.

The below assumes Stage I or higher disease, which is by definition "invasive" breast cancer, meaning that it has broken out of the ducts or lobules into the surrounding breast tissue.

The invasive breast tumor has been in there a long time before surgery. There is some risk (even in node-negative disease) that some of the tumor cells were capable of metastatic spread, and that some cells may have escaped the breast to distant site(s) via the bloodstream or lymphatic channels, laying the foundation for metastatic recurrence. The main purpose of "adjuvant" chemotherapy administered post-surgery is to kill any cells that may already have escaped to distant sites.

The role of the medical oncologist is to use available clinical and pathologic information to determine the patient's risk profile (e.g., the risk of suffering distant recurrence), and to recommend appropriate treatments for consideration in light of the risk profile and patient presentation (e.g., age, co-morbidities).

With invasive breast cancer, such as invasive ductal carcinoma ("IDC"), if "systemic drug treatments" are recommended, they may include one or more of:

(1) Chemotherapy; and/or

(2) For HER2+ disease only: HER2-targeted therapies, such as trastuzumab (Herceptin), pertuzumab (Perjeta)); and/or

(3) For ER+ and/or PR+ disease only: Endocrine therapy (also called hormonal therapy) to block the action or production of estrogen, such as tamoxifen or an aromatase inhibitor ("AI").

Whether one or more of these are considered or recommended depends on various factors, including the histology (e.g., ductal, lobular, etc.), size of the tumor, lymph node status, estrogen receptor ("ER") status, progesterone receptor ("PR") status, and HER2 status, as well as other factors such as grade, certain test results if appropriate (e.g., OncotypeDX test for certain hormone receptor-positive, HER2-negative patients), personal medical and family history, age, and co-morbidities. Some women may receive endocrine therapy only.

In some cases, systemic drug treatment is given prior to surgery ("neoadjuvant" treatment), for example in some cases of "triple-negative" (ER - PR - HER2-) or HER2-positive (HER2+) disease, particularly if the tumor is larger and/or there is node involvement.

Otherwise, surgery is the first step in treatment, and the results of the surgical pathology, lymph node biopsy, and possible additional test results (e.g., Oncotype), will provide information that shapes your treatment plan.

Best wishes for a smooth surgery and the best possible pathology results.

BarredOwl

Hi Reka:

Welcome. It sounds like you have already had surgery? The guidelines for treating HER2+ disease may differ according to various factors, such as tumor histology (e.g., ductal, lobular, etc.), tumor size, lymph node status, and/or hormone receptor status. Among HER2+, node-negative (N0) patients, the tumor size is an important consideration.

There is a HER2+ forum and various topics which are relevant to different situations.

Forum: HER2+ (Positive) Breast Cancer: https://community.breastcancer.org/forum/80

You can start a new topic there, or find one to join.

BarredOwl