Treatment options!

Nick60F · November 2016

Thank you barbe1958! Yes it's good to have a plan but I think the chemo may be tough. Feeling slightly gloomy right now, just pondering what may or may not come to pass. I realise that's a total waste of mental energy but hard to snap out of it sometimes

muska · November 2016

Nick, glad to hear you have a plan. TAC regimen is not the same as AC+T but similar.

Good luck with the plan!

mellee · December 2016

Nick, did your oncologist give you the option of taking the Mammaprint? It's a genetic biomarker test that measures your risk of distant metastatic recurrence within 5-10 years (which is when you get the primary chemo benefit). I mention it because it's the reason I'm not getting chemo even though I had a 2.3 cm tumor with 2 positive lymph nodes.

My story is slightly similar to your wife's. I had a mastectomy on Nov 8, and was expecting clear lymph nodes. They were clinically negative on physical examination and MRI. Even during the sentinel node biopsy part of the surgery, they appeared and felt normal (usually cancerous lymph nodes are large and hard). So my surgeon was shocked when the intraoperative pathology came back positive for 2 of 5 nodes. Turns out I had macrometastases in 1 node (largest deposit was 3 mm) and micrometastases (< 2 mm) in a 2nd node. Based on that, they did a Level 1 and 2 axillary dissection, with 27 additional lymph nodes examined, all of which came back clear.

Because of the positive nodes, my oncologist originally said I needed chemo. But I asked for the Mammaprint test. It came back that I was low risk and she totally reversed course. My surgeon also presented my case before a tumor board, and they were unanimous in the decision to forgo chemo, primarily based on the Mammaprint results.

If you can postpone chemo and get the test, I highly recommend it. If you fall in the low risk category, the 5-year distant metastatic risk for those with 1-3 positive nodes is 4.4% (the rate for node-negative is 3.3%). More importantly, chemo only decreases risk by 0.7% in the low-risk population, so there is little to no benefit over endocrine therapy alone.

Nick60F · December 2016

Hi melee, thanks for your reply and aplogies for not replying sooner. I'm not sure how much we use Mammaprint in the UK, but we definitely use oncotype DX which does the same kind of job. I think oncotype was on the cards until the positive node came up. On its own that may not have meant chemo, but coupled with grade 3 and LVI it was enough for our oncologist to say chemo. On the basis that we had quite a small tumour (approx 1cm) that had moved as far as the sentinel node, the onc speculated that the oncotype may have come back at least intermediate and possibly high. In the US I think they would just do the test rather than speculate. That's certainly what the Hopkins Breast Center said when I used their 'ask an expert' free service. Anyway, we are now on TAC, one down five to go. Chemo for Christmas :-(

Best of luck to you :-)

ruthbru · December 2016

I think she is doing the right thing. It isn't any fun now, but it will give her insurance and reassurance in the future. Best of luck!

mellee · December 2016

Best of luck to you and your wife as you go through treatment. Sending you good thoughts!

Nick60F · December 2016

Hi all, we saw the onc today ahead of next week's 2nd round of TAC. My wife had CT and bone scans early December. Results were all clear except CT showed two axillary nodes that looked slightly enlarged. We had one sentinel node removed during MX and that had a 2.5mm met. Based on that small node met, I was kind of hopeful that the node involvement was limited to that, but this latest information makes me worry a little more. The onc did say that the enlarged nodes were only about 1cm, and in his opinion they might be reactions to the surgery and SNB rather than more cancer. Has anyone encountered this sort of situation? In late September prior to surgery the axillary nodes all looked normal on ultrasound so I'm leaning towards the theory that this is a reaction rather than more nodal involvement. Wishful thinking? Hopefully not!

muska · December 2016

Nick, is she going to get radiation? If so they will radiate axillary nodes. 2.5 mm of cancer is considered macro mets, that is not small.

Nick60F · December 2016

Hi muska, yes rads are in the plan. The question I asked above doesn't really need an answer from a medical perspective - the treatment plan won't change. It's just me trying to get my head around what stage my wife is at. If that sentinel node met had been half a mm smaller we'd be stage 1b. If these two slightly enlarged nodes are positive, then we are up to three nodes in total and not that far from stage 3a - it feels like a big difference, but does it matter - probably not!

muska · December 2016

Nick, staging is no more than grouping of cases based on spread evaluation. The most important thing is, they didn't find distant mets. Up to stage 3a this is considered to be early stage breast cancer.

lisabekind · February 2017

Nick60F- curious, how's everything going? I'm kinda in the same boat, but with 2 sentinel positive nodes, and 1 positive node.

Nick60F · February 2017

hi Lisa, sorry i haven't logged on for a while. We now have a plan. My wife has just finished round 4 of TAC so 2 to go. Chemo was always in the plan, it was the next bit we were waiting for some news on. We are going down the RT route. Several reasons - they seem to think my wife probably has minimal disease in the axilla. When they did the sentinel node imaging one node showed very strongly with absolutely no dye taken up elsewhere. She had 2.5mm of cancer in that sentinel node, so their judgement is that there is probably not much happening elsewhere. Second reason for RT is that they said they would extend the RT treatment to the collar bone area which would treat nodes that would never be considered
for surgical treatment. In that sense they would consider RT to be a 'more complete' treatment- our oncologist's words. That second point was the clincher for us. Good luck on your treatment journey:-)

Treatment options!

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