Question from a newbie on treatment plan

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Lizo_biker
Lizo_biker Member Posts: 10
edited April 2017 in Triple-Negative Breast Cancer

Greetings!

I'm newly diagnosed with TNBC. There is some question on the size of the tumor- long story that involves typos on my report, and confusion on whether or not this is 1 or 2 tumors; my BS went and looked at the x-rays, says its not as big as originally thought; they're also still not sure if its 1 or 2. Bottom line, it's probably 5+ cm if its all 1 tumor, so T3, grade 3. MO wants to do neoadjuvant chemo. My MO is currently calling this stage 2b, but could be 3a, we're not yet sure if lymph nodes are involved- he thinks they aren't, but I'm not sure what that's based on.

I'm getting an MRI next week, but my understanding from the BS is that we won't know for sure if the there is lymph node involvement without a sentinal node biopsy. I'm getting a VAP put in this friday, but the MO didnt want to do a node biopsy- BS said it wouldn't change the treatment plan if we knew if there was node involvement or not.

My MO seems great, part of the Stanford network, we're currently planning on AC-T and Carboplatin (sp?) - I'm still learning all the terms and technology, lol. Once my genetic tests and a few other tests are back, we'll finalize the treatment plan, but looks like i may qualify for a clinical trial.

Anyway- my question is, is this normal for neoadjuvant chemo patients to not know if you're NO or N1? The surgeon said if I respond well to chemo, then its sometimes difficult to tell node involvement when we do surgery 6 months later (I'll be doing 2 rounds- 1 8 weeks, 1 12 weeks). Is there a reason for me to push to have a sentinal node biopsy when they do the VAP?


Thanks for any info!!


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  • Yvette66
    Yvette66 Member Posts: 17
    edited March 2017

    High Lizo:

    I know this post is almost two weeks old so I suspect you have proceeded in one way or another... Did you pursue the sentinel node biopsy? How is your treatment going?

    I can't say if it is normal for patients to "not know" about lymph node involvement but I do understand why they say it would not change the treatment plan. I had a needle biopsy done at the time of my tumor biopsy on a node that looked suspicious on ultrasound and MRI. It came back positive but that did not alter the treatment plan in any way, it only freaked me out more... I had the same chemo that you will be having and had subsequent lumpectomy with sentinel node removal. All pathology came back clear, no cancer cells found in node or where tumor had been.

    My first thoughts on this are that they are pretty good at seeing signs of disease in nodes on ultrasound and MRI. Also, the chemo you are having would be treating your nodes just the same as your tumor. Do you know if your surgeon plans to remove the sentinel node at the time of surgery? Did you sort out if it is one or two tumors? What is your surgical plan?

    Hope all is going well with your treatment and your plans. There is every reason to be positive for an excellent outcome!!

    Yvette

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  • Lizo_biker
    Lizo_biker Member Posts: 10
    edited April 2017

    Hi, Yvette66-

    Thanks so much for your response!! I've since found out that I'm BRCA1 positive, so my surgical plan is now a double mastectomy. Luckily, I already had an oophorectomy about 7 years ago, so at least I'm ahead of the curve there;). I start chemo tomorrow; I'm both nervous and excited to get going on this!!

    The MRI showed no node involvement, and we didn't do a sentinel node biopsy when we put my port in; i'm assuming they'll check when we do the mastectomy, but that's 6 months away, so we haven't really discussed yet. My surgeon did say that if i have a good response to chemo, it will be difficult to tell if there was node involvement- something I'm hoping for;) They're calling this all one tumor "structure"- it looks like two smaller tumors with a connection, almost like a yin/yang symbol in the MRI.

    My surgeon feels comfortable calling this N0 based on the MRI, ultrasound and physical exam- but i also know there are the macronets that can't be found without a biopsy. For now, I'll take the IIb staging, and hope it's accurate!

    Overall, I'm feeling pretty good about the treatment plan, and very positive about the outcome; though that's probably a lot easier to say the night before I start chemo;) thanks again for the support.

    Liz




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