No need for chemo?

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Brightness456
Brightness456 Member Posts: 340
edited July 2017 in Chemotherapy - Before, During, and After

Hi everyone. My new doctors are questioning my numbers on the biopsy pathology report. They plan to base my plan off the pathology from my lumpectomy. Two doctors mentioned that I may not need chemo, just surgery and radiation. My question is, what numbers (ER/PR, her2?) would make this possible. My tumor is now thought to be 8.something mm (it was a long day and I simply can't remember the exact number). I'm trying not to get my hopes up, but want to be educated and ready to ask the right questions when the discussion resumes. My surgery is August 10.

Thank you in advance. I'm so thankful for this community and your knowledge

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  • windingshores
    windingshores Member Posts: 704
    edited July 2017

    Your doctors are probably right: my pathology from biopsy differed from pathology after surgery!

    If you are HER2- and strongly ER/PR+ then you may be able to rely on a hormonal approach (tamoxifen or aromatase inhibitors). They will probably do an Oncotype Dx for you to determine whether chemo is a good idea or not. (The Mammaprint is being used for ambiguous cases, apparently, and includes those who are HER2+ or ER/PR-, but others know more about that test).

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  • sweetp6217
    sweetp6217 Member Posts: 365
    edited July 2017

    I'm HER2+ with invasive ductal carcinoma (main lump now 3.3 CM) and lymph carcinoma as well. Chemo first for me, then lumpectomy (hopefully), possibly followed by radiation. My diagnosis did not include the possibility of using Tamoxifen, etc.

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  • Brightness456
    Brightness456 Member Posts: 340
    edited July 2017

    My original pathology said ER/PR <5.5 which was interpreted as - for each.

    It also said her2-, then after fish analysis it said her2+.

    My KI67 was 96%

    My new doctors said based on my numbers, they may have considered my ER/PR+ and based on the new numbers, they most likely wouldn't have even dine the fish analysis, thus would have interpreted my her2 status as negative. Based in the slow growth of my tumor, they thinkmthe KI67 number is incorrect and said many places don't even use the KI67 number because it is often incorrect. So essentially, starting over with a detailed specimen makes sense. Still, I don't understand what numbers would indicate no need for chemo and what would be necessary instead.

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  • lovepugs77
    lovepugs77 Member Posts: 296
    edited July 2017

    Brightness, are they doing a sentinel node biopsy with the lumpectomy? That was the deciding factor for my team. Prior to that, I was only going to have surgery and radiation, but then came back with four positive nodes, so I needed chemo, too.

    Have they talked about doing an oncotype test? Often the chemo decision is based on that

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  • Brightness456
    Brightness456 Member Posts: 340
    edited July 2017

    Yes, they will do the SNB. At this time there doesn't appear to be node involvement so fingers crossed about that. That's a good point about the oncotype dx. I asked about the mammaprint test since I was assuming I was her2+, but I don't think we discussed the oncotype test. I'll have to make note to call about that Monday. Thanks for the suggestion. :

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