Help with treatment plan!!!

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FindingACure88
FindingACure88 Member Posts: 6
edited March 2018 in Just Diagnosed With a Recurrence or Metastasis

My mom was 14 years in remission from stage II lobular breast cancer when she found an axillary mass on the side of her mastectomy. Prior to her surgery a full bodyPET scan was completed which showed that cancer was contained to the right axilla only, praise the Lord. She is 54 years old and otherwise completely healthy.

She had a right axillary lymphadenectomy where they removed a large (7cm)tumor with extensive matting of lymph nodes. The entire tumor was successfully removed along with 3 other surrounding lymph nodes were, all of which were positive for cancer.

Pathology showed she is ER positive, however only 15%. She is PR negative and HER-2 negative. Her Ki-67 score was 20% and her genetic panel came back negative.

After meeting with her oncologist, it was decided that she would undergo 6 weeks of radiation, starting 3 weeks post op. After this she will be taking a hormone pill.

My question is, does it seem odd that she will not receive chemo? Her oncologist was very optimistic saying it wasn't indicated because the cancer was so well contained. However, I'm nervous by the node involvement. Does his confidence come from the clear PET scan? Doesn't 15% ER positive seem like a low percentage? I truly trust her doctor as he spent his residency at MD Anderson, but I want my mom to have the best possible treatment plan. Any advice or input is appreciated!

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Comments

  • KBeee
    KBeee Member Posts: 5,109
    edited March 2018

    Her hormone percentages are not that strongly positive. I would strongly recommend a second opinion. I has seen an oncologist at Mayo with my recurrence who was certain that my recurrence must have just been something left behind and that I only needed radiation and a switch to an AI. My gut said I needed chemo. I sought s second opinion closer to home and asked to have an oncotype run. It came back very high, so chemo was started. My MO chatted with Mayo, who at that point agreed.

    Seek multiple opinions and also request that the oncotype be done. She has many positive nodes, and a weak hormone percentage. Any MO worth anything will always support you getting a second opinion. Mine has encouraged it and told me he was fine if I wanted a third opinion.

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  • sheila888
    sheila888 Member Posts: 25,634
    edited March 2018

    Definitely a second opinion needed

    Good luck

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  • FindingACure88
    FindingACure88 Member Posts: 6
    edited March 2018

    Thank you guys for your input, I think a second opinion is a good idea as well. Initially the plan was for surgery, radiation, and then chemo. However, after the clear PET scan they decided they wouldn't do chemo. I thought that the treatment plan seemed a little backwards to begin with, don't people usually undergo chemo first and then rads? This whole process has such a learning curve! I appreciate your input greatly.

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  • Georgia1
    Georgia1 Member Posts: 1,321
    edited March 2018

    Hi there. There are so many factors; it is possible it's her HER status and low Ki-67 score that are making them think chemo is not necessary. The main thing I think is to convince your mom to take her time and ask lots of questions - traveling to an accredited breast cancer center in another city if necessary. Everything is a heckuva lot easier once you know you're in experienced hands.

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  • FindingACure88
    FindingACure88 Member Posts: 6
    edited March 2018

    Georgia1,

    Thank you for your insight with regards to those factors. Fortunately she is at an accredited breast cancer center. I'ma nurse practitioner, however I work in critical care and oncology is relatively foreign to me. Sometimes I think that working in healthcare can make someone extra cautious when it comes to treatment, as you really do put your life in someone else's hands. As per all of the replies, I think a second opinion is a great idea. Thank you guys again for taking the time to reply to me.

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  • Hopeful82014
    Hopeful82014 Member Posts: 3,480
    edited March 2018

    A Ki-67 of 20 is not exactly low. Per BCO it's at the upper edge of intermediate and some sites would consider it high.

    It does sound as though an Oncotype or Mammaprint would be in order, along with that 2nd (or more) opinion.

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