Chemotherapy Advices

jango786 · April 2018

My mother 64age...Operation done " Right Breast Tricut Biopsy" on 13th March 2018.....Left breast already operated 2010 and chemotheraphy was being done in 2010...They have recommended me Oncotype DX Test..I lived in Pakistan..Test is not availaible in pakistan...Should i ll take a decision of chemotherapy type TC without Oncotype DX test...Please advice

Moderators · April 2018

Hi jango, and welcome to Breastcancer.org,

We're so sorry to hear about your mother's diagnosis, but we're really glad you found us. We're sure you'll receive lots of great advice here soon, but it may help if you could tell us a little more about your mother's diagnosis -- do you have any information on the type of breast cancer that was diagnosed? What about if there was lymph node involvement? Do you know if the cancer is positive or negative for hormone receptors? What about the HER2 status? All of these factors can help you and your mom and her doctor make the decision about the best chemotherapy combination to try for her cancer.

You can find more about this on the main Breastcancer.org site's page on Who Gets Chemotherapy?, and the page on Choosing a Chemotherapy Combination, and also the helpful Talking to Your Doctor About Chemotherapy.

We hope this helps -- please keep us posted on how you're mother is doing!

--The Mods

moth · April 2018

I'm in Canada and we had to send my sample away to California for the Oncotype DX test. I believe the test is only available there.

The test gives you a numerical score which is an estimate of the risk of recurrence/metastasis of the cancer, and the benefit of chemotherapy to prevent this recurrence. If the score is low, you might avoid chemotherapy altogether as the risks of it would outweigh the benefits. On the other hand, if the score is high, you may choose to treat thecancer very aggressively.

I think if you are being offered this test and have the opportunity to do it & can afford it, I would do it as it does help with decision making.

best wishes

jango786 · April 2018

I am really glad for your prompt response and concerned....got reply's from both of you and indeed feel blessed to see humanity and caring from your sides...GOD Bless U All and keep doing the good work....

Details are following :

Your Question : do you have any information on the type of breast cancer that was diagnosed?

Biopsy Result : Right Breast Lump (Invasive lobular carcinoma, grade II)

Your Question : Do you know if the cancer is positive or negative for hormone receptors?

BioMarker Results :

Estrogen Receptors : Positive (Score = 8)

Strong Staining

Positive Staining in 90% of tumor Cells

Progesterone Receptors : Positive (Score = 4)

Intermediate Staining

Positive Staining in 5% of tumor Cells

your Question : What about the HER2 status?

Oncoprotein Report : C-erb-B2 (Her 2/Neu) ONCOPROTEIN = 0 / Negative

After Surgery

Your Question : What about if there was lymph node involvement?

Surgical Pathology Report : F1 - F5 - All five sentinel lymph nodes are negative for malignancy (0/5)

AXILLARY LYMPH NODES = Two benign lymph nodes seen (0/2)

Final Diagnosis :

I - II) Right axillary sentinel lymph nodes (FS):- Five benign sentinel lymph nodes seen (0/5)

A) Right breast tissue (simply mastectomy):-

1. Multiple biologically separate invasive carcinomas seen. Two foci of invasive lobular carcinoma grade II according to Modified Bloom Richardson grading system.

a) Largest focus measuring 2.8 x 2.5 x 2.2 cm, which is 4 cm away from closest posterior resection margin as per gross.

b) Smaller focus measuring 2 x 1.5 cm. It is 3.5 cm away from posterior resection margin grossly.

c) Third focus of tumor seen, composed of extensive ductal carcinoma insitu with a small focus of invasive carcinoma measuring less than 0.1 x 0.1 cm (micro invasive carcinoma). It is 4.8 cm away from posterior resection margin. Size of invasive tumor is less than 0.1 x 0.1 cm.

2. Skin of nipple and areola is tumor free.

3. Two benign axillary non-sentinel lymph nodes seen.

______________________________________________________________________________

Thank you so much for your unconditional support and guidance.

Thank you moth for your support and valuable comments...

moth · April 2018

jango, you are welcome.

The ER+ (estrogen receptor positive) result is good as it means that she may be a candidate for hormonal therapy (an aromatase inhibitor or tamoxifen) to help prevent recurrence.

Negative lymph nodes is also very good news.

Oncotype is still new technology and well trained oncologists are skilled in making recommendations without it. Until a few years ago, it wasn't available in my province. I don't know if it helps you at all, but the British Columbia Cancer Agency has their full clinical guidelines available online. I would suggest if you can to read through section 6-3.0 (Management - Early Invasive) for details about the factors oncologists would consider in determining whether chemotherapy is appropriate and discuss that with your team. While individual countries and health units (& even oncologists!) have variations in their protocols, I found it helped me to understand how they approach the decision making. I think it might help you when discussing the possible plans with your mother's doctors. http://www.bccancer.bc.ca/health-professionals/cli...

jango786 · May 2018

Thank you moth for such a valuable and generous knowledge...it help me out in different perspective.

Oncologist (my mother doctor) has suggested me to start the chemotheraphy without the oncotype dx test. so i have take a decision to start it without further delay and as per the recommendation of doctor. The doctor has suggested the Chemotheraphy Regimen : TC

Regimen Detail : Dpcetaxel, Cyclophosphamide (4 Chemo cycle) each cycle in 3 weeks...Just pray from GOD that It ll went well...Thank you again for your time and support....

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