Isolated Chemotherapy

Options
Iam38
Iam38 Member Posts: 9
edited September 2019 in Chemotherapy - Before, During, and After

Has anyone heard of isolated chemotherapy and how effective it is compared to the traditional type of chemotherapy in the treatment of breast cancer. I was diagnosed with Ductal Carcinoma in SITU. I've seen this mentioned but I haven't found much literature about it.

· Share on FacebookShare on Twitter

Comments

  • Ingerp
    Ingerp Member Posts: 2,624
    edited August 2019

    If you only have DCIS, you're not having chemo, right?

    · Share on FacebookShare on Twitter
  • Iam38
    Iam38 Member Posts: 9
    edited August 2019

    I had biopsy done, they said it was a cancer that responded to hormone therapy. They said they wouldn't be able to tell me if I need chemo or not until they remove the masses, and biopsy my sentinel lymph nodes. I went to UCLA and they recommended the DIEP flap procedure. Because I'm 38, they believe I will have a better recover chance without difficulties with implants.

    · Share on FacebookShare on Twitter
  • Ingerp
    Ingerp Member Posts: 2,624
    edited August 2019

    Yes--that's the ER+/PR+, which means hormone (or rather, anti-hormone) therapy will be recommended. That's typically Tamoxifen, or ovarian suppression and an aromatase inhibitor, for pre-menopausal women. Yes--sometimes IDC is found during surgery. Is the area of DCIS large? Is lumpectomy off the table? (FWIW--I elected not to have them take any lymph nodes when I had pure DCIS.)

    · Share on FacebookShare on Twitter
  • Iam38
    Iam38 Member Posts: 9
    edited August 2019

    Originally it was one mass about 3 cm and they found two more about 1 cm each in different locations of the breast. Lumpectomy I feel is off the table. The MD said it's better to remove lymph node and see if it spread, but I didn't even know that you could refuse lymph node removal. I wonder if I'm over treating my condition.? How was your experience?

    · Share on FacebookShare on Twitter
  • Ingerp
    Ingerp Member Posts: 2,624
    edited August 2019

    Just my experience--I had a large area of DCIS in 2016 (8cm x 6cm x 3.3cm) but opted for lumpectomy. The BS left it up to me as to whether or not to look at any lymph nodes and I said then let's not. I know lymphedema is a possibility, and didn't want to risk it. With the IDC in 2018, I knew that it made sense to take the sentinel lymph node, although the BS looked at my lymph nodes with an US and said he didn't expect to find anything. It might be worth asking if they could take a look with an ultrasound before surgery. I believe that if they end up discovering IDC, you could do the sentinel lymph node with a later surgery.

    Definitely do what makes you more comfortable.

    · Share on FacebookShare on Twitter
  • Beesie
    Beesie Member Posts: 12,240
    edited August 2019

    Iam38,

    Until you have your surgery, your final diagnosis is unknown. It sounds however as though your medical team may be expecting to find invasive breast cancer (IDC) in the final pathology. Should that be the case, chemo may be required, although there is a lot that goes into that decision, including the size of the tumor, the nodal status, the grade of the tumor, possibly the Oncotype score (a genetic analysis of the cancerous tissue that helps determine the degree of aggressiveness), and consideration of your age.

    That said, it is important to note that if your final diagnosis should remain DCIS, with no invasive cancer found, then chemo will not be required. DCIS is a pre-invasive condition, Stage 0, and chemo is never given when the diagnosis is pure DCIS.

    With regard to checking the nodes, this is required for invasive cancer but it is not necessary for DCIS. The issue however is that to do a Sentinel Node Biopsy, the first step is several injections into the breast. Once someone has a mastectomy, there is no longer a breast, which obviously makes a SNB difficult to do. For this reason, women who have DCIS who are having a mastectomy usually do have an SNB, just in case some invasive cancer is found in the final pathology. Women with DCIS who have a lumpectomy usually do not have an SNB because if invasive cancer is found, an SNB can easily be done later in a small, quick separate surgery.

    Since your diagnosis at this point is DCIS, if you don't want to have nodes removed, one option is the Pink Lotus method. This involves doing the injection prior to the MX but not removing any nodes during that surgery. If the final pathology shows invasive cancer, a SNB can be done within the next day or so, while the isotopes/blue dye from the injection is still in the nodes. I don't think many facilities do this procedure but you can ask your surgeon about it, if you would prefer to not remove nodes unless necessary (i.e. because of a finding of invasive cancer).

    While imaging of the nodes, such as an ultrasound, may show inflammation caused by significant invasion, if there is only a small invasion into the nodes, this can only be found when the nodes are removed and examined under a microscope. I recall reading that ultrasounds only identify something like 30% of cases that are node positive. Additionally, ultrasound imaging might show inflammation in the nodes that's been caused by a reaction to the biopsy itself, when the nodes are in fact negative. So while ultrasound imaging prior to surgery might provide some helpful information, it does not substitute for an SNB and it is not particularly predictive of what the SNB will find.

    · Share on FacebookShare on Twitter
  • exercise_guru
    exercise_guru Member Posts: 716
    edited September 2019

    My right breast had several pockets of DCIS through it . It was such that there was not enough breast tissue to save my Rt breast. It was not required that I have lymph nodes on the DCIS side but I chose to. How it works is they inject a small amount of die into the aeriola / nipple area and find the node where the lymph drains. They remove that node or 1-4 nodes with the dye in them . The assumption is that they will find out if the cancer is traveling outside of the breast. They can only do this with an intact breast so it is kind of a decision that needs to be made.

    When they removed my Rt Breast tissue there were actually 2 distinct tumors in there that were ER/PR + and at that point I was glad that I had removed the sentinel node because it showed that the cancer wasn't traveling as far as they could tell. Then they send the extracted material out for analysis. they do an oncotype if they find actual tumors and determine if Chemo is indicated. Often a Mastectomy is it and they don't do Chemo if the cancer is stage 1 and the pathology doesn't indicate it.

    You are young so I know this is not something you would likely do but I would have preferred to have the double mastectomy ( if warranted) Heal up and then have the DIEP the following year after I finished treatment. The problem is the chest area looks quite gross with bunched up skin and not appealing at all. I do not think my body healed well at all because I did Chemo after. If Chemo isn't indicated you could do the DIEP and move on with your life.

    Since you are young I want to recommend you look up nutritionfacts.org and search the videos for "Breast Cancer" and especially on cooked mushrooms and Broccoli sprouts. I think you would find the studies interesting and Broccoli sprouts are very easy to do with a jar and a screen lid. There was one study of women who ate 1 cup of Broccoli sprouts a day before having breast tissue extracted. They found the cancer fighting product had gone in the breast tissue . I think that is very cool and pretty cheap and easy to do. It would be worth a watch, sorry I am away from home or I would find you the link.


    · Share on FacebookShare on Twitter

Categories