52 yrs grade3 three foci with 1 positive node, Chemo?

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bbbddd168
bbbddd168 Member Posts: 32
edited April 2020 in Chemotherapy - Before, During, and After

I am 52 yrs old, no period for 10 months now. Did lumpectomy on Mar.12 with 2 foci, IDC with Mucinous features, one is 10mm grade 3 with positive margin, next to it is at least 7mm grade 2 with lateral margin 2mm, lymphovascular Invasion. Surgeon only took out one sentinel node which has 1.5mm cancer with no extranodal extension. On Mar.27, I did reexcision to clear margin, but found out more lateral margin had another IDC 2mm (even surgeon said I have ridiculous request to do 2mm margin but I am glad she did finally). So I have at least 3 areas which has cancer tumor now. ER+ 100%, PR+100%, HER2- (0).

Oncotype result is 8 , but ki-67 30-40%.

My oncologist who is young and told me if I am her sister she would want me to consider Chemo 4 rounds but understand if I do not do it. I asked her to ask for second opinion, then next day her head called me and said I do not need to do Chemo because my oncotype score and mucinous feature. I called another experienced oncologist and he said if I do not have more than 4 nodes involved then no Chemo.

My puzzle now is my ki-67 is high, grade 3, multifoci, at least one sentinel node positive. What about if one cancer cell dropped to other parts of body which Chemo now can kill it. Do not want to regret in 5-6 years later. I am still debating Chemo or not. How do I know that I do not have more than 4 nodes positive now without ALND?

I will do radiation end of this month and Tamoxifen afterwards if no Chemo. Otherwise, my oncologist said I can start Chemo on 4/9.

Any advice is greatly appreciated.


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  • JRNJ
    JRNJ Member Posts: 573
    edited April 2020

    Tough decision. If is was me, I would probably do it due to LVI, ki67, pre-menopausal, positive node and uncertainty of additional nodes and at least one Dr. recommending it. My goal was to be aggressive, I didn't want to regret doing too little. My oncotype was 15 and ki67 was 18% and I'm 54 and pre-menopausal. I went for 3 opinions because I didn't want to look back with regret. My MO said I don't know what to do with you. nci center Dr. said no chemo. Sloan said yes do the chemo. But if I was under 11, they probably would have said no. But recommended cmf because I was in the gray area and it had less permanent side effects. Sloan also recommended ovarian suppression and AIs over tamoxifen. I have anxiety that I should have done the stronger chemo or should have had more nodes removed. Forget the guy that said no chemo under 4 nodes. My BS said that too, and I have since dumped her. Not looking at whole picture, too general. If you are not taking out more nodes, you don't really know what was left behind. It can spread to additional nodes, even if a small amount in one node. But I have ILC, and it is very sneaky on how it spreads. Sloan has a node calculator. It showed I had a 17% chance of having it in additional nodes. But I do have macro in 2 nodes, which you do not, but not much bigger, mine were 2 mm and 3 mm. Are you anywhere near Sloan for an opinion? Although now is a tough time to get in.

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  • bbbddd168
    bbbddd168 Member Posts: 32
    edited April 2020

    Thank you very much. No I live in California. Does Sloan do any consultation online? Who can do node calculate, MO? I do not have Extra nodal Extension, that is why my mo said I have less chance if having more nodes

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  • JRNJ
    JRNJ Member Posts: 573
    edited April 2020

    Based on the CMF threads, most of the people doing CMF were in the states near Sloan and some people in CA, so you may want to ask about CMF. I found the node calculator on line, never talked to MO about it. Breast surgeon didn't believe it, but I dumped her.

    http://nomograms.mskcc.org/Breast/index.aspx

    I know you shouldn't rely on one case, but someone posted about having micromets in 2 nodes, and pushing for ALND, and they found 2 more nodes with macromets and her Oncotype was less than 11. LeesaD, 8/31/2019 at:

    https://community.breastcancer.org/forum/91/topics...

    this post influenced me, as I was already paranoid that she only took out 5 nodes. When they recommended radiation, I gave up on the ALND, as NCCN guidelines recommend one or the other.

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  • bbbddd168
    bbbddd168 Member Posts: 32
    edited April 2020

    Thank you. I did node calculator and I have 66% possibilities of having more lymph nodes positive chances. Cry. I will ask tomorrow how I can check nodes without surgery or of there is a way. Apparently my surgeon refused to check nodes again for me.

    I read the other post also finding more nodes positive doing another ALND also which frightened me

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  • JRNJ
    JRNJ Member Posts: 573
    edited April 2020

    Didnt want to scare you. Studies show radiation is just as effective as additional node dissection and they are trying to minimize lymphedema. Problem Is it also affects chemo decision and staging, not knowing. Scans won't show node invasion that small. Even after testing during surgery they only thought 1 node invaded until final pathology came back.

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  • bbbddd168
    bbbddd168 Member Posts: 32
    edited April 2020

    Thanks. Very touch decision for me.

    My radiation doctor just told me I can do radiation first at end of this month and do chemo if I still want to do right after radiation to buy me more time for thinking of doing chemo and avoid the covid19 time of doing Chemo. I know this is not the standard treatment. Chemo should be earlier than radiation. But I prefer to do radiation first. I am doing more studies now

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  • bbbddd168
    bbbddd168 Member Posts: 32
    edited April 2020

    Thanks JRNJ.

    I am post-menopause for almost a year now. 53 yrs old now. Did Sloan tell you to do ovarian suppression if you are post-menopause also? My oncologist said I do not need to do ovarian suppression since I do not have period any more. Oncologist also said I can have 1-2 yrs Tamoxifen then change to AI

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