Bi rads 4 c

Ampmusic, whether or not chemo is recommended has nothing to do with the type of surgery - lumpectomy or mastectomy.

For those who are ER+ and HER2-, the criteria for chemo include the extent of nodal involvement (if any) and the aggressiveness of the cancer. At the extremes - very small non-aggressive tumor with no nodal involvement, or large aggressive tumor particularly if node positive - the pathology alone will determine whether or not chemo is recommended. In most cases however, the aggressiveness of the cancer is assessed by the Oncotype test (or similarly, the Mammaprint test), which evaluates the genetic make-up of the cancer cells (the Oncotype test looks at 21 genes within the cancer cell). If the cancer is found to be aggressive, chemo will be recommended regardless of whether the patient had a mastectomy or a lumpectomy.

Chemo is a systemic treatment; it's role is to track down and kill off any rogue cancer cells that might have escaped the breast (through the nodes or the bloodstream) and moved into the body. These rogue cells are what can develop into a metastatic (i.e. distant) recurrence. So chemo is given to reduce the risk of a metastatic recurrence. And because a metastatic recurrence happens outside of the breast, this risk is not reduced by having a mastectomy. That is why the type of surgery doesn't impact whether chemo is recommended. It's all based on the pathology and genetic make-up of the cancer.

Have you met with your Medical Oncologist yet? Surgeons only operate; it's the MO who looks at the whole picture and recommends the treatment plan. Was an Oncotype test done on your biopsy sample? If not, then it is premature for your doctor to tell you that chemo won't be recommended - there simply is not enough information available yet about your cancer to know what the most appropriate treatment plan will be. Sorry if that is disappointing.

Ampmusic14, your post caught my eye. I just wanted to weigh in and ditto the fact that large tumors are not necessarily aggressive. My BC had infiltrated over an entire quadrant of my breast, and every member of my care team really thought I would be getting chemo, to the point where my MO was already talking about clinical trials he wanted to put me in, before I had surgery or an oncotype score. After surgery, my score came back and chemo was off the table.

It is my understanding that chemo is sometimes done before surgery when they want to try to shrink the tumor down first (usually to do a lumpectomy instead of mastectomy). That might be what your doctor meant by no chemo being needed unless you had a lumpectomy. I remember my surgeon mentioning that possibility to me early on. Beesie is extremely knowledgeable and very correct in that there is really no way to know anything for sure about what your treatment plan will look like until after your surgery and oncotype are done. Whether or not chemo and/or radiation is recommended will take everything into account-your age, tumor size, aggressiveness, node involvement, etc.

I know that everyone tells you not to worry, and I also know that is impossible. Spending time with those you love and staying busy are good strategies. Personally, I was prepared for the worst, so I was surprised when it wasn't as bad as I thought it was going to be. So sorry you're going through this.

ampmusic - I'm assuming you aren't HER2 positive, or you WOULD be having chemo first. When you get a chance, go to 'my profile' and fill in the diagnosis & treatment plans to date so we can follow you more easily. Good luck with your surgery.

I'm confused. The nodes that are closest and get removed during surgery are the sentinel nodes, I thought? Why would a surgeon by-pass the sentinel nodes and take out others? And if it's not in your nodes, how can it be in the lymphatic system? I hope your surgeon clarifies everything.

Ampmusic - great news - no lymph involvement & clean margins. Woo Hoo.

Sorry to hear that. I suspected that chemo would be part of your treatment plan, given your age and the size of your tumor. Hopefully chemo does it's job and brings your recurrence risk nice and low. Good luck with chemo!