Post Mastectomty

jenluv201,

I'm sorry that your mother is going through this.

To your question, with the large size of the tumor and the number of positive lymph nodes, the LVI is a lesser concern.

With clear margins, it hopefully means that there is no more cancer in the breast. But the risk from breast cancer is not the cancer in the breast, it's that the cancer might spread beyond the breast. Most cancers take years to develop; during that time, it's possible that some breast cancer cells might have moved through the lymph nodes or the bloodstream into the body. That's how a metastatic recurrence develops - when breast cancer is found somewhere else in the body, such as the bones or the liver or the lungs. So clear margins are great, but that's not the whole picture. The biggest concern is the possible spread of the cancer into the body, beyond the breast.

And this is why chemo is prescribed. Chemo doesn't just treat the breast but goes into the whole body. The goal of chemo is to track down any breast cancer cells that might be lying dormant in the body, and hopefully kill them off before they can develop into a metastatic recurrence. When chemo is given prior to surgery, as in your mother's situation, it is also given to shrink the tumor in the breast and the nodes. Unfortunately it doesn't appear that this happened for your mother. What this means is that your mother likely will be given a different type of chemo now - not AC again but something different that hopefully is more successful at attacking any cancer cells that might be in her body.

Has your mother had a CT scan or PET scan or bone scan? Those tests aren't always done, but with a Stage IIIC breast cancer, normally some or all of those tests would be done. (Note that I'm guessing the Prognostic Stage, Stage IIIC, based on a 7cm tumor, 4 positive nodes, grade 3, ER-, PR-, HER2-).

The one thing I don't understand is when you say that your mother will be prescribed a pill for 5 years. I'm not that familiar with triple negative cancers, but usually the 5-year pills refer to anti-hormone therapy, and those aren't given to triple negative patients. But maybe there is something new for TN patients (maybe that's the clinical trial). Hopefully someone who is triple negative comes along to comment.

I hope this helps with your understanding of your mother's diagnosis. It sounds like you and others in your family are questioning the treatment, but with her diagnosis, radiation and chemo absolutely should be given. How is your mother doing? And how does she feel about the proposed treatment plan?

oh and just want to point out that chemo is a very general term. It's essentially like saying "heart medicine" or "cancer medicine".

There are many chemo drugs and they have different mechanisms of action and target different cell processes so just because 1 didn't work, doesn't mean you don't try another.

I will have a look later to see if I can find the NCCN guidelines on treatment when there is no pcr (pathologically complete response) after neoadjuvant treatment.