"Age Related" chemo ?

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BustersMom
BustersMom Member Posts: 495
edited June 2014 in Managing Side Effects of Breast Cancer and Its Treatment
"Age Related" chemo ?
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  • BustersMom
    BustersMom Member Posts: 495
    edited May 2008

    I was just dx & I'm setup for my 2nd surgical opinion next week.  It's looking like either single or double mast (up to me).  Unless I want to chemo-shrink first & then lumpectomy.   

    I would like to avoid chemo if I can - who doesn't?    Frown

    I've seen a few comments re: chemo being rec'd for women because "they are young".   That's exactly what my surgeon said to me today - she would recommend chemo "because I'm young", even if my nodes come back clear.   (I'm 42 - not that young... but anyhoo)

    So I wonder:  If, after surgery, my nodes come back clear - does it make sense to have chemo "just in case"? 

    Do I want to book a consult with onco (or 2) to ask about this now?  

    My biopsy shows that I am grade 1, tumor is about 3cm.  

    This might be premature since I haven't even had surgery yet; Just trying to understand what I should do next.   

    Thanks for your input - it's greatly appreciated Kiss

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  • gracejon
    gracejon Member Posts: 972
    edited May 2008

    I am under the assumption that young means under 50 in the breast cancer world and also defined by pre menopause versus perimenopausal versus post menopausal.  Surgery and it's pathology defines more for information regarding chemo need or no need.  Also if your tumor is hormonally receptor positive and no positive nodes are found,  a test on tissue called Oncotype dx is helpful in determining whether chemo would be effacious.  I believe you are still in the "state of learn" and need more information.

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  • BustersMom
    BustersMom Member Posts: 495
    edited May 2008

    Thanks Grace - and thanks for telling me about the Oncotype, I was wondering what that was & when it could be done.

    I'm just a major control freak & hate not knowing what's coming next, ya know ?  

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  • smerf
    smerf Member Posts: 615
    edited May 2008

    Hey Julie,

    It's great that you are gathering all your information for an informed decision.

    The oncotype is a good test, but I don't think an oncologist will recommend doing without chemo just because of the size of the tumor. Knowing you now, it might be a good idea for you to make a medical oncology appointment so you can hear what they have to say. The med oncologist is the one who orders and administers the chemo in any case.

    I know you want all this info pronto, but please take some time to savor the gnocci!

    Big hugs, Smerf

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  • ritajean
    ritajean Member Posts: 4,223
    edited May 2008

    Hey Julie!  That smerf just has a special way with words, doesn't she?  If you want to find out more about your chemo/no chemo options, I agree with smerf.  Make an appointment with an onc now before your surgery.  I saw my onc before my second lumpectomy surgery and it helped me so much to put things into perspective and to "get my ducks in order."  Like smerf, I really don't think they're going to recommend going without chemo for you regardless of the lymph nodes...based both upon the size of the tumor and your age (which is indeed young).  I know how much you dread the chemo.  I was so darn afraid when I walked through the doors of the chemo room for the first time and claimed "my recliner."  However, do keep in mind that it is doable.  Almost everyone sitting around that big table Wednesday night has gone through it and we're still smiling!  LOL  If it is necessary, you will get through it and the Illinois gals, as well as the other gals on this site, will help you through!   I am so glad that I had the chance to meet you!  Hope the tooth is better.

    Love, Rita

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  • otter
    otter Member Posts: 6,099
    edited May 2008

    Hey, Bustersmom (Julie?)--

    So, you are wondering why your docs consider 42 "young"?  Two of the factors my oncologist used in his decision that I ought to have chemo were my age and the size of my tumor.

    I am 56, and my tumor was 1.8 cm.

    Like the other women have said, if I were you, I would start getting used to the likelihood that you will need chemo.  I'm not even sure if Oncotype testing is done on tumors that are 3 cm, since those generally warrant chemo even with negative nodes.  There is a long history of BC research suggesting that the size of the tumor correlates with the chances that cells have escaped from the breast and gone elsewhere ... even if the nodes are negative.

    otter 

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  • smerf
    smerf Member Posts: 615
    edited May 2008

    Hi Julie!

    I sure hope you're out enjoying some of this beautiful day.

    Otter is absolutely correct....you probably need to get used to the idea of chemo. 3cm is too large to go without it, and 42 is so young. You should have at least 42 more, and chemo is your best insurance for that.

    I'm 63, and I was 60 at dx. Three months short of being 61, actually. my tumor was 2cm, and the docs all said I was young too! What they meant was that I have no other medical conditions, and chemo was my best shot at a long life. The first medical oncologist I saw recommended 4 tx of AC, and then rads. The second onc said 4 tx of AC followed by 12 weekly taxols, and then rads. I asked her why the difference in opinion, and she answered "because your tumor is so large." I went with the more agressive chemo because the first time is the best time to do it. I've been doing great, and it has been 21 months since I finished tx. You can do it too, and we will all be here to help!

    I know this is a lot to take in, and I know how you feel. Call me anytime if you'd like to ask questions...I could meet you for coffee, lunch or dinner again if it would help.

    Big hugs, smerf

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  • smerf
    smerf Member Posts: 615
    edited May 2008

    Slight correction.....I finished chemo 21 months ago, but then I did seven weeks of rads. So end of August for chemo, end of October for rads. Just had 4 monthe checkup the morning of our dinner, and everything looks good.

    smerf

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  • BustersMom
    BustersMom Member Posts: 495
    edited June 2008

    Smerf, RitaJean & Otter

    Thanks a lot you guys.  I hear ya - I need to get used to the idea of chemo. 

    I'm in denial right now - I admit it.  I keep trying to figure out how I can avoid it. 

    I have the names of 2 oncs & plan to call tomorrow & meet with them.  

    Meeting you guys on Wednesday night really DID make me see things differently.   You guys are proof that you can get through chemo & still be a wonderful, happy, lively person.  What can I say - for someone still standing on the outside, I've got the horrific visions of what chemo does to a person.  Just like anyone else who hasn't been through it, I guess (?)

    These responses really meant a lot to me. 

    And smerf - i'd love to meet up with you sometime again!!  I'll send you a PM - maybe we can arrange something geographically desirable for both of us :) 

    You guys are the BOMB.   JulieR

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  • BustersMom
    BustersMom Member Posts: 495
    edited June 2008
    PS to Smerf - it only took you about 1 minute after meeting me to determine that I'm a control freak - so you are probably not at all surprised that I want to know everything before it's even possible to have the ansers, hmm??   LOL!!!  Wink
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  • zap
    zap Member Posts: 2,017
    edited June 2008

    Hi ladies:

    Based on the posts we seems to be on a downside here.  It appears to be "raining" literally as well as metaphorically. I am an English teacher and I talk funny. Not altogether sure I spelled that correctly, but then I am nearing summer vacation.

    First of all, I hope all are safe in Southern Illinois.  I heard the storms were bad and a tornado struck down.

    Sabrina, yes girls scare me with their lack of knowledge combined with the seductive way they dress.  I teach 13 and 14 year olds and they scare me with the clothes they wear and what all they show.

    Julie R., I hope you are feeling well.  As soon as you settle with a great doctor you will place your confidence in him/her.  Quite frankly, you can control only so much.  I do wish you well.

    Wendy, you are so nice to people~keep it up!  Let us know about the mri.  I had a slipped  disk and I cried the pain was so awful.  I was told that I was not a candidate for surgery as it was not bad enough.  YIPES!  My hand grip was strong enough and I had bladder control (well, not really....but that is a different story) so no surgery.  I do have to say that it healed but I worry all the time it will slip again.  If it does I might fake the strong grip and use the bladder issues for all they are worth!  My neurosurgeon told me that people get so desperate when in pain that they will say anything to just get relief.

    Connie, scary story about the mri.  Unfortunately for me, I will remember that awful story.  I did a root canal just recently and took the nitrous.  Meds are becoming more desirable with age.

    Okay....the thunder is hitting.  Have a happy day!  GRADUATION tonight!  YAHOO!

    Susan 

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited June 2008

    Hi Julie

    I was 46 at dx almost two years ago, my tumor was 2.4 cm so came in at Stage II, Grade I, no nodes, er/pr highly positive w/her2 negative....

    My onco never recommended chemo and when I questioned it he ordered the OncotypeDX testing be done on my tumor....the score for that came back at 12-low/if any benefit for me...I had a lumpectomy w/snb, 7 weeks of rads, complete hysterectomy, tamoxifen and just passed my 18 month follow up with flying colors....NED (no evidence of diease).....

    Take your time, research the heck out of things....I met a lady while in rads that was closer to your age and she basically did the same that I did with treatment options.....Its a very personal and hard decision to make....

    You will do fine either way you choose and as you've discovered chemo is very doable and it just might give you the reassurance that you've done everything you can to beat the beast.....

    Best Wishes

    Jule

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  • collector
    collector Member Posts: 193
    edited June 2008

    Keep in mind that the actual size of the tumor and the pathology report might be somewhat different after surgery is done.  Chemo was not part of my program until after my lumpectomy when both the size and grade of the tumor changed from my original biopsy report.  Both oncs I consulted with recommended chemo and although an Oncotype test is being done, both said they would recommend chemo regardless of my Oncotype score.  I am 59.

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  • ghappy
    ghappy Member Posts: 3
    edited June 2008

    Hi,  I am new as of today and I may be the oldest.  I was diagnosed last Winter at age 67 and opted for a masectomy.  I am 68 now and about to have my last chemotherapy in another week.  It will be #6. My youngest son is a doctor and gave me a simple one-liner when I asked him why the chemo when only 1 sentinel lymph node  was cancerous and everything was taken out.  He said because of the 1 cancerous microscopic cell that may or may not be still floating around.  That has always stuck in my mind and to me was a good reason to plunge in whole heartedly.  Chemo makes me not feel good each time for about a week, so that leaves 2 weeks of feeling pretty good before we do it again (every 3 weeks).  Then there will be 5 years of medicine.  I am so thankful to be able to have chemo and medicine that will make things okay again.  It's a wonderful thing to live in a time when these things are available to us.  Don't you agree?  My oncologist diagnosed me and made the appointment with the surgeon for the breast removal and guides me through my chemo and will prescribe my medicine for the next 5 years.  I am an ostrich and only want to know what I have to.  Because if someone says this may cause you to have green spots all over, I will have them.  I know this is my failing.  So if noone tells me about the green spots, I don't get them.  It just saves me a lot of grief.  Noone told me I might feel lousy because they know how I am, so when I did I just called the doc and asked him about it.  It sounds like you know yourself too, so whatever you decide will be alright for you.  Listen to your oncologist.  He deals with this all the time.  I wish you smooth sailing through all the ups and downs, sincerely.

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  • Young79
    Young79 Member Posts: 55
    edited June 2008

    Yah doesn't that suck? I was the same way. I'm 36 and was DX in March. Turned out I had stage II, no nodes, both invasive and non invasive but the grade was 2/3 which is aggressive and the tumor was 2.4cm.

    I'm still not happy about the chemo. I had bilateral mastectomy May 30th and they found nothing in any of the tissue removed. (My 3rd lumpectomy/excision showed a few cells in the ducts close to the nipple so my surgeon suggested to just go ahead with the mast since there wouldn't be much left of the breast anyway).

    I start chemo next week but because of the BL mast. I won't need radiation treatments. I do however wish that I could have consulted an Oncologist at the Cancer Treatment Center of America (www.cancercenter.com) mainly because they seem to have everything under one roof and you don't have to run here and there and deal with a bunch of BS on top of everything else. Also because they offer other types of support that my center does not. But I don't live near one of the centers. I'm not sure if any of the other people on the boards have gone there or what their experiences may have been but it might be something to look into.

    I understand that the idea behind chemo is to kill any cells that might have "escaped" to other parts of my body but it just seems counter intuitive to me. But you gotta do what you gotta do. The people on these boards are living proof that it works.

    Good luck,

    Laura 

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  • kellyb45
    kellyb45 Member Posts: 2
    edited June 2008

    My Mom is 65 and her onc. basically said chemo is up to her.  (stage IIa, sentinal node+,er+, tumor1.9, but some microscopic cells near a node) What to do?  She opted for chemo for the same reason your son gave you.  She will have 4rounds for 12 weeks.  You sound so strong.  I am going to share your message with my Mom.  Thanks

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  • Lisa1965
    Lisa1965 Member Posts: 171
    edited July 2008

    Hi Girls,

    Just to share my experience at this time, I met with my medical oncologist yesterday who proposed to me a study for candidates with my diagnosis...She has ordered the oncotype Dx test for me and should receive the results in 10-14 day...Now I'm on the fence about this because I too am 42 years old and premenopausal with a borderline larger tumor - 2 cm - Grade 2 - 0/8 nodes clear.  The clinical trial is called Tailorx Study involving a primary study group being the intermediate oncotype score between 11-25...as apposed to the secondary study groups low risk (1-10 no chemo for sure) or high risk 26+ (chemo for sure) which if I fall within the intermediate group and decided to participate in the study, a computer will randomly determine if I only have rads&hormonal therapy versus chemo/rads&hormonal therapy...Now I am leaning towards wanting to do chemo if my score falls in the intermediate group, because of my age,tumor size, grade, premenopausal...Even the nurse conducting the study told me only women post-menopausal and 50+ have signed up...I think sometimes doctors just see you as a case with the perfect diagnosis for their studies...not really who you are???  After hearing about all your oncologists suggesting chemo for you at your ages with your diagnoses...who is mine to say I may not need it...even if I fall in the intermediate range???  Should I consider myself an experiment or should I think of myself and my young sons and go for the more aggressive therapy..involving chemo/rads/hormonal therapy...if all you girls can do chemo...why can't I??  If I fall in the low range for sure I will not do chemo, but the intermediate range is experimental and that worries me because I'm too young... I think???  Everyones comments are all so thoughtful and helpful...Thx so much, hugs Lisa

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  • otter
    otter Member Posts: 6,099
    edited July 2008

    Lisa, I was 55 when dx'd, and I, too, was urged to enroll in the TAILORx clinical trial.  I declined for the same reasons you have mentioned, except "youth" wasn't on my list.    :)

    I figured that if my Oncotype score was less than 15 (never mind less than 11), I would not want chemo because the absolute benefit in disease-free survival would be so small.  If my score was higher than, say, 22, I would want chemo.  If my score was between 15 and 22, I would have to do some serious thinking and reading.  I had mentally set "18" as a break-point between chemo and no chemo, but that number wasn't written in stone and I knew it might change when I received my Oncotype results.

    In the end, I decided I didn't want a computer to make the decision for me.   Keep in mind that the categories of "low"-, "intermediate"-, and "high"-risk for Oncotype scores are not the same as the treatment categories being used in the TAILORx trial.  A score of 26 would be considered "intermediate risk," but that person would automatically get chemo if enrolled in the TAILORx trial.  Ironically, I decided not to participate in the trial; and then my score came back "26" so I would have received chemo anyway.

    otter

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  • Lisa1965
    Lisa1965 Member Posts: 171
    edited July 2008

    Thx Otter for your comments...your thinking and decision making has gone along the same lines as mine and at this point the more I read on the board the more I feel comfortable with my decision to have chemo if I fall in the intermediate range...  Even today when I met with the radiation oncologist, she suggested due to my diagnosis and my age she would suggest chemo to make sure not one microscopic cell didn't escape into my system from the invasive tumor...  Thx again and warmest wishes to you for good health...hugs, Lisa

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  • Tamara67646
    Tamara67646 Member Posts: 293
    edited July 2008

    I am on the fence about the Oncotype test and whether I will really use the results to make a decision.  Part of me thinks - do the chemo no matter what just for the "insurance" and then a read through all the chemo side effects and think if there is a chance to avoid them - I should take it.  I also worry about delaying the start of the chemo waiting for oncotype results.

    Had lumpectomy and axillary node removal on 6/16/08 - 7mm tumor with micromets in SN (1/13 nodes).   

    Is there a standard recommendation of what % benefit there needs to be to do the chemo?  

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