Mastectomy + Radiotherapy?

spoticus · Posted: Thu Aug 09, 2007 6:54 pm Post subject: Mastectomy + Radiotherapy?

Hi there,

My 32yo partner has a Her2 +ve, ER -ve breast cancer (DCIS) diagnosed in March. The cancer cells from biopsy were grade 3.

The original tumour was 20 x 30mm and one lymph node was positive (swollen to about an inch in size) - so roughly stage 2b.

She is having pre-surgical chemotherapy. First was 3 months of Epirubicin and Cyclophosphamide which has reduced the tumour so that it's not visible with ultrasound. She is now doing 3 months of Docetaxel and Herceptin (with 9 months Herceptin planned for after surgery).

We are trying to plan surgery and were hoping to have a choice between lumpectomy and radiotherapy, or mastectomy with immediate reconstruction. However, the breast surgeon is insisting on a mastectomy, the radiotherapist is insisting on radiotherapy, and the cosmetic surgeon is insisting on a delayed reconstruction if there is going to be radiotherapy. We feel like we are being railroaded into mastectomy + radiotherapy + delayed reconstruction.

We're confused because everything we've read says that radiotherapy is only required with a mastectomy in cases with larger tumors or where more lymph nodes are involved. We want to balance eradicating the cancer with limiting the side effects.

My concern is that my partner's heart function has already been reduced from the Epirubicin (from an LVEF of 59% to 55%) and if radiotherapy affects her heart further then that will mean she can't continue to take Herceptin which will likely provide much more benefit than the radiotherapy (the cut-off for the Herceptin here is 55%).

The doctors are hammering us with empirical data but don't seem to be taking my partner's specific situation into account.

Any advice with regards to having mastectomy [u]and[/u] radiotherapy would be much appreciated.
Thanks

Muttsmom · Posted: Thu Aug 09, 2007 8:04 pm Post subject: Re: Mastectomy + Radiotherapy?

Hi,

1st I'd read the pathology report and see how she can have a dx of DCIS AND have a lymph node positive. DCIS means incapsulated and hasn't spread outside that area.

You can get a 2nd opinion as far as what they think the best treatment plan is. I would put less importance with reconstruction and forcus on dealing with the cancer.

How old is she? I had Epirubensin and it was for ILC. I've heard of ladies that had heart problems with AC, even though the ones I've heard of doing that, had pre-existing problems and then they would give Epirubensin. Epirubensin is really good chemo. I had it with STage III and 9+ nodes.
_________________
Nancy
2/14/02 ILC 43 - 5.5 cm 9+/16 nodes
Stage IIIA er/pr+ Her2-
2/02 MRM
FECx6 radsx33
Tamoxifen - Arimidex (chemo induced menopause)
4/03 SM w/bilat. recon.
9/03 expanders removed
5/04 repair reconst. disaster
10/04 Actonel for bone/joint pain from Arimidex
NED - 5 years
3/07 Diabetes
In memory of Kim 12/1/04

spoticus · Posted: Thu Aug 09, 2007 8:22 pm Post subject: Re: Mastectomy + Radiotherapy?

Here is the core-biopsy pathology report . . .

MACRO
1. R breast cores
Specimen consists of two cores of fibrofatty tissue up to 12mm in length.
A. 2/ai/levels ;

1. R breast.

MICRO
1. Histology reveals breast tissue cores which are infiltrated by a mammary adenocarcinoma of no special type. This shows little tubule formation, moderate to marked nuclear pleomorphism and readily identifiable mitotic figures (modified Bloom and Richardson grade 3 in these cores). There is no convincing in situ disease or vascular space invasion.
Slides seen by PBB.

SUMMARY
RIGHT BREAST CORES - ADENOCARCINOMA (BR).

. . . there was a little bit more with IHC results which we don't have a copy of - but we know that it is HER2 3+.

After the biopsy was done, a CT scan was done that showed a swollen lymph node in the arm pit.

To be honest I don't know what any of the pathology report means. When I asked if the cancer was ductal or lobular I was told ductal.

My partner is 32 years old, but has always had a slightly "eccentric" heart beat.

Thanks for the feedback.

Nick

Muttsmom · Posted: Thu Aug 09, 2007 9:32 pm Post subject: Re: Mastectomy + Radiotherapy?

Hi Nick,

Did they remove the swollen lymph node + more and send them to pathology? Or is the surgeon basing his opinion that she has 1 node positive on breast cancer based on a swollen node?

This is the definition of DCIS

Ductal carcinoma in situ (or DCIS) refers to the most common type of SCAM breast cancer in women. In situ, or "in place," describes a cancer that has not moved out of the area of the body where it originally developed. With DCIS, the cancer cells are confined to milk ducts in the breast and[b][u] have not spread into the fatty breast tissue or to any other part of the body (such as the lymph nodes).[/u][/b]

From what I've read of her pathology report, it's saying that she has Invasive Ductal. If she 1 node involved, I'm really surprised that they aren't planning on doing chemo. The tumor is very very small, but if it was just a biopsy, then they just took a sample, which means there's more that will be added to the actual size, which still could be very little.
_________________
Nancy
2/14/02 ILC 43 - 5.5 cm 9+/16 nodes
Stage IIIA er/pr+ Her2-
2/02 MRM
FECx6 radsx33
Tamoxifen - Arimidex (chemo induced menopause)
4/03 SM w/bilat. recon.
9/03 expanders removed
5/04 repair reconst. disaster
10/04 Actonel for bone/joint pain from Arimidex
NED - 5 years
3/07 Diabetes
In memory of Kim 12/1/04

cjago · Regular Joined: 14 Jan 2006 Posts: 42

My guess is that your various doctors are advising aggressive treatment because the original tumour was grade III (ie aggressive itself). I would definitely agree with Muttsmom's advice to focus on the cancer, not a reconstruction. The swollen lymph node is indicative of spread even if it's not definite without a biopsy.

Is there a reason you are worried that radiotherapy would have an effect on your partner's heart? AFAIK these days, linear accelerators (ie radiotherapy machines) are much more accurate, and also I see that it is her right breast that is affected (the other side from the heart). What does the radiologist say about this?

I think Muttsmom is right that the cancer is invasive ductal carcinoma, not DCIS.

Best of luck with whatever you go with.
_________________
adenocarcinoma of the breast, now widely metastatic (stomach, liver, pelvis, pancreas, bones, skin)
survived 11 years so far

spoticus · Posted: Sat Aug 18, 2007 12:57 am Post subject: Re: Mastectomy + Radiotherapy?

We know that the one swollen lymph node was positive because a doctor did a fine needle aspiration on it and it contained cancerous cells.

You're right it is Invasive Ductal Carcinoma. It sure takes a while to understand some of the terminology.

I have been reading the stats from some studies into post-mastectomy radiotherapy.

One study was of women who had 1 to 3 histologically involved axillary lymph nodes, a T1/T2 primary tumour, mastectomy, chemotherapy/hormonal therapy where appropriate and no radiotherapy.

The results showed on average 16% of the women in the study had Loco-Regional Recurrence after 4 years. But there were a number of risk factors - for the women that matched those four factors the loco-regional recurrence rate rises to 67%. My partner matches all four of those factors - less than 40 years old, ER -ve, tumour size >= 3cm, lymphovascular invasion.

The radiotherapy recommendation is making more and more sense.

Nick

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