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Breast Cancer (Expert Forum)
Prognosis - Recently Diagnosed Breast Cancer
Questions posted in the Breast Cancer Forum are answered by medical professionals from The Cleveland Clinic. Topics include Breast Biopsy, Chemotherapy, Hormone Therapy, Lumps, Lumpectomy, Lymph node dissection, Lymphedema, Mammograms, Mastectomy, Radiation Therapy, Reconstruction, Self Breast Exam, and Surgery.
Prognosis - Recently Diagnosed Breast Cancer
by Damabelle, Oct 26, 2003 12:00AM
I am 37 yo female, who found a breast lump in upper medial quadrant of Left Breast during a hospital admission for a recurrent low grade fever of unknown origin. (usually 2 -5 week duration < 38.5 celsius).
Lumpectomy and Axillary dissection performed on 16 September 2003 after positive mammogram, ultrasound and core needle biopsy confirmed invasive ductal caricinoma. Tumor was 2.5cm (surgical margin 13mm, 6mm for DCIS), 7 axillary nodes cleared, one node was affected, this metastatic node measured approx 5cm by 3cm by 3cm, with extensive tumour replacement and extranodular involement of the adjacent fatty tissue. The surgical margin for the axillary dissection was less than 1mm. The tumour and lymph node tested ER and PR negative, and 3+ positive for C-erb-b2 receptors. Histologically the tumour was Nottingham grade 3+3+3. I have started on a chemotherapy/radiation therapy regime(AC (Adriamycin 60mg/m3 and cyclophosphamide 600mg/m2) for four cycles, radiation therapy and Taxol for four cycles).
My radiation oncologist doesn't want to perform raidation on the axilla due to the threat of lymphodema (I am obese), however I am concerned about the close margin, especially considering the agressive characteristics of the tumour.
What are 5 and 10 year survival and disease free stats for my type of tumour, with and without the proposed treatment regime? What is the liklihood of local or regional occurence, with the proposed treatment regime, and what impact would radiation therapy of the axilla have on this. Could fever be cancer related (Doctor thinks not).
Lumpectomy and Axillary dissection performed on 16 September 2003 after positive mammogram, ultrasound and core needle biopsy confirmed invasive ductal caricinoma. Tumor was 2.5cm (surgical margin 13mm, 6mm for DCIS), 7 axillary nodes cleared, one node was affected, this metastatic node measured approx 5cm by 3cm by 3cm, with extensive tumour replacement and extranodular involement of the adjacent fatty tissue. The surgical margin for the axillary dissection was less than 1mm. The tumour and lymph node tested ER and PR negative, and 3+ positive for C-erb-b2 receptors. Histologically the tumour was Nottingham grade 3+3+3. I have started on a chemotherapy/radiation therapy regime(AC (Adriamycin 60mg/m3 and cyclophosphamide 600mg/m2) for four cycles, radiation therapy and Taxol for four cycles).
My radiation oncologist doesn't want to perform raidation on the axilla due to the threat of lymphodema (I am obese), however I am concerned about the close margin, especially considering the agressive characteristics of the tumour.
What are 5 and 10 year survival and disease free stats for my type of tumour, with and without the proposed treatment regime? What is the liklihood of local or regional occurence, with the proposed treatment regime, and what impact would radiation therapy of the axilla have on this. Could fever be cancer related (Doctor thinks not).
Doctor's Answer
by CCF-RN,MSN-JS, Oct 28, 2003 12:00AM
Dear damabelle, Based on the information you have provided above your disease would be staged as a stage IIB. Most survival statistics are discussed in 5 year survival terms, not both 5 and 10 year.
5 year survival based on stage (AJCC Staging Manual, 1998)
Stage I - 87-98%
Stage IIA - 78-88%
Stage IIB - 68-76%
Stage IIIA - 51-56%
Stage IIIB - 42-49%
Stage IV - 13-16%
Please keep in mind that in order to have 5 year survival data, the numbers must be at least 6 years old assuming the data were all collected the same year. Also, take into account the year of publication and the data are even older. In the last 10 years, many new treatments have been developed that have likely improved survival - but we won't know that statistically for a few more years. New information is constantly being published that will have other statistical figures. Physicians must read these articles critically in order to interpret the data correctly and incorporate the information correctly into their practice. In other words, statistics provide a guideline only. They help to guide treatment decisions. They are NOT meant to be applied to individuals. Also survival statistics are based on persons who have had treatment, as most patients have had some type of adjuvant therapy.
As you have noted your tumor exhibits some more aggressive features - grade 3, and less favorable prognostic characteristics - positive Her2 neu status. This information would lead to more aggressive approach to adjuvant chemotherapy (as is being done).
In regard to radiation therapy since you have had a lumpectomy radiation to the breast would be standard of care. As to radiation to the axilla - treatment of the axillary lymph nodes was standard-of-care for women with early-stage breast cancer up until about a decade ago. At that point it was recognized as one of the two major contributors to lymphedema, the other being full axillary dissection. At this time the use of a "posterior axillary boost" to specifically target axillary nodes is only standard for women who have an inadequate nodal sampling (too few nodes examined: a number that is controversial and technique dependent), gross residual disease in the axilla after surgery, and management of inflammatory breast cancer.
Some radiation oncologists would add axillary treatment if a large percentage of nodes were involved (e.g., 23 of 24 nodes positive).
Extracapsular extension is only an indication for axillary treatment if the extension is obvious in the gross pathology specimen as opposed to a microscopic finding.
Regarding your question of fever; fever can be attributed to many things, and there are cases where fever can be directly attributed to the cancer, however, it is not a common symptom with breast cancer, and another source of continuing fevers would likely be considered.
5 year survival based on stage (AJCC Staging Manual, 1998)
Stage I - 87-98%
Stage IIA - 78-88%
Stage IIB - 68-76%
Stage IIIA - 51-56%
Stage IIIB - 42-49%
Stage IV - 13-16%
Please keep in mind that in order to have 5 year survival data, the numbers must be at least 6 years old assuming the data were all collected the same year. Also, take into account the year of publication and the data are even older. In the last 10 years, many new treatments have been developed that have likely improved survival - but we won't know that statistically for a few more years. New information is constantly being published that will have other statistical figures. Physicians must read these articles critically in order to interpret the data correctly and incorporate the information correctly into their practice. In other words, statistics provide a guideline only. They help to guide treatment decisions. They are NOT meant to be applied to individuals. Also survival statistics are based on persons who have had treatment, as most patients have had some type of adjuvant therapy.
As you have noted your tumor exhibits some more aggressive features - grade 3, and less favorable prognostic characteristics - positive Her2 neu status. This information would lead to more aggressive approach to adjuvant chemotherapy (as is being done).
In regard to radiation therapy since you have had a lumpectomy radiation to the breast would be standard of care. As to radiation to the axilla - treatment of the axillary lymph nodes was standard-of-care for women with early-stage breast cancer up until about a decade ago. At that point it was recognized as one of the two major contributors to lymphedema, the other being full axillary dissection. At this time the use of a "posterior axillary boost" to specifically target axillary nodes is only standard for women who have an inadequate nodal sampling (too few nodes examined: a number that is controversial and technique dependent), gross residual disease in the axilla after surgery, and management of inflammatory breast cancer.
Some radiation oncologists would add axillary treatment if a large percentage of nodes were involved (e.g., 23 of 24 nodes positive).
Extracapsular extension is only an indication for axillary treatment if the extension is obvious in the gross pathology specimen as opposed to a microscopic finding.
Regarding your question of fever; fever can be attributed to many things, and there are cases where fever can be directly attributed to the cancer, however, it is not a common symptom with breast cancer, and another source of continuing fevers would likely be considered.
I read so much about lymphedema after radiation. I had 14 positive nodes out of 15 taken out. I had chemotherapy, radiation and am taking Tamoxifen. I was radiated in the axillary area under my armpit, and I have NOT had lymphedema.
My arm looks the same as the other one.
the histopathology results determined that no node were involved however diameter of tumor size of slightly higher than 5 cm. ER and PR done previously was negative, however at that time 2 out of 17 nodes were involved. this time it is considered grade 2 cancer.
my oncologist is actually suggesting chemotherapy and i am reluctant to go for it as it was bad experience when i had it last time.
What are the chances of my 5 and 10 year survival and disease spread if i choose to go chemo free this time. please suggest.