Asking for opinions

[Lindugas]

Hi and Happy Holidays to all.

I am 2 1/2 weeks post-op from left breast Mastectomy. I had previously had  lumpectomy "7" years ago in the same breast with postive hormone receptors, 18 clear lymph nodes and 2.5 cm size tumor, ductal carcinoma.
I had radiation and chemo last time and tolerated all well.  I chose not to take Tamoxifen.
This time I had a 1.4 cm tumor (no lymph nodes left to dissect) Pathology showed clear margins, but DCIS around the tumor site (?) This time my hormone receptors are both E&P negative.
My Oncologist suggests 4 Cytoxon & Adriamycin (sp) and 4 Taxol chemo treatments.  I have been told that the basis for this treatment plan is my negative hormone receptors this time. She
keeps waving though..strongly suggesting I take both forms of
chemo and yet says we will see if we need to do the Taxol? I am
confused to say the least. My doctor has also advised me pre-op and postop that it would depend on my pathology which I thought
was pretty good from what the surgeon said (with the clear margins.   Any input?  Also the Adriamycin info I got scares me as does the Taxol info.   Any feedback on that issue?  Thanks so much for any feedback.

[CCF-RN,MSN-rf]

Dear Lindugas:  The decision to pursue chemo is likely based upon the size of the tumor.  Research shows that there is some benefit to doing chemo in any tumor over 1.0cm.  Unless the pathology was all DCIS, it is unlikely that it would influence the decision to do chemo.  Adriamycin, Cytoxan and Taxol is becoming today's standard of care, although most of the research adding taxol was done on "high-risk" (node-positive) breast cancer.  So this may be an aggressive approach to your problem.  Hormone therapy is not an option this time, given the negative receptors.  You mention that you took chemo the last time around and tolerated it well.  I'm not sure what drugs you took but most women tolerate AC+T fairly well.  You can learn more about the drugs on www.chemocare.com

[surgeon]

there are data that indicate value in chemotherapy when the tumor size is greater than 1 cm, regardless of other factors. So the margins aren't an issue in the recommendation you have received. Which combination of drugs you take depends on various factors; but the recommedation to do it is based on the tumor size. Recurrance within the treated breast at this time frame may in fact have better overall prognosis than a tumor which arises for the first time. So there's no inference that your tumor is particularly bad; it's just about data gathered over time....

[Lindugas]

Hi Surgeon, thank you for your response.

I have been read many posts and the general concensus appears to
be to have chemo for any tumor over 1 cm. I am just really scared
about the chemo drugs and the fact that there could be more severe side effects with these newer drugs.
I guess what I am looking for is some feedback from others that have had the same types of chemo and how they made out. I know I have to have chemo and I am more afraid this time than the first time. My Oncologist wavering about the certainty about whether she will need to give me the taxol is also a bit unnerving...why would she suggest it so strongly and then keep saying we will see if we need to do that? Anyways, any input from others going through or having already gone through the same chemo treatment
would be most helpful.  thank you all.

[bethl]

I'm sorry to hear that you are going thru all of this. I was diagnosed nearly 3 years ago and did the chemo that has been recommended for you. 4 cycles of adriamycin/cytoxan, then 4 cycles of Taxol. While it was very difficult, it was certainly not impossible and wasn't as bad as I had feared. I usually found that the first 3-4 days after A/C I really needed to use the anti-nausea meds, but then I was ok. EXTREMELY tired -- but it never stopped me from doing things that I really wanted to! (I didn't waste energy on housework, but went to all my kids school programs and 2 vacations while on chemo!). I thought the taxol was much easier - I was still tired, but not as badly, my hair actually began to grow back (little tiny wisps, but it was encouraging!), no trouble with nausea and only minimal problem with neuropathy (some numbness in hands and feet).
Best of luck!!
beth

[Lindugas]

Hi Beth
Thank you for your comments I really appreciate that you were able to share your experience with me.  
I know the Oncology office (dr. and nurses) are just trying to prepare me for this chemo but was really scared about the adverse reactions noted on the printed info on the meds for this course of chemo.
I know I will lose my hair and have a wig from last time and will
be looking for turbans too. I have to work, so was very worried
about being sick and losing a lot of time from work too.
I know that in the grand scheme of things its more important to look at the  end result of having chemo to prevent any microscopic spread of cancer cells, than to worry about the finances and all that. I am a worrier by nature though so anything that can cause me any  worry, bingo..I worry.  Thanks again for your input. :) Hope all is well for you.

[Nhita]

I was reasonly diagnosed with breast cancer. I have completed 2 sessions of chemo got the lump shrunk to about 1.2cm (initially was 2.5cm)did a lumpectomy. My margins are clear,none of the nodes were affected,but I am ER and PR receptor negative.Mine is a type 3 cancer. Due to this my doctor has asked me to complete the 4 remaining cycles of chemo.What I would like to know is what are the pros and cons of my prognosis.