Aa
Does it need radiation and chemoterapy
Hi Doctor,
I am in Indonesia. We really need advice for my wife treatment.
My wife has had 2 times operation for her breast. Firstly Doctor has been made Excision operation for about 12X8 mm size of the tissues. Then the biopsy result was Medullary Carcinoma Mammae.
By its Biopsy result has been made for the second operation about 3 cm around of the first operation and taken 15 pcs lymph node. From the biopsy and IHC Clear and clean from the tumor and malignancies and outwarding appearance of P63 gave positive reactions in the immune cells in the ductuli mioepitel no need to continue for treatment.
But the results of the first excision biopsy operation concluded Medullary Carcinoma mammae. It has been requested again to IHC for the final decision and the result is Estrogen and progesterone Receptor Negative, and c-erb B2 positive.
Doctors Oncologists finally make a letter to Dr. Radiation Oncologist to do 30 times the radiation.
And then later on chemotherapy. He said although there was no malignancy of the tumor at the surgery BCS, as it is standard procedure. I think it's very painful.
As Doctor said Medullary is less aggressive compare to others type of carsinoma and good prognosis, So, Does she still need to radiation and chemotherapy?
Thank you for your kindness to us.
A restless husband
Siagian
I am in Indonesia. We really need advice for my wife treatment.
My wife has had 2 times operation for her breast. Firstly Doctor has been made Excision operation for about 12X8 mm size of the tissues. Then the biopsy result was Medullary Carcinoma Mammae.
By its Biopsy result has been made for the second operation about 3 cm around of the first operation and taken 15 pcs lymph node. From the biopsy and IHC Clear and clean from the tumor and malignancies and outwarding appearance of P63 gave positive reactions in the immune cells in the ductuli mioepitel no need to continue for treatment.
But the results of the first excision biopsy operation concluded Medullary Carcinoma mammae. It has been requested again to IHC for the final decision and the result is Estrogen and progesterone Receptor Negative, and c-erb B2 positive.
Doctors Oncologists finally make a letter to Dr. Radiation Oncologist to do 30 times the radiation.
And then later on chemotherapy. He said although there was no malignancy of the tumor at the surgery BCS, as it is standard procedure. I think it's very painful.
As Doctor said Medullary is less aggressive compare to others type of carsinoma and good prognosis, So, Does she still need to radiation and chemotherapy?
Thank you for your kindness to us.
A restless husband
Siagian
Best Answer
Hi all good people,
2 days ago after 5 times radiations my wife has taken her blood for testing of her conditions. From the blood results laboratory, she is very healthy and the number in the range. Thanks to all of you for the praying.
Warm Regards,
Mick
2 days ago after 5 times radiations my wife has taken her blood for testing of her conditions. From the blood results laboratory, she is very healthy and the number in the range. Thanks to all of you for the praying.
Warm Regards,
Mick
Thanks for the update!
I hope your wife's radiation treatments go well. If she has burning or irritation of the skin, be sure to ask the doctor or his nurse about creams that will help a great deal.
My thoughts anbd prayers are with you both,
bluebutterfly
I hope your wife's radiation treatments go well. If she has burning or irritation of the skin, be sure to ask the doctor or his nurse about creams that will help a great deal.
My thoughts anbd prayers are with you both,
bluebutterfly
Hi....,
Today is third day my wife has a radiation from 25 times planned.
My prayer and thought and hope from you to make safe of my wife.
Warm Regards,
Mick
Today is third day my wife has a radiation from 25 times planned.
My prayer and thought and hope from you to make safe of my wife.
Warm Regards,
Mick
It is a favorable factor that your wife's BC was detected at Stage I.
However, since it is HER2+, and over 1 cm, the best chance for the miracle you are hoping for would be the treament you don't want to hear about. The report I quoted above indicated that chemo was already the standard of care for HER2+ tumors larger than 1 cm, and the new study suggested it should also be used on smaller tumors, even node negative ones less than 1 cm.
And here is an earlier MedHelp post by a doctor, discussing treatment for cancer of the type your wife has:
"by PaulMD , Apr 28, 2008 01:49AM
Hi there.
The decision to receive chemotherapy or not depends on the stage (usually if positive lymph nodes or tumors greater than 1 cm in size [NCCN guidelines]). However, a grade 3 cancer can add a new dimension on the decision to undergo additional treatment. Though medullary cancer generally behaves less aggressively than the usual invasive ductal cancer, a grade 3 finding can influence you and your oncologist to give additional treatment (like chemotherapy). It will also depend if your tumor is ER/PR positive or Her2Neu positive. I suggest you discuss these things with your oncologist for proper guidance. You can also visit the National Comprehensive Cancer Network website."
These recommendations are why I suggested that, if at all possible, you arrange that additonal consult with a Medical Oncologist (who would have the latest knowledge about factors influencing the decision regarding chemotherapy).
Regards,
bluebutterfly
However, since it is HER2+, and over 1 cm, the best chance for the miracle you are hoping for would be the treament you don't want to hear about. The report I quoted above indicated that chemo was already the standard of care for HER2+ tumors larger than 1 cm, and the new study suggested it should also be used on smaller tumors, even node negative ones less than 1 cm.
And here is an earlier MedHelp post by a doctor, discussing treatment for cancer of the type your wife has:
"by PaulMD , Apr 28, 2008 01:49AM
Hi there.
The decision to receive chemotherapy or not depends on the stage (usually if positive lymph nodes or tumors greater than 1 cm in size [NCCN guidelines]). However, a grade 3 cancer can add a new dimension on the decision to undergo additional treatment. Though medullary cancer generally behaves less aggressively than the usual invasive ductal cancer, a grade 3 finding can influence you and your oncologist to give additional treatment (like chemotherapy). It will also depend if your tumor is ER/PR positive or Her2Neu positive. I suggest you discuss these things with your oncologist for proper guidance. You can also visit the National Comprehensive Cancer Network website."
These recommendations are why I suggested that, if at all possible, you arrange that additonal consult with a Medical Oncologist (who would have the latest knowledge about factors influencing the decision regarding chemotherapy).
Regards,
bluebutterfly
Hi for your goodness,
Thanks, you still responded our worries.
I might need to add others data about the size of tissues identified from USG, mammo and Exicion operation is 13 mm X 9 mm (Dr said that stadium 1) Is it making more easier to do treatment? I am really waiting a miracle new to hear.
God always Bless a Good people.
Warm Regard,
Mick
Thanks, you still responded our worries.
I might need to add others data about the size of tissues identified from USG, mammo and Exicion operation is 13 mm X 9 mm (Dr said that stadium 1) Is it making more easier to do treatment? I am really waiting a miracle new to hear.
God always Bless a Good people.
Warm Regard,
Mick
It sounds as though you had a very good consultation, which helped you to understand better the possibility of micrometatases (tiny cells escaping which cannot yet be detected), and thus the importance of further treatment to reduce the risk of recurrence.
Radiation is a local treatment, which is intended to affect any hidden cancer cells in the radiated area. I am glad you have decided to at least do radiation, which I believe was recommended by your wife's original oncologist. This will be time-consuming, but should not too difficult for her to tolerate.
Chemo, on the other hand, is a systemic treatment which is intended to reach hidden cells anywhere in the body. I do not understand this doctor's comment about "hormone is the second treatment not chemotherapy," since you previously indicated that her cancer is ER-/PR-, and thus would not be responsive to hormone therapy.. (Since her cancer is HER2+, Herceptin would be the effective agent, along with chemo.)
But perhaps the standard of care is different in your country than in the USA where I am located...
I know you are very stressed and overwhelmed and may not want to pursue this further, but the one additional step I would recommend is that, if at all possible, you seek a consultation with a Medical Oncologist (the type of doctor who actually prescribes and administers chemo and other anti-cancer medications) for a final opinion on her treatment plan, since it sounds as though you have been dealing primarily with a Surgical Oncologist and a Radiatioin Oncologist.
Whatever you decide, my thoughts and prayers will be with you both.
bluebutterfly
Radiation is a local treatment, which is intended to affect any hidden cancer cells in the radiated area. I am glad you have decided to at least do radiation, which I believe was recommended by your wife's original oncologist. This will be time-consuming, but should not too difficult for her to tolerate.
Chemo, on the other hand, is a systemic treatment which is intended to reach hidden cells anywhere in the body. I do not understand this doctor's comment about "hormone is the second treatment not chemotherapy," since you previously indicated that her cancer is ER-/PR-, and thus would not be responsive to hormone therapy.. (Since her cancer is HER2+, Herceptin would be the effective agent, along with chemo.)
But perhaps the standard of care is different in your country than in the USA where I am located...
I know you are very stressed and overwhelmed and may not want to pursue this further, but the one additional step I would recommend is that, if at all possible, you seek a consultation with a Medical Oncologist (the type of doctor who actually prescribes and administers chemo and other anti-cancer medications) for a final opinion on her treatment plan, since it sounds as though you have been dealing primarily with a Surgical Oncologist and a Radiatioin Oncologist.
Whatever you decide, my thoughts and prayers will be with you both.
bluebutterfly
Hi All,
This morning we went to the one of Oncologist Surgery Founder in Indonesia.
He is very old man. We shown him all of the copy data Pathology, Mammography, USG Abdomen, Photo Torack of My Wife. He check the Excision an BCS area has been made by the first Dr. Oncologist Surgery.
We asked him what is next treatment we should take to get assuring this safely. He explained us by Drawing himself of the twice surgeries has ben made. He told us about first excion is Medullary Carcinoma and Second operasion no seen any tumor and malignancies either from 15 lymp node (it is good), but a group of malignancies (Cancer) is clear to see by microscope, but if one small cell out to go can not be seen to be easy. So he said must do Radiation for 30 times, not Chemotraphy. If not, hormone is the second treathment not Chemoterpy. So we plan to go to Dr. Radiation (Oncl). Please give us a true comment
Warm Regard,
Mick
This morning we went to the one of Oncologist Surgery Founder in Indonesia.
He is very old man. We shown him all of the copy data Pathology, Mammography, USG Abdomen, Photo Torack of My Wife. He check the Excision an BCS area has been made by the first Dr. Oncologist Surgery.
We asked him what is next treatment we should take to get assuring this safely. He explained us by Drawing himself of the twice surgeries has ben made. He told us about first excion is Medullary Carcinoma and Second operasion no seen any tumor and malignancies either from 15 lymp node (it is good), but a group of malignancies (Cancer) is clear to see by microscope, but if one small cell out to go can not be seen to be easy. So he said must do Radiation for 30 times, not Chemotraphy. If not, hormone is the second treathment not Chemoterpy. So we plan to go to Dr. Radiation (Oncl). Please give us a true comment
Warm Regard,
Mick
You are most welcome, and please keeped us posted in the future on how things are going for you and your wife--we care!
Wishing you all the best,
bb
Wishing you all the best,
bb
Hi bluebutterfly2222,
From my depth heart I am grateful for your goodness to give me a support.
Kind Regards,
Mick
From my depth heart I am grateful for your goodness to give me a support.
Kind Regards,
Mick
Here is a link where you can obtain a free download of a guidebook for men dealing with cancer in their partners. It is called "Man to Man." I hope this will be helpful to you in dealing with your stress and fears, as well being a good source of information (although it is about now about 8 years old).
http://www.hospicewindsoressex.com/downloads/06030801.pdf
Regards,
bb
http://www.hospicewindsoressex.com/downloads/06030801.pdf
Regards,
bb
Hi..,
I grateful to all of your support and suggestion.
We'll take it to be consider, we are planning this Thursday to meet another senior Doctor Surgeon Oncologist to ask others opinion.
I am so afraid with this now, I have no free time not to feel stress. I hope God gives us a good way to solve.
Warm regards,
Mick
I grateful to all of your support and suggestion.
We'll take it to be consider, we are planning this Thursday to meet another senior Doctor Surgeon Oncologist to ask others opinion.
I am so afraid with this now, I have no free time not to feel stress. I hope God gives us a good way to solve.
Warm regards,
Mick
Hi again,
We completely understand all of the anxiety, confusion, and doubts associated with the sudden diagnosis of breast cancer. We also respect every patient's right to self-determination, so please do not think we are trying to force you to make a decision you do not feel ready to make. We just want to make sure you have all the information important to making such a decision.
It is very good that your wife's second operation obtained clear margins, ant that examination of her lymph nodes show no lymph node involvement.
Unfortunately, there is always the possiblity of micro-metastases that are still too small to be detected. This is one of the reasons that it has become the standard of care to recommend chemo for anyone who has a BC tumor 1 cm or larger. And because HER2+ BC tends to be so aggressive, it is now recommended that BC of that type be treated concurrently with chemo and the targeted treatment of Herceptin even when the tumor is smaller than 1 cm.
Here is a comparison of early stage HER2+ BC to other types, based on the 2008 report I cited above:
"In those analyzed with HER2 positive tumors, the five-year, recurrence-free survival was 77.1 percent; in contrast, HER2 negative patients' recurrence-free survival was 93.7 percent. Five-year distant recurrence-free survival was 86.4 percent in women with HER2 positive tumors compared to 97.2 percent in women with HER2-negative tumors. Patients with HER2-positive tumors had 2.68 times higher risk of recurrence and 5.3 times higher risk of distant recurrence than those with HER2-negative tumors. In addition, women with HER2-positive tumors had 5.09 times the risk of recurrence and 7.81 times risk of distant recurrence than women with hormone receptor-positive tumors."
Please feel free to post again regarding this issue or other concerns, and we will do our best to help in a nonjudgmental manner.
Regards,
bb
We completely understand all of the anxiety, confusion, and doubts associated with the sudden diagnosis of breast cancer. We also respect every patient's right to self-determination, so please do not think we are trying to force you to make a decision you do not feel ready to make. We just want to make sure you have all the information important to making such a decision.
It is very good that your wife's second operation obtained clear margins, ant that examination of her lymph nodes show no lymph node involvement.
Unfortunately, there is always the possiblity of micro-metastases that are still too small to be detected. This is one of the reasons that it has become the standard of care to recommend chemo for anyone who has a BC tumor 1 cm or larger. And because HER2+ BC tends to be so aggressive, it is now recommended that BC of that type be treated concurrently with chemo and the targeted treatment of Herceptin even when the tumor is smaller than 1 cm.
Here is a comparison of early stage HER2+ BC to other types, based on the 2008 report I cited above:
"In those analyzed with HER2 positive tumors, the five-year, recurrence-free survival was 77.1 percent; in contrast, HER2 negative patients' recurrence-free survival was 93.7 percent. Five-year distant recurrence-free survival was 86.4 percent in women with HER2 positive tumors compared to 97.2 percent in women with HER2-negative tumors. Patients with HER2-positive tumors had 2.68 times higher risk of recurrence and 5.3 times higher risk of distant recurrence than those with HER2-negative tumors. In addition, women with HER2-positive tumors had 5.09 times the risk of recurrence and 7.81 times risk of distant recurrence than women with hormone receptor-positive tumors."
Please feel free to post again regarding this issue or other concerns, and we will do our best to help in a nonjudgmental manner.
Regards,
bb
Thanks to all of you are good people to give us the sugestion. Honestly I just trying to think as usual if the second operation had cut the tissue 3 Cm around from the first exition and resulted from 5 VC and 15 Cupes/15 Casets (250 gram) and took 15 pcs Lymph Node no contain of tumors and malignancies. What are those means? Is it meaning no metastasis yet. IHC said no need to continue treathment. I am so sorry to make it very complicated, i do not want any mistastake on trathment to damage her body by radiation and chemotherapy.
I hope all of you are still understand my feeling now. And God always bless of you.
a very fright people
MSiagian
I hope all of you are still understand my feeling now. And God always bless of you.
a very fright people
MSiagian
No one can tell you what to do, but please give serious consideration to my comment above, those of SueYoung55, and the following information presented to the San Antonio Breast Conference in December 2008:
"New data shows a higher than predicted rate of breast cancer recurrence even with very small breast cancers that are HER2 positive. The data is from the first large study to analyze early-stage breast cancer patients with HER2 positive tumors one centimeter or smaller. All these women would benefit from adjuvant Trastuzumab, also known as Herceptin, (for one year, the standard in America) - along with adjuvant chemotherapy. This represents a shift in the way women with early-stage HER2 positive breast cancer should be assessed for risk of recurrence and considered for treatment, according to the study's author."
Please also research carefully whether there have been ANY well-controlled clinical trials showing that "Noni juice" has any scientifically documented effectiveness against breast cancer, before betting your wife's health, and possibly her life, on it!
Wishing you only the best,
bluebutterfly
"New data shows a higher than predicted rate of breast cancer recurrence even with very small breast cancers that are HER2 positive. The data is from the first large study to analyze early-stage breast cancer patients with HER2 positive tumors one centimeter or smaller. All these women would benefit from adjuvant Trastuzumab, also known as Herceptin, (for one year, the standard in America) - along with adjuvant chemotherapy. This represents a shift in the way women with early-stage HER2 positive breast cancer should be assessed for risk of recurrence and considered for treatment, according to the study's author."
Please also research carefully whether there have been ANY well-controlled clinical trials showing that "Noni juice" has any scientifically documented effectiveness against breast cancer, before betting your wife's health, and possibly her life, on it!
Wishing you only the best,
bluebutterfly
Yes her diagnosis definetly calls for chemo AND radiation. Noni juice won't do a thing to assist your wife with her cancer diagnosis and ignoring it would be a horrid mistake with a worse outcome.
Thanks for the replied.
The letter from Dr. Oncologist to Dr Radiation Oncl. is saying Stadium 1 for the status of the cancer. At now we have not decided yet to take radiation and chemotherapy to her condition.
But now she is taking to drink every 2 hours of 30 cc juice Tahitian Noni this very famous at the moment by various information to counter the cancer and regenerate to be good tissues.
My wife now is very fit condition and happiness. She is not intending to follow to get the Radiation and Chemo either.
Please comments.
Cheers,
MSiagian
The letter from Dr. Oncologist to Dr Radiation Oncl. is saying Stadium 1 for the status of the cancer. At now we have not decided yet to take radiation and chemotherapy to her condition.
But now she is taking to drink every 2 hours of 30 cc juice Tahitian Noni this very famous at the moment by various information to counter the cancer and regenerate to be good tissues.
My wife now is very fit condition and happiness. She is not intending to follow to get the Radiation and Chemo either.
Please comments.
Cheers,
MSiagian
A point of claification: I am not a physician.
Questions in this forum are answered by volunteers, generally not identified as health professionals.
Questions in this forum are answered by volunteers, generally not identified as health professionals.
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With any cancer, it is important to "stop it in its tracks" if possible when it is first diagnosed and might be considered "curable," rather than refuse certain difficult types of treatment and risk a recurrence, which could be far more serious.
And this is especially important in breast cancer of the type your wife has, ER-/PR-/HER2+. Since it is hormone receptor negative, risk of recurrence cannot be reduced by the commonly used hormone-suppressing treatments (such as tamoxifen). And since it is HER2+ (another name for the term for "c-erb B2 positive" that you used), which is often associated with a particularly aggressive cancers, it is recommended that even very small tumors be treated aggressively. Fortunately, there is a targeted treatment, Herceptin, for HER2+ cancer, and combined with chemotherapy, it has improved the outlook for this type of BC.
Best wishes to both you and your wife,
bluebutterfly