Invasive Ductal Carcinoma- Type of treatment

[umak]

My mother 57 years old, hypertension and diabetic since 8 yrs and menuposal since 3 yrs has a tumor measuring 5x4x4cm.

Path reports shows infiltrating duct carcinoma with modified BR score of 5 of 9, insitu component present, resected margins free of tumor, 13 of 13 nodes free of metasatic tumor deposits.

HET2/NEU 3+ positive 80%, ER/PR negative

She had a mastectommy done and is being given 4 doses of A/C chemo, and the doctor suggests that is enough. What is your suggestion in a case like this? Does she need more chemo, or needs Taxol, or herceptin. What kind of measures should be taken to avoid recurrance?

Thank you
Umak

[jinkz]

A related discussion, invasive ductal carcinoma was started.

[rockingrochester]

My mother is 62 years old and was recently diagnosed with invasive ductal carcinoma (2 cm x 2cm).  It was picked up on mammogram. Then she had a lumpectomy.  During her surgery one of the lymph nodes on "wet prep" were read as positive but later on H and E staining the results were negative.  Her physician is proposing regional radiation as followup. Now my aunt with the very same diagnosis is also getting chemotherapy.  Can you explain to me the possible difference (other than that they live in different cities).

Thank you.

[ming]

In Jan. 2000, my sister, who is now in Japan, got a left modified radical mastectomy and the pathology was Invasive ductal carcinoma schirrous type with 12 positive nodes among 14 dissected axillary nodes. They removed two tumors: 45x45x20mm and 15x20mm respectively. She received a postoperative adjuvant therapy of cyclophosphamide-epirucin followed by taxol and zoladex.
In Nov. 2001, her doctor found a right breast lesion, a nodule measuring 9x4 mm medio-superior-subareolarly. She got a right modified radical mastectomy in Dec. 20, 2001. Her pathology was the same as the first time, with 9 positive nodes. Her last report showed that lymphatic invasions were frequently identified, and invasion into the adipose tissue was also observed.
Doctors suggest to start with prophylactic adjuvant radiotherapy to node bearing areas including supraclavicular and parasternal regions.
Her recent examination for distant metastasis showed negative for chest, liver and bone scan.
Herceptin is just becoming available in Japan and doctors are also considering it. Is it advisable at this stage of her treatment? which will be the difference between the two mentioned therapies? and will this therapy be enough to avoid future recurrence?
your comments will be appreciated.

[CCF-RN,MSN-JS]

Dear Umak, The current standard of care based on the National Institute of Health 2000 concensus panel regarding adjuvant therapy (adjuvant therapy is given after surgery to try to prevent or minimize the growth of microscopic deposits of tumor cells that might grow into a recurrent tumor) is combination chemotherapy, such as what your mother is receiving.  

The current data are inconclusive regarding the use of taxanes in patients with node-positive breast cancer.  In patients with negative lymph nodes, the recommendation is that use of taxanes should be restricted to randomized clinical trials.  (We don't want to expose person to more toxicity without some evidence that it would be of benefit, thus the reasoning for the recommendation "only as part of a randomized clinical trial").

Current consensus is adjuvant hormonal therapy should not be recommended to women whose tumors are estrogen receptor negative.

Herceptin has been approved for use in the setting of metastatic breast cancer.  It's uncertain at this time if there will be a role for Herceptin in adjuvant therapy, at this time it is not recommended.