Need another opinion!! soon!

[bewilma]

I am 50 and have no history, family or self, of any kind of cancer. Heart attack and stroke runs in my family. No kids,no smoking, fit and active, eat low-fat, low-carb., HRT for 6 years, full hysterectomy in '97. I was devastated when diagnosed with medullary breast cancer. A tiny lump was found just under the skin. Dr's thought I had a 5% chance of cancer. Path report said otherwise. The lump was 1.7 cm
estrogen/progesterone both negative and HER-2 NEU overexpression 3+. Had a lumpectomy and the margins came clean, first try (prior lumpectomy 2/4 margins were not) Sentinal lymph node clean, until the path report revealed "single intracapsular micrometastasis of carcinoma 0.15mm greatest dimension"
______
My oncol recommended 4 chemo, 5 weeks radiation then 4 chemo
The chemo formula is: Taxotere, Epirubicin and Cytoxan
Note: I do have kidney disease cause by a severe kidney infection after the hsyterectomy.

I have read that this formula is extremely aggressive and I am not sure why this is called for with such a small tumor. I know that there is a higher risk of recurring cancer due to the estro/prog and HER-2 neu results. However, why would not radiation alone be sufficient? I had a PET scan prior to the lumpectomy and my body is totally clean of any other issues. More than 2 months after the diag. the cancer had not spread at all. Is this an overaggressive "preventative" treatment?
Your opinion please!!! Survival rate?
Thanks so much!!!
Bewilma




  

[CCF-RN,MSN-rf]

Dear Bewilma:  Radiation therapy is a local treatment only.  It is being done to treat the remaining breast tissue.  Research has shown that lumpectomy plus radiation prevents LOCAL recurrence as well as mastectomy.  The chemotherapy is being recommended in part due to the ER/PR and HER2-neu status as you referenced.  The major reason chemotherapy is recommended is due to the metastasis in the lymph node.  This indicates that the disease has spread - at least at the microscopic level.  There is no test available to date - including PET scan - that can detect microscopic disease.  The possibility exists that there could be additional micrometastasis either in additional lymph nodes - it does not always go in succession - or elsewhere in the body.  For this reason, chemotherapy is recommended to attempt to kill any unidentified cells thus preventing recurrence.  The specific drugs and treatment protocol vary according to where you live and doctors preference.  If you are concerned, consider a second opinion.  Regarding survival rates the general statistic quoted for stage IIA disease ranges from 78%-88% five year survival.  Please understand that these statistics are, by definition, old and cannot be applied to individual cases.

[surgeon]

radiation is to reduce the risk of recurrance within the breast. Chemo is to reduce the risk of recurrance elsewhere in the body. The data are very clear that with spread to lymph nodes, taking chemo significantly reduces the chance of such recurrance. The problem with any cancer treatment is our inability to fine-tune: some women in your category -- most, probably, would be cured without chemo. Some would not. Of those that would not, some would become cured by taking chemo. Some would not. Since there's currently no way of figuring our who's in which category, it's recommended that all women with nodal disease, even the minor amount you have, undergo treatment with chemo. Medullary breast cancer in general seems to have a better prognosis than the more common types: so one might think a less aggressive combination of chemo would be a consideration. So there may be more room for argument over which drugs to use than over whether to take drugs at all. Some day, hopefully, we'll be able to tell which women in your category don't need any chemo at all. Your cure rate ought to be high, whatever you decide.

[bewilma]

My oncol was particularly concerned with the ER,PR and HER-2 neu (neg./neg/strongly positive, respectively) as the reason for chemo. tratment. Does that make sense to you? If it were you knowing what I have provided, what regimine would you suggest? It is just for my information as a possible protocol.

Will I find more information at another website, such as NHI (National Health Institute) or AMA?? I really do not want to suffer so with a more aggressive therapy than I need. I am only 125 at 5'6" with occasional IBS and a sensitive stomach. I fear I will get very very sick. I am also hypothyroid.
Thanks
Bewilma