Management of infiltrative duct carcinoma

I have infiltrative duct carcinoma grade II without  18 lymph node metastasis with significant grade II intraduct component > 35% Stage pT3NOMx   NPI( Nottingham prognostic index)around 6.4 .  estrogen and progesterone receptors are negative with Her -2 neu overexpression. bone scan free , chest X ray free , abdominal pelvis sonar free , CEA 9.72 ng/ml NORMAL RANGE UP TO 5 IN NONSMOKER AND 10 IN SMOKER , CA 19.9 17.79 U/ml normal up to 37 . My age 41 years and 6 months , I am not menopausal my menstruation is regular but decreased in amount . I need your advice about the best line of management and what is the prognosis .

[CCF-RN,MSN-JS]

Dear hananfouad, From the information provided above your disease would be staged as a 2B cancer (T3N0M0) and adjuvant chemotherapy would be recommended.  Adjuvant treatment is treatment given after surgery to try to prevent or minimize the growth of microscopic deposits of tumor cells that might grow into a recurrent tumor.  There are various combinations of drugs that are used and if you are in relatively good health, with good heart function, the combination would likely include an anthracycline type chemotherapy.  You might also be evaluated for participation in a clinical trial that is looking at use of Herceptin in the adjuvant setting (as you have Her-2 neu overexpression).  Herceptin is currently approved for use in the setting of metastatic disease, it's use in the adjuvant setting is still being studied.