When is enough?

[motherof2insouthernflorida]

I know it's somewhat of a personal decisions, but when is enough enough on Chemotherapy.  At the age of 36, I was dignosed with Inflamatory Breast Cancer and In situ Ductual Carcionma when I was 17 weeks pregnant.  I started in Adrymocycian and Cytoxan at 19 weeks preganant and had 5 sessions (15 weeks) before the baby was induced at 34 weeks.  The A/C combination did take care of the Inflamatory Breast Cancer, but did not work to well shrinking the tumor itself.  I had my masectomy 3 days after the baby was born - clean margins obtained.  Since then, I have had 3 additional chemotherapy treatments of Carboplatin/Taxol. My doctor wants to do three more treatments of Carboplatin/Taxatere.  I know after the chemotherapy I am going to have to have radiation to my breast and underarms (11 positive nodes out of 11 taken).  Without the tumor to monitor -- how can you or the doctor know if the chemotherapy is doing what it needs to do and when it is time to stop the treatments.  The screening tests I had after the baby was born did not indicate that the cancer had metasized.  I want to beat the cancer, but I also want to enjoy my new baby and my 3 year old little girl.  I'm getting physically and emotionally drained with all the chemicals going in me and the demands of being a new mother.  Any advice would be greatly appreciated.  What else do I have in store for me after I finish up the chemotherapy and radiation?  When will it all be overwith??

[CCF-RN,MSN-JS]

Dear motherof2,  With Stage IIIB cancer (based on the information provided above), because concern of hidden metastasis is so high (over 50%) it is treated very aggressively with adjuvant chemotherapy.  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.  The additional chemotherapy cycles are to hopefully eradicate any remaining cancer cells.  Currently it is not known the best way of doing this.  Decisions about the protocol are based on how the cancer historically has been shown to act, studies on how combinations of drugs work, how a person is tolerating treatment, as well as individual tumor, and quality of life factors.  If you are receiving treatment as part of a clinical trial, there are specific guidelines about the treatment plan that are spelled out to be followed for that particular study.

If all goes well after the adjuvant chemotherapy and radiation therapy, treatment is complete.  Unless you had tumor that was hormone responsive, then hormone therapy would be recommended.  You will be followed closely, to make sure you are recovering from side-effects of treatment, as well as to detect any evidence of recurrence.

[heyjo]

Hi, i, too am on a jouney through the breast cancer dilema. So many questions, never enough answers. However there is a website...msn.health... that has alot of info and also has a board for communicating with others who are going through the same thing. I'm not a doctor, but I have found comfort in talking with others who have been going through the same process as me..
Just an Idea..
I am sorry that you have to go through this, especially after just having a baby. Congratulations on being so brave to go through all this and still be a mom.

[surgeon]

the treatment schedules and doses for various chemotherapies have been worked out, essentially, by trial and error: try a combination and dose, compare it to others, see which is best. It's true we have, at the present time, no way to indentify on an individual basis who could do with less, who will not respond to any recipe, etc. Treatment schedules are based on studies of thousands of people, not on one at a time. There's not a way to know in any particular case, if it's ok to stop early. The cancer you had is very aggressive, and the fact that all nodes were involved indicates a significant chance there could be cancer cells outside the treatment field. That's what chemo is for. Unless there's evidence your body can't handle it, it's better to err on the side of aggressive treatment, rather than to cut it short.