Treatment and surgery concern

[KeRe]

Thank you. I'm impressed with this site and quick response. Oncologist says 1/2 to 1 percent overall lifetime survival rate if I take chemo (Adriamycin and Cytoxin). Hardly seems worth considering this option. Yet according to your opinion over 1 cm chemo should definately be considered. I assume by this response you believe there is a greater percentage benefit than 1/2 to 1 percent overall lifetime survival. She says the goal is to put me in menopause, so if Tamoxofen and perhaps Lupron do it that would be sufficient. Radiation is not an issue; it is a definate. Again, I'm 43. Father had colon cancer. Tumor size between 1cm to 1.6 to 1.7 centimeters, depending on which doctor is calculating. 1 sentinel node biopsy done - neg. Stage 1; grade 3; poorly differentiated ductal carcinoma and focal intraductal carcinoma; ER/PR, 90%/>90%; following surgery margin of 1cm. clean.
Also, this may seem to be a silly concern, but during my initial biopsy (stereotactic), I about hit the roof at one point because I was not sufficiently anesthetized. (local). This was obviously when instrument was inside me, so tissue was torn as I jumped, creating good sized hematoma. I'm large breasted and tumor was relatively deep in the breast. The clip was vacuumed out with the blood so the hematoma was used as a marker for surgeon. My concern is, because of the tearing of the tissue what are the chances that some of those cells on the biopsy instrument were released into the bloodstream, and should this affect which treatment I choose. It is 2 months since biopsy. Thanks in advance for reply!

[CCF-RN,MSN-JS]

Dear KeRe, Decisions about adjuvant treatment for breast cancer are based on tumor characteristics, size as well as the features that may indicate a cancer might be more aggressive such as tumor grade, differentiation of the tumor. On the basis of available data, it is accepted practice to offer chemotherapy to most women with primary breast cancers larger than 1 cm in diameter (both with node-negative  and node-positive disease).

Radiation therapy is done to treat the local disease and decrease probablity of local (in the breast) recurrence.  Systemic adjuvant therapies include chemotherapy and hormone therapy and are designed to get rid of microscopic deposits of cancer cells that may have spread from the primary breast cancer.  Adjuvant hormone therapy is recommended only when the cancer cells have positive hormone receptors.

The trauma from the biopsy may be considered in the decision to provide chemotherapy or not.  However, other features would likely influence the recommendation such as tumor size (1cm or larger), grade 3 and poorly differentiated, rather than a possibility that cancer cells broke off during trauma of the biopsy.  This is, of course, a recommendation.  The decision is ultimately up to you.

[surgeon]

tumor manipulation by biopsy has long been a theoretical issue. However, whether a person jumps or not, they all have with stereotactic biopsy a fairly large needle passing through and "traumatizing" the tumor; so what happened to you is not much different, really. And all the women who've ever been cured of breast cancer (which is the great majority, especially with your tumor data) have had some trauma to their tumors in the process. So best we can tell, the method of biopsy has no impact on the outcome. Studies have actually looked at that, as well.