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Treatment for stage II, invasive ductal carcinoma, node neg.
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Treatment for stage II, invasive ductal carcinoma, node neg.

I have recently been diagnosed with Stage II invasive ductal carcinoma, neg nodes, HR positive, Her2/neu neg. Tumor size 2.1cm. The tumor was very close to the chest wall with 1mm margin. I am also post menopausal.  My question is if radiation or chemo is recommended?  My oncologist has recommended Hormone Therapy, probably Femara. I had a total mastectomy 2 weeks ago.
I live in Santa Cruz , CA.. now, but grew up  in Cleve. I am happy to have this sent to you.
thank you for your time.
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322973_tn?1239908038
Hi,

I need additional information from you. What is your histopathology report? Specifically, what is the grade of the tumor, and is lymphovascular invasion present?

American guidelines formulated by the National Comprehensive Cancer Network (nccn.org) state that for node negative, ER positive, HER2 negative tumors like yours, adjuvant chemotherapy must be considered if tumor is > 1 cm, or if tumor is 0.6 cm to 1 cm and has lymphovascular invasion or grade 2-3 features.

European guidelines formulated at the St Gallens Conference state that for ER positive, HER2 negative tumors, consider chemotherapy of tumor is > 2 cm, or Grade 2-3, or age is < 35, or lymphovascular invasion is present.

Based strictly on size criteria, both American and European guidelines may justify use of chemotherapy, as your tumor was 2.1 cm in size. However, this is a relative indication for chemotherapy, and not a strict indication. American guidelines strictly call for chemo in case of node positivity, and European guidelines if number of positive nodes are 4 or more.

Please discuss the pros and cons with your oncologist. In your case, hormone or chemo are both reasonable. Please update me on the tumor grade and LVI as requested.

All the Best, and God Bless!

3 Comments
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Dear Dr. Saini
My tumor is grade II and No LVI.  I have received the Oncotype DX results.. The recurrence score is 22. That indicates a Distant Recurrence % of 14.  This is in the intermediate range.
I appreciate your response, thank you so very much
Kami88
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322973_tn?1239908038
Hi,
With  2.1 cm tumor, Grade II, intermediate Oncotype, node negative, no LVI, receptor positive, HER2 neg, we are truely in the "grey zone" where there is no strict "correct" treatment decision between chemotherapy versus hormone therapy.
The guidelines say that you must "consider" chemotherapy for two reasons: tumor size is 2.1 cm and tumor grade is II. One additional point of worry is that tumor margin was just 1 mm near the chest wall.
Please obtain the suggestions of your treating doctors, and then take an informed decision.
All the best!
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