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Breast Cancer  (Expert Forum)
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decision between mastectomy or radiation, should it be rushed?
Questions posted in the Breast Cancer Forum are answered by medical professionals from The Cleveland Clinic. Topics include Breast Biopsy, Chemotherapy, Hormone Therapy, Lumps, Lumpectomy, Lymph node dissection, Lymphedema, Mammograms, Mastectomy, Radiation Therapy, Reconstruction, Self Breast Exam, and Surgery.
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MedHelp Member's Question

decision between mastectomy or radiation, should it be rushed?

by linapril, Aug 17, 2006 12:00AM
On 8/9 on I had a lumpectomy with sentinel node removal. My surgeon removed 3 cancerous tumors but the path report is 4 pages and confusing - only one tumor size on “diagnosis” area which states “the tumor is multifocal ranging from 1.3 to 0.5 cm maximally” but under "gross" there are 7 othr measurments, most much larger. My surgeon is recommending a mastectomy because even with a combination of a mammogram, ultrasound or MRI, the ability to detect more tumors is not dependable. I am trying to weigh whether I should go forward with mastectomy or instead to radiation so have the following questions. Thank goodness the lymph node was benign.

Can radiation be given safely to only the breast,but the whole breast? This is my left side and I have family history of heart problems.



Is my cancer, mucinous adenocarcinoma, a ductal cancer? Is it invasive? Wouldn’t a non-invasive cancer be a “better type” of cancer to have?



The TNM on path reports pT1c, pN0(i-), pMX which I believe partially states the tumors were beginning to invade and the node was negative. Is my belief accurate and does this rating say more?



Is it really for my own good, the need to rush? It sounds like everyone wants me to decide today and proceed in a week with mastectomy or radiation and I feel resentful and emotionally fragile of this rushing more than the whole issue of the cancer.



Lastly, are breast cancer statistics being gathered to be better than now for our future generations to use?



Thank you in advance for your assistance.

(I am 51 years young and in generally good health).

Doctor's Answer

by CCF-RN,MSN-rf, Aug 18, 2006 12:00AM
Dear linapril:  From the information you have provided, this appears to be a stage I invasive breast cancer.  Tumor sizes listed in "TNM" staging generally refer to invasive tumor size when looked at under the microscope. The other measurements seen on your pathology report may refer to the sizes of the pieces of tissue removed, but it is hard to know without reading the report.  The data demonstrating simiilarly good results with mastectomy versus breast conserving surgery and radiation apply to tumors with a single focus. Breast conservation for multifocal tumors is associated with a higher risk of breast cancer recurrence which may be why your surgeon recommended mastectomy. The T1c indicates that the largest of the tumors that was removed is more than 1cm but less than 2cm (this is a measurement of size of the invasive tumor).  When radiation therapy is done to the breast, it is generally done to the whole breast.  Blocks and techniques are used to minimize exposure to other areas of the body but there is no way to ensure that there will be no exposure.  It is understandable to feel a bit fragile at this point.  There is some time (a few weeks) for you to think about and make your decision, it would not be advisable to wait too long since there is a possibility that the cancer could grow.  Breast cancer statistics are always being updated.  Statistics in print today, represent data that was collected a couple of years ago.  There is reason to hope that the statistics printed in years to come will be better.
Member Comments (14)

by Under Forty Pam, Aug 17, 2006 12:00AM
Do not rush or you may regret your decision.  Get a second opinion from a breast surgeon, perhaps they will clear your mind.  Go visit a radiation oncologist too.  Get everything explained in more detail, pros/cons.  Ask to review the entire report line by line if needed.  You need to be comfortable with your decision and not regret it or second guess it later.  One extra week will not make or break you.  You've had this already for sometime in all likelihood.  Don't put it off but be sure in your head.  Take someone with you to ask questions and absorb info.  My husband attended all appointments, at first he felt strange but by the end he was asking a lot of questions too.  Bring a friend or someone close to you.  It is a big decision, make it be the right one for you.  I had a lumpectomy and am adding radition to it now and have not regreted the decision because I did lots of homework upfront.  I saw two breast surgeons and 2 radiation oncologist before my surgery.  They can fit you in relatively quickly (usually a few days).  Good luck.

by Under Forty Pam, Aug 17, 2006 12:00AM
Did they say anything about having clear margins?  My lumpectomy was July 28 and my first radiation treatment was today and I pushed fast to get going.  They will not start radiation until you are deemed "healed" which is about 3-4 weeks so you have some time to continue researching.

by linapril, Aug 17, 2006 12:00AM
yes, margines are free.

by linapril, Aug 17, 2006 12:00AM
and.. thank your for your comments. how do you feel from the radiation treatment?  do you have to take meds in conjunction with radiation?

by Under Forty Pam, Aug 17, 2006 12:00AM
To: linapril
Clear margins are good.  Get out there and get a few opinions, can't hurt to hear more about what you are dealing with.  I feel fine today but it is only Day 1 about 5 hrs post radiation treatment.  They say nothing much happens for about 2 weeks then side effects kick in that vary by the person.  It is like having an xray, you don't feel anything, just hear a little noise when it turns on and off and the machine moves around to zap different spots.

by Under Forty Pam, Aug 17, 2006 12:00AM
Medication comes after radiation is complete for 5 years.  Yet another doc to find, they are medical oncologists.  I see one of these Aug 30 just to find out more in advance.  I don't finish radiation until early Oct but I like to know what to expect and find someone I like so I tend to get moving quickly.

by lizziecee, Aug 18, 2006 12:00AM
To: Under Forty Pam
I beg to differ with your last posting. Here in England. and I can only speak for my own experience, after my two surgeries, 6 months of chemo, I was put instantly onto Tamoxifen before I even started radiotherapy. Two months along, I was changed to Arimidex, which as an aromatose inhibitor, seems to be much better in controlling any further recurrence. I feel I got the very best of post operative treatments that were available some 3 years ago.

Take care,

Liz.

by lizziecee, Aug 18, 2006 12:00AM
To: Under Forty Pam
Yikes - where on earth did you get the impression that meds comes after 5 yrs of treatment? I had 2 surgeries, 6 months of chemo, was on Tamoxifen before I even started radiotherapy, and was suddenly, after 2 months, switched to Arimidex. And this is in England, where we have socialised medicine, so no control over what doctors prescribe. Perhaps your posting didn't mean what you said. Perhpas you could be more explicit in future in your postings, as I found your post alarming in the context of my own treatment.

Take care,

Liz.

by boninclyde, Aug 18, 2006 12:00AM
I think she meant radiation then you take 5 years of tamoxifon.

I believe you totally miss understood.