chemo or not

[jetrsa]

Hi I am hoping this is posted in right place for a medical answer, but I would appreciate anyone's advise if been in similiar situation.  I am 39 and had a bilat mastectomy with tissue expanders put in for reconstruction on 11-12-07 for dcis and idc.  Total size of tumor was 1.5cm with areas of invasive disease 0.1cm and 0.5cm.  It was grade 1, er 30%pos, pr neg, and her2 pos.  Sentinel and one other node negative.  My doctor is really not sure regarding chemo.  Oncotype pending.  Is chemo normally suggested for this size invasive tumors?  Or is it due to her2?   Also path report started suspicion for angiolymphatic invasion.  Want to do everything to prevent recurrence,  but don't want to go thru chemo if not really necessary, and have already been aggressive with bilat mast.   Any help would be greatly appreciated.

[judi0125]

A related discussion, breast cancer was started.

[oz_lady]

Here are some statistics by two prominent Professors one an Oncologist, the other a Radiologist.

http://www.laetrile.com.au/otherpages/chemo1.htm

[oz_lady]

http://www.breastcancer.org/research_herceptin.html

Serious heart side effects

Research News:

Preliminary results from the HERA Trial: Herceptin Taken Less Frequently at Higher Doses Does Not Increase Risk of Heart Damage Less commonly, Herceptin can damage the heart's ability to pump blood effectively. Find out more about the benefits and side effects of Herceptin. Rarely (about 5% of the time), the heart damage is bad enough that women experience stroke or life-threatening congestive heart failure—a condition in which the heart can't pump effectively. Slightly more often (about 7% of the time), Herceptin causes mild heart failure.

Women who experience mild or more serious heart damage can stop taking Herceptin and start taking heart-strengthening medications. This often brings heart function back to normal.

While heart damage can be more severe when Herceptin is given along with other chemotherapy drugs known to cause heart damage, including Adriamycin (chemical name: doxorubicin) and possibly other drugs like it.

Taking Herceptin with the chemotherapy drug Taxol (chemical name: paclitaxel) does not increase your risk of severe heart damage. Studies have shown that this combination causes only slightly more mild heart damage than Herceptin alone. Women in clinical trials who are receiving Herceptin plus Taxol are being watched very closely for this effect.

Testing your heart before and during Herceptin treatment
Before starting Herceptin therapy, you should have an echocardiogram or a MUGA scan to check how well your heart is functioning.

An echocardiogram uses sound waves to take detailed pictures of the heart as it pumps blood. For this quick test, you lie still for a few minutes while a device that gives off sound waves is briefly placed on your ribs, over your heart. There is no radiation exposure with this test.  

ALTERNATIVE MEDICINE

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http://www.laetrile.com.au/testimon/testimpage1.htm


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[Cleveland Clinic]

Dear jetsra,   Decisions about adjuvant chemotherapy or hormonal (antiestrogen) treatment are based on several factors including size of tumor, status of lymph nodes under the arm, the appearance of the cancer under the microscope, the presence or absence of hormone receptors for estrogen and/or progesterone, as well as HER2 status, the general health of the patient etc.    We can not make specific treatment recommendations for an individual in this forum. We can tell you that antiestrogen treatments are frequently given following surgery for ER-positive breast cancer to reduce the risk of recurrence in the form of metastatic disease. Chemotherapy may add an additional benefit that needs to be weighed against the potential side effects. Her 2 positive tumors generally increase risk to intermediate or high risk which would increase the likelihood of adjuvant chemotherapy being recommended.  A bilateral mastectomy by itself would not factor into the whether or not chemotherapy would be given.  Your oncologist will be better able to discuss these options with you.  Another item you may want to consider is a consultation with a genetics counselor, these specialists are usually associated with large academic centers.

[txgrl01]

My onc told me it was based on size and grade, er/pr/her2 status, angiolympatic invasion and node status are considered.  Generally greater than 1.0 cm is considered for chemo but all the above factors in.  You might try looking a AdjuvantOnline and plugging in what you know.  It gives recurrance %, without chemo, with chemo and hormonal therapy.  My onc discussed all the possible scenarios with me before we made a treatment decision.  Every patient is unique so read up on treatment options and discuss them thoroughly with your onc.  God Bless