Hormone Therapy or Chemothrapy

[Gaurav9211]

Hi

My mother(57 years) has been diagnosed with invasive lobular cacinoma. Sector mastectomy from the left breast with axiarry nodes have been done. The giagnosis of histopathology reports is

ER             Strong Positive in 90% of tumour nuclei
PgR           Strong Positive in 90% of tumour nuclei
Her2Neu     Weak Positive(2+)

Margins of excision- Free from tumor
Axilllary nodes No metastasis(0/21)

Please suggest whether chemotherapy is better for her or hormone therapy will be better.

Gaurav

[Dennis MD]

Hi.
I would like to stress that breast cancer treatment should be individualized.  The prognostic factors (stage, hormone receptor status, etc.) should all be considered in making the decision as to the form of treatment given.  
Your mother will benefit from chemotherapy and hormonal therapy.  These treatments are given to decrease the risk of recurrence and improve the overall survival of patients with breast cancer.  The sequence of chemotherapy followed by radiation therapy, then hormonal therapy is usually followed.  Hormonal therapy (tamoxifen or aromatase inhibitors) is a reasonable option for early breast cancer patients not given chemotherapy.
The American Society of Clinical Oncology gave out guidelines as to when to offer post operative radiotherapy.  In their guidelines, post operative radiotherapy is recommended for those patients with 4 or more positive lymph nodes and those with stage III disease except those with T3N0M0.  
Hope this helps.

[Gaurav9211]

Hi AgainI am very confused as one of the oncologist suggested that we should get Chemotherapy followed by radiation and hormone therapy and the other onclogist suggested that  have radiation and hormone and no need for chemothrapy as this point, He further suggested that  that since cancer is local and metastatis is negative these is no need for immediate chemotherapy as the advantage one has by having chemotherapy instead of hormone is hardly 2-4%.Please suggest your opinionGaurav

[Dennis MD]

Hi again.
Based on the information you gave, your mother’s TNM stage is IIA (T2N0M0) provided her work-ups did not reveal any metastatic site.
Since she has co-morbid illnesses (coronary artery disease and diabetes mellitus), that will somehow limit the type of chemotherapy drugs that can be used.  Depending on her cardiac status, she may not be given anthracyclines like doxorubicin because of the potential cardiotoxicity of the drug.  Luckily, there are other available chemotherapy drugs that can be used.  
The risks and benefits of treatment should be weighed as I have already mentioned.
Take care.    

[Gaurav9211]

Hi

Thanks for the response.

The tumor Size is 2.5 cm and the other problem is that she is a heart patient and diabetic. Infact she had a major heart attack three years back. All the lymph nodes are clear. We are a little worried whether she will be able to cop up with the side effacts of chemotherapy.

Gaurav

[Dennis MD]

Hi Gaurav.
How are you?
Do you know the size of the tumor?  Did the laboratory use IHC or FISH in determining the Her2Neu expression?  Form what you posted, it seems that your mother is in the early stage of breast cancer.  She will benefit from either chemotherapy or hormonal therapy.  She can undergo chemotherapy then hormonal therapy after she is done with her chemotherapy.  Her hormone receptor status is positive.  A positive hormonal status has better prognosis compared to those with negative hormone receptor status.  Consider also the other prognostic factors like tumor size, lymph node status, and patient’s age in making the decision.      
You should discuss the treatment options with your mother’s oncologist.  The risks and benefits of treatment should be weighed.  
Good luck.