Tumor size and chemotherapy

[Zooz]

Why is the size of a tumor determined only by its longest edge? My tumor (invasive ductal carcinoma, ER+/PR+, her/2neu 3+) was 1.5 x .8 x .7, giving the tumor an average size of 1 cm, for which chemotherapy is not recommended. I had a lumpectommy (dirty margins), sentinel node biopsy (clean), them a mastectomy. I am scheduled for chemotherapy (4 rounds A/C) to begin at the end of June. I am considering declining chemotherapy treatment -- I've read that it is not as effective for node negative cancer and women with er+/pr+ cancer. Should I get another opinion? Thank you for this valuable service.

[JBK]

In July at the age of 37 I was diagnosed with breast cancer and I am now 22 weeks pregnant.  Yesturday I received my second round of 6 rounds of chemo.  I had a masecomy and my tumor size was 2 cm with 3 lymph nodes involved out of 10.  My primary concern is that I was also HER-2neu positive with a score of 18.78.  I was also PR positive.  My doctor has said my cancer was extremely aggressive, I am terrified of reoccurance and my chances of recovery this time.  Since I am pregnant I have not been able to have MRI or CAT scans.  However, through blood work it seems liver and bone are within normal ranges.  Can you give me some encouraging news about my HER-2neu scores being so high and chemo's effectiveness?  What are my chances of reoccurance? Thank you.

[CCF-RN,MSN-JS]

Dear zooz, Over the past decade there has been more information that more clearly defines the subpopulations of women with localized breast cancer, for whom adjuvant chemotherapy is indicated as a standard component of treatment. Adjuvant treatment is treatment given after surgery to try to prevent or minimize the growth of microscopic deposits of tumor cells that might grow into a recurrent tumor.  Chemotherapy has been shown to substantially improve the long-term, relapse free, and overall survival in both pre menopausal and post menopausal women up to age 70 years with node-positive and node-negative disease.   Investigation continues as to whether there are specific patient populations for whom it is reasonable to avoid the administration of chemotherapy.  Unfortunately, very limited information is available to answer this important question.  On the basis of available data, it is accepted practice to offer cytotoxic chemotherapy to most women with primary cancers larger than 1cm in diameter (both node-negative and node-positive).  This information is from the National Institute of Health Consensus Statement on Adjuvant Therapy for Breast Cancer compiled in December, 2000.  

(The largest dimension is the measurement that was chosen as the standard to be used in studies.  Thus this becomes the measurement used to interpret individual results and to make recommendations based on clinical trial data).

If you would feel more comfortable having a second opinion regarding this important decision, you should do so.