What's my next step?

[cancer46]

I was diagnosed with breast cancer, had a radical mastectomy in April, just finished consultations with the radiation and medical oncologists.  The cancer is 4.5 cm, no lymph or vascular involvement, clear though close margins, grade 6-7, ER+ & HER2 3+; it's been around for 2 years with noticeable breast changes as indicated in mammogram in Jan. 2007.  Radiologist who read the mammo concluded the changes were benign without follow-up.

The radiation oncologist recommended no radiation.  The medical oncologist recommended a chemo regimen with six rounds of TCH followed by H for a total of one year and 5 years of Tamoxifen after chemo.

In going for a PET scan before surgery to determine cancer spread, a suspicious lump was noted on my thyroid.  The surgeon ordered ultra-sound test and did not look at the result carefully.  At the recent consultation with the medical oncologist, he told me the ultra-sound result was of my carotid duplex, not of the thyroid.  Will have another ultra sound this Monday.

I'm 62 and am not sure whether I really want a full dose of chemotherapy that would degrade my quality of life substantially for the foreseeable future.  Are there cutting edge trials with a new lighter regimen that I could consider as opposed to what's recommended by the medical oncologist?

Additionally, I would like to have a definitive answer about the thyroid lump before starting chemo.  For if the thyroid lump turns out to be cancerous, shouldn't I have surgery first before considering chemo for adjuvant therapy?  

Any suggestions/recommendations would be greatly appreciated.

[cancer46]

Thank you again for your helpful response.

My oncologist just got back to me, through his assistant, regarding the ultra sound result.  The answer is cyst only.  The assistant then said the oncologist then talked to the endocrinologist who said I should have a biopsy later on on my right side.

I'm scratching my head since the suspicious lump was noted on my left thyroid.  Is there a scenario where the biopsy should be taken from the right side when the cyst is on the left?  Should I insist on talking to the oncologist himself - he is quite busy?

The oncologist also said I should go ahead with the chemo this Friday without bothering about the biopsy right now.  My thinking is that I should settle the issue of the "cyst" first before beginning chemo.  I really need to hear the course of action you would recommend in such a case: insist on doing the biopsy first or just go ahead with the chemo and leave the biopsy to a later date?  

I do like the way you end each email message with God bless and so forth.

Regards

[PaulMD]

Hi,  I think an ENT-Head and Neck surgeon is better apt for the task.  Best wishes.

[cancer46]

Thank you very much for getting back so promptly!

Granted the thyroid lump is probably not a metastasized cancer from the breast, but given the operation of Murphy's Law and my recent luck with the radiologist and ultra sound etc., the thyroid lump may be an unrelated cancerous growth :-(

Are surgeons in general surgery the ones who perform this type of operation or an ENT surgeon?  

Yes, I do need God's blessings.  

Regards

[PaulMD]

Hi there.

If the thyroid lump is indeed part of the cancer, then it is best to remove that before undergoing further treatment.  Though from what you have described, this thyroid lump may just be an incidental colloid cyst or other benign condition.   The oncologist's plan to put you under chemo and 1 year of herceptin is a good decision.  The fact that your cancer is Her2 +3, this means that you will get maximal benefit from Herceptin, and the tumor would probably have a high chance of recurrence without it.  The additional hormonal treatment will also give you additional survival benefit.  Studies show that this regimen that your oncologist propose does not cause deterioration of the quality of life too much, and you will still be able to enjoy your daily activities.

Good luck with your treatment.  Wishing you all the best.  God bless.