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3 Questions on My Treatment Plan

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    Posted: Feb 24 2009 at 8:57pm

I'm reading various posts and questioning the A/C regimen I'm currently on. I'm getting A/C every three weeks. I just had treatment #2 of 4 last week, and wonder if I should ask to switch to "dose dense" for the final two treatments?? My Oncologist mentioned the dose dense option in the beginning, but stated that studies showed no disadvantage to waiting that additional week while your body recovers. As I read more on this forum, I feel that this might not be the case with TN.

I had my bilateral mastectomy just one week after my diagnosis. Margins were clear and no node involvement. I'm told radiation is not necessary as there is nothing left to radiate. Should I be asking for radiation of the chest wall??
 
Because this all happened so quickly, I don't ever recall my Oncologist giving me the option of chemo before surgery. My surgery happened so quickly, and now I'm reading of others on this site opting to do chemo first, in an effort to see how the tumor will respond. Are there any downfalls or disadvantages to having mastectomy first, then chemo?
 
UGH- I thought I'd thought this all out so well! I was trying to be as aggressive as possible by leaping in to a bilateral mastectomy. If only I had found this site two months earlier!


 

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Post Options Post Options   Thanks (0) Thanks(0)   Quote mainsailset Quote  Post ReplyReply Direct Link To This Post Posted: Feb 25 2009 at 2:23am

Fear Nothing:

    What did the biopsy show for your tumor? And did they send it down, as cq (Connie) has suggested for a test on its 'chemo sensitivity'??

     At this point you may want to take  a deep breath and go for a 2nd opinon.  Better now than farther down the road.

     Best of luck to you and don't hesitate to advocate strongly for yourself, you have good instincts!

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Post Options Post Options   Thanks (0) Thanks(0)   Quote krisa Quote  Post ReplyReply Direct Link To This Post Posted: Feb 25 2009 at 3:51pm
there are pros and cons to having chemo first or after surgery.  I wanted the tumor out as soon as possible, it was growing by leaps and bounds.
 
I remember a gal in the infusion room who was having chemo first before surgery and later, in an email, she told me how disappointed she was that the chemos had not shrunk her tumor all that much. For me, I don't want to have that kind of news and from what I have read, not shrinking the tumor a whole lot doesn't mean it didn't work.

If mets occurred I would want to know the progress of chemo, in case chemos needed to be changed.
Probably doesn't make any sense, but there it is.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote sibu Quote  Post ReplyReply Direct Link To This Post Posted: Feb 25 2009 at 4:09pm
Hi there--

First, be gentler on yourself! Since you have already had the mast., you can just cross off your list whether you should have had chemo first or not! That's a chicken-n-egg one anyway.

And, you HAVE been aggressive with your treatment (look down and notice your "new" chest).

They usually only radiate if there are 4+ nodes involved. If you were node-free (hooray!) there is no clear evidence that I've seen giving a significant advantage. A very small one, maybe, but then again there can be negative long-term side effects from the radiation.

Look through the resource section for the dose dense articles. Are you following up with 12 weeks of T in addition to the AC chemo?

Lots of love your way,

Donna


Donna, age 42
Dx IDC 12/06, 5/18 Nodes + BRCA1+
Double mast. 1/07
Chemo 6 X TAC 6/07, rads 10/07
Hyst./Recon. 12/07
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Nancy Quote  Post ReplyReply Direct Link To This Post Posted: Feb 25 2009 at 4:27pm
Fear Nothing,
 
I just posted this link today for someone...actually someone else posted it and then I got the current link. I do go on sometimes don't I?Embarrassed
 
Anyway...this is for the weekly Taxol. It is in our news and resources forum...but posted many months ago.
Hugs,
Nancy
 


Edited by Nancy - Feb 25 2009 at 4:29pm
Nancy
DD Lori dx TNBC June 13,2007
Lumpectomy due to incorrect dx of a cyst
mastectomy July 6 2007
chemo ACT all 3 every 3 weeks 6 tx Aug-Nov
28 rads ended Jan 2008
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Fear Nothing Quote  Post ReplyReply Direct Link To This Post Posted: Feb 25 2009 at 6:00pm

God bless you girls. You've really made me feel better. I guess I threw myself in to a bit of a panic, questioning whether I'm making all the right choices. I suppose that uncertainty is inevitable, given the number of decisions we're faced with in our journey.

Nancy- thank you so much for the article on taxol. I am in fact doing taxol after my A/C, so this article is very reassuring.

I have every bit of confidence in my Oncologist- I absolutely love him, and he knows me well enough to know that I want the most aggressive treatment possible. He took care of me three years ago when I went through this w/ colon cancer, and I feel very safe in his hands. I am going to talk with him tomorrow about the possibility of switching to dose dense for the last two A/C treatments.

  "What did the biopsy show for your tumor? And did they send it down, as cq (Connie) has suggested for a test on its 'chemo sensitivity'??" 
I'm not sure I understand this question- the biopsy of the tumor itself was IDC (TN) of course, and the remainder of that breast showed "smears" of DCIS all over. My margins and lymph nodes were clear. I'm not aware of any testing they did for chemo sensitivitiy. Is this something my surgeon would have requested?
 
Donna- you have given me a sense of peace, so thank you for that. And you're right- my newly renovated chest was definately the right thing to do!  I just want so badly to do everything right and fight this in every way humanly possible. Some moments I have to remind myself that I'm doing all I can, but that it's ultimately in God's hands.
 
Thank you from the bottom of my heart for all of your knowledge and support. You've helped put my mind at ease.
 
Fear Nothing!
Jodi


Edited by Fear Nothing - Feb 25 2009 at 6:02pm
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Nancy Quote  Post ReplyReply Direct Link To This Post Posted: Feb 25 2009 at 6:27pm
Jodi,
 
The chemo sensitivity is to see which chemo your tumor will respond to...you know ...kill the sucker dead!! The onc would have requested that. I am pretty sure, as the surgeon knows little about oncology.
 
They very seldom ever do this. WHY??? That's what we would like to know. If one chemo isn't working then for crying out loud...switch. But...they don't do that. They just do the standard chemo for everyone, and...your tumor is not everyone's tumor. It has an identity all of it's own. That's why the test should be done on everyone with cancer.
 
Maybe it's those idiots in the insurance companies who are paid to deny all the tests unless "they" think it's necessary? You know the ones in the cubicles reading the latest Inquirer.Big%20smile Oh I just had to get that in!
Hugs,
Nancy
Nancy
DD Lori dx TNBC June 13,2007
Lumpectomy due to incorrect dx of a cyst
mastectomy July 6 2007
chemo ACT all 3 every 3 weeks 6 tx Aug-Nov
28 rads ended Jan 2008
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Post Options Post Options   Thanks (0) Thanks(0)   Quote krisa Quote  Post ReplyReply Direct Link To This Post Posted: Feb 26 2009 at 2:45am
i asked my onc's nurse about testing my tumor to see what chemo would bebest, since my doctor had given me a choice AC/Taxol dd, or Taxol and Cytoxan.
She told me that it could take months to do that test because the tumor would have to be sent to a lab that would grow the tumor and then apply the different chemos to see what worked.  and it would be expensive to do.
this was january 08, so this has changed?  the test is fast and easy to do?
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Nancy Quote  Post ReplyReply Direct Link To This Post Posted: Feb 26 2009 at 7:40am
Krisa,
 
As to the timeline, I do not know, but will check that out for everyone...if I can. Does it not seem rediculous to even have this testing available if they cannot do it on everyones tumor?  I mean really, there has to be a way to do this in a shorter time frame.
 
Just going through chemo and then finding out that it did not work, seems to me to be fruitless, and can be the fifference for recurrence or another primary, or mets.
 
So, after adjuvant chemo, you just cross your fingers and hope that it did work. Too much money to be made in chemo drugs? So this is a test only the very affluent can afford? But really, could they afford to wait for months before starting chemo? Or if you have neoadjuvant, and one chemo did not work, then you go to another, and another. It's that od catch 22.
 
Let me see what I can find.
Nancy
Nancy
DD Lori dx TNBC June 13,2007
Lumpectomy due to incorrect dx of a cyst
mastectomy July 6 2007
chemo ACT all 3 every 3 weeks 6 tx Aug-Nov
28 rads ended Jan 2008
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