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With or Without Chemo?

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euniceywt View Drop Down
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    Posted: May 16 2017 at 3:46am
Hi everyone, this is a post from Taiwan. My mom was diagnosed with tnbc this March, mastectomy, two foci, one tumor size 0.9cm DCIS and another one 3.3cm also DCIS but with 0.3cm invasive, grade 2, stage IA. Most of the doctors we've consulted didn't recommend chemo for such early stage <5mm, but they left it up to us to decide since there is no standard treatment for tnbc right on this borderline, and some of them regard chemo for a case at such early stage not so effective as a preventive treatment. My mom is glad she doesn't need to go through chemo, but I am really concerned about recurrence. Anyone here has experienced similar situation to my mom's without chemo and didn't have relapse in long term? I cannot find similar case to relate to in my country, I'm really anxious whether we've made a proper choice or shall we accept chemo?      

Edited by euniceywt - May 18 2017 at 7:15pm
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123Donna View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: May 16 2017 at 9:57am
You are correct that the guidelines for chemo is 5mm.  Most TNBC is diagnosed at a higher grade and stage than your mom's so it's probably the reason you can't find too many similar cases.  I had a friend who was dx over 9 years ago with TNBC DCIS and lobular with a small IDC portion.  She had a mastectomy only without chemotherapy and no recurrence.  Wishing your mom the best.

Donna
DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Tulips Quote  Post ReplyReply Direct Link To This Post Posted: May 16 2017 at 9:59am
Oh Eunice, what a difficult decision!  I'm sorry I can't help with having gone through the same decision, but I will just confirm that that is what I've always heard in the US--that the cutoff for standard-of-card chemo is >= 5 mm.  But it sounds like this is being left up to you to weigh the pros & cons and make your own decision, which I can sympthasize with how difficult that is.  Best of luck to you both!
Tulips
Dx April 2015 IDC TN 2.2 cm, Grade 3, Chemo started May 2015: Taxol/Carbo then AC, Lx with SNB Nov 2015, 33 Rad Dec 2015-Feb 2016. 6 months Capecitabine starting March 2016
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Post Options Post Options   Thanks (0) Thanks(0)   Quote euniceywt Quote  Post ReplyReply Direct Link To This Post Posted: May 17 2017 at 3:23am
Dear Donna and Tulips, thank you for confirming the guideline, and I felt much reassured by knowing a case similar to my mom's without recurrence. I was in a panic when my mom was dx with tnbc since information about this type of cancer I've searched in our country appears ugly......but now I believe we can fight that beast! I am glad I've found this place where I can seek support and info. Wish both of you nothing but the best Smile  



Edited by euniceywt - May 19 2017 at 12:28pm
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gordon15 View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote gordon15 Quote  Post ReplyReply Direct Link To This Post Posted: May 19 2017 at 5:07pm
euniceywt: I don't know what age your Mom is, but I think my numbers are accurate, that chemotherapy increases lifetime survival (or chances of recurrence, that is a different percentage)by about 5%, so if she is older (over 70) if it was my mother, I would ask that question of percentages versus damage from chemo drugs.


Edited by gordon15 - May 19 2017 at 5:09pm
wife: IDC/Lobular Stage2B 2008 lumpectomy/TAC+rads
TNBC Stage 3A/w/metaplastic/squamous Nov2015 Carboplatin-Gemzar chemo/masectomy Taxolchemo+rads 4-16
PET scan stable 9-2016/ 1-2017
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Post Options Post Options   Thanks (0) Thanks(0)   Quote euniceywt Quote  Post ReplyReply Direct Link To This Post Posted: May 20 2017 at 1:03am
Thanks for providing certain statistics, Gordon. My mom is 59, but she is not willing to accept chemo unless it's being recommended (highly I may say) by doctor. One of the oncs we've consulted said that the percentage of chances of recurrence reduced by chemo is less than 1% for case like hers. I'm not sure why that is but I guess it might be related to her IDC tumor size less than 5mm. We've got four opinions, two of them didn't recommend chemo and the other two left it up to us. We finally decided not to do chemo and try to keep a healthy diet plus regular exercise. Thanks again for informing me the number! 
Eunice


Edited by euniceywt - May 24 2017 at 12:56am
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gordon15 View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote gordon15 Quote  Post ReplyReply Direct Link To This Post Posted: May 22 2017 at 6:09pm
euniceywt: you said : < diagnosed with tnbc this March, mastectomy, two foci, one tumor size 0.9cm DCIS and another one 3.3cm also DCIS but with 0.3cm invasive, grade 2, stage IA.>

I think you made the right decision for your Mom NOT to have chemo. Like Donna said, TNBC is almost always Grade 3 (more aggressive) I stand by my statistic that most circumstances chemo reduces chances of recurrence and/or survival  by "up to" 5%, but I'm not a doctor.
 
My wife has had an aggressive cancer that needed to be bombarded with chemo, because a 1% could make a real difference. That's why it's great you asked a lot of questions on behalf of your Mom.
wife: IDC/Lobular Stage2B 2008 lumpectomy/TAC+rads
TNBC Stage 3A/w/metaplastic/squamous Nov2015 Carboplatin-Gemzar chemo/masectomy Taxolchemo+rads 4-16
PET scan stable 9-2016/ 1-2017
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Post Options Post Options   Thanks (0) Thanks(0)   Quote euniceywt Quote  Post ReplyReply Direct Link To This Post Posted: May 24 2017 at 12:35am
You are right that every percentage does count! That's why I had been struggling to make decision for my mom. Knowing that tnbc can be more unpredictable than other types, I want to make sure that we've done what's best for her after weighing pros and cons. Thank you for letting me know I've done what I can do! Best wish to you and your wife, may her be well ever after!


Edited by euniceywt - May 24 2017 at 12:52am
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gordon15 View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote gordon15 Quote  Post ReplyReply Direct Link To This Post Posted: May 24 2017 at 8:33pm
Thanks for letting us know, if there is only a 1% survival rate for NON-recurrance after 5 years, but there is a higher rate of getting leukemia from chemo,  that is the question for your Moms' oncologist. Also, chemo and radiation cause mutations to the dna.

It's great you have weighed all the options for your Mom. Radiation and chemo both cause mutations to the dna and existing cancer, so the cancer can come back, if it's chemo-resistant, somewhere else, or stronger.

That's why it's important to weigh the remedies for an early stage cancer vs an aggressive Stage 3 cancer, which my wife was told she needed to undergo the maximum therapy.

Hope this helps....
wife: IDC/Lobular Stage2B 2008 lumpectomy/TAC+rads
TNBC Stage 3A/w/metaplastic/squamous Nov2015 Carboplatin-Gemzar chemo/masectomy Taxolchemo+rads 4-16
PET scan stable 9-2016/ 1-2017
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euniceywt View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote euniceywt Quote  Post ReplyReply Direct Link To This Post Posted: Yesterday at 10:20am
Just like what you said, treatment differs according to stage. According to our onc, since the recurrence of IDC tumor less than 5mm is comparatively low, the benefit brought by chemo might be less than 1%, but for most tnbc cases the effectiveness is much higher than that. I've came across a study even claims that chemo reduces recurrence by 41%. Most oncs in our country also consider ki67 as a useful info, but some studies don't yet agree on that. Thank you for sharing those info about chemo and radiation, Gordon. I'm really glad I found this site!
Eunice


Edited by euniceywt - Yesterday at 1:03pm
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