Sigh . . . another new member :-(

Hello all:

Unfortunately my wife has just been diagnosed with TNBC. Luckily I've found this site and now know more than I ever wanted to know about BC & TNBC. I'm more of the online person in the relationship so you'll probably see me on here more often than her.

Both my wife's mother and grandmother had breast cancer, so to some degree we were prepared for the diagnosis (well, as prepared as you can be for such horrible news), so we've been dealing with it OK emotionally. A few breakdowns here and there, but overall OK I would say.

At any rate, we are in a bit of a weird situation treatment wise, and I was hoping I could get some feedback on my wife's treatment thus far. I realize that forum advice is not strictly medical advice, but we are happy to get as much information and perspective as possible.

Here is the timeline thus far (she is 34 yo):

1. Found lump during self exam (late February)
2. 3/5 - Clinical exam including mammogram (negative) and ultrasound (positive)
3. 3/6 - FNA confirming carcinoma
4. 3/9 - Meeting with surgeon to discuss options. She had 2 tumors, so a lumpectomy was not a good option. Decided on a mastectomy (skin sparing) with immediate reconstruction).
   
5. 3/9 - MRI  to confirm extent of cancer in breasts.
6. 3/9 - Blood drawn for BRCA genetic testing (results not available yet, should be in a few weeks).
   
7. 3/11 - Core needle biopsy to rule out false positive.
   
8. 3/12 - Surgery (mastectomy) with sentinel node biopsy. All nodes (9 in total) returned negative.
9. 3/20 - Discharged from hospital, drain removed.
   

So, that's it for treatment thus far. She is going to get the full pathology report on Wednesday (3/25), but we know a bit now:

• 2 tumors, the larger being 2.2 cm
• Stage 2a because of tumor size, with no lymph node involvement
• 1 tumor was grade 3, 1 was grade 2
• 1 tumor was ductal (the larger), the other was lobular
• Cancer is triple negative

One of the complicating factors is that all treatment thus far has been in Hong Kong, where my wife has been doing research. The doctors and facilities here have been great and very proactive. But, we are from the bay area of California, and we're heading home soon (as soon as my wife is cleared for air travel). She has 2 more surgeon follow up visits scheduled to make sure the wound is healing OK before she leaves Hong Kong.

We considered waiting for surgery, etc. til we returned home, but my wife does not like medical procedures, needles, etc. and wanted to get the cancer out ASAP w/o having to have a bunch more diagnostic procedures. I don't blame her.

As I've been reading various threads and profiles on the site, it seems as if my wife's treatment has been a little unorthodox perhaps? Maybe because we did not know of the TNBC diagnosis until after the mastectomy. She will be starting chemo soon after she returns home. From what I've read, it seems that most folks with no node involvement and a mastectomy do not have radiation, but it appears as if some of you have? The surgeon has said it is not necessary, but I guess we'll wait to see what the oncologist back in CA says.

Some random questions I had:

1. She's not had any bone scans, CAT scans or PET scans. Is this something she should get back in the states?
2. How long is the period between mastectomy and chemo? From what I understand 3-6 weeks?
3. She's very anxious about chemo. It seems like the anthracycline & taxane (dose dense) is fairly standard for TNBC (at least in her relatively early stage). What is the normal duration for this? Is it 16-18 weeks (as I understand)?
4. Would radiation be normal in her case?
   

Thanks for reading this far. Any answers, insight, comments, etc. are much appreciated.

Sorry to be in the TNBC club but happy to have found you folks and this site,
Jason

Hi Jason,

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Jason you and your wife will be in our prayers for a successful surgery and speedy recovery.

Dear Jason,

You certainly are on your way to have an appropriate treatment plan....having said that I think it is important that you factor in the characteristics of the lobular...triple negative is aggressive and lobular is sneaky. If your dear wife has a positive BRCA - then bilateral mastectomies, hysterectomy and bilateral salpingo-oophorectomy will take care of the areas the triple negative and the lobular migrate to. It is important to be very proactive regarding having baseline scans especially in the event of lobular - since lobular is difficult to detect and symptoms are dismissed as other causes, gastrointestinal for instance.

ILC is more likely than IDC to occur in both breasts — about 20 percent of women with ILC in one breast will also have it in the other one.

ILC is slow to spread outside the breast (metastasize). If the cancer does spread, it may show up in the gastrointestinal tract, the lining of the abdomen or the ovaries.

Please research the different delivery models regarding chemotherapy - the metronomic dosing (weekly) or the Livingston model is something the researchers are looking at for triple negative since the cells divide and split so quickly and are so aggressive (grade 2-3). I had the AC + T dose dense (every two weeks) for my protocol but it seems to be more common to have the Taxol weekly for 12 weeks (cuts down on side effects but not the dose).