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Cinderwee 
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 Topic: Chemo optional?Posted: Feb 07 2011 at 9:31pm |
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My oncologist presented chemo as an option, due to the tumor size.
While I am going to proceed with the treatment, I thought being given
the choice was a bit odd....Has anyone else dealt with this? And, I'm worried that the regimen won't be potent enough.
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Cindy 46
DX 11/29/10 Stg1 G3 IDC ER-PR-Her2- <1cm,cln marg,0/1 neg No BRCA Lumpectomy 12/28/10 MammoSite rads 1/10-1/14 Taxol/Her x12 DONE! CVP/Her ev 3wks x4 begin 6/23 Continue Her Mar2012 |
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123Donna
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Joined: Aug 24 2009 Location: St. Louis, MO Status: Offline Points: 13510 |
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Posted: Feb 07 2011 at 10:04pm |
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Cindy,
From your signature it looks like your tumor was less than 2 cm. Is your oncologist only recommending Taxol? Most of us have had a combination of chemos, eg, T/C or A/C and T. Have you thought about getting a second opinion from another onc? Chemo is the only adjuvant therapy available for TNBC. We don't have any therapy like Tamoxifen for ER+ breast cancers. Here's a brochure you can download and read about TNBC. http://www.lbbc.org/Understanding-Breast-Cancer/Guides-to-Understanding-Breast-Cancer/Guide-to-Understanding-Triple-Negative-Breast-Cancer Denise posted this important study in another thread: http://forum.tnbcfoundation.org/attentiOn-newbies-do-taxol-before-adriamycin_topic7771.html Wishing you the best in your decision. Donna |
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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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Cinderwee
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Joined: Feb 05 2011 Location: AZ Status: Offline Points: 52 |
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Posted: Feb 07 2011 at 10:11pm |
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I don't know the exact tumor size, only that the stereotactic needle biopsy removed most of it and lumpectomy removed MAYBE 1 millimeter (!) remaining. Yes, second opinion is exactly what I'm going to do, thank you. That's how the cancer was found after I was told the mammo revealed a common calcification and it was suggested I wait 6 months....thank God for second opinions!! And, thanks for reminding me it's an option and my right.
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Cindy 46
DX 11/29/10 Stg1 G3 IDC ER-PR-Her2- <1cm,cln marg,0/1 neg No BRCA Lumpectomy 12/28/10 MammoSite rads 1/10-1/14 Taxol/Her x12 DONE! CVP/Her ev 3wks x4 begin 6/23 Continue Her Mar2012 |
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Cinderwee
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Posted: Feb 07 2011 at 10:23pm |
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Hmm...I stand corrected on the tumor size, from what I can tell from my path reports it was larger than I thought. Will have surgeon confirm tomorrow; but also they only did a sentinel node biopsy during surgery...I thought they were supposed to take out more and diagnose further after surgery. Not happy...I want some answers and plan on getting them first thing in the AM.
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Cindy 46
DX 11/29/10 Stg1 G3 IDC ER-PR-Her2- <1cm,cln marg,0/1 neg No BRCA Lumpectomy 12/28/10 MammoSite rads 1/10-1/14 Taxol/Her x12 DONE! CVP/Her ev 3wks x4 begin 6/23 Continue Her Mar2012 |
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123Donna
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Joined: Aug 24 2009 Location: St. Louis, MO Status: Offline Points: 13510 |
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Posted: Feb 07 2011 at 11:18pm |
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Cindy,
I think the size of your tumor will help you decide which treatment is best for you. It should be listed on your path report, but your surgeon can help you out also. The sentinel biopsy is the standard. If they find positive lymph nodes in the sentinel node(s), then they usually remove more lymph nodes (auxiliary). You are doing the right thing by educating yourself, asking questions and getting answers. Donna |
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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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Cinderwee
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Posted: Feb 08 2011 at 12:24am |
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I should note that my ER was WEAKLY positive at 5% and have been told
that <10% is considered negative. Another factor in my concern too that the
recommended regimen will not be potent/accurate.
Thanks....  |
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Cindy 46
DX 11/29/10 Stg1 G3 IDC ER-PR-Her2- <1cm,cln marg,0/1 neg No BRCA Lumpectomy 12/28/10 MammoSite rads 1/10-1/14 Taxol/Her x12 DONE! CVP/Her ev 3wks x4 begin 6/23 Continue Her Mar2012 |
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Charlene
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Joined: Aug 14 2010 Location: Atlanta, GA Status: Offline Points: 613 |
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Posted: Feb 08 2011 at 7:53am |
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Your case sounds very similar to mine, even the "common calcification" part. My oncologist said that the standard of care per NCCN guidelines for a triple negative tumor, greater than 1 cm, is adjuvant chemo therapy. I did 4 rounds of Taxotere/Cytoxan, 21 days apart. When I asked him why 4 instead of 6, he said that the survival rates were the same. All the investigating I have done since says that triple negative always requires chemotherapy. The best of luck to you!
Charlene
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DX 3/10 @59 ILC/TNBC
Stage 1, Grade 2, Multifocal; Lumpectomy/re-excision SNB 0/4 nodes, BRCA-; Taxotere/Cytoxan X4, 30 rads 3/14:NED |
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conniec
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Posted: Feb 08 2011 at 8:57am |
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Hi Cindy,
My lumpectomy did not have clear margins at 1.3 cm. I had the sentinel node surgery before my double mastectomy b/c I wanted to rule out node involvement before reconstruction. I had the double mastectomy by choice and the final pathology was 1.7. I was told even at the 1.3 that I would get the 3 chemo drugs. The first onc I went to wanted to do the 2 week dose dense. Went for a 2nd opinion and found my current Onc. I've been on the every 3 week regime with Adriamycin, Cytoxan, and Taxotere. Technically, I was cancer free from the surgery.... the chemo is the triple punch at the microscopic cells that may be there. We each make our best choice given the info we have... make the right one for you. We are here to support you! Connie
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Age 40,
Felt lump 8/20/10 Lumpectomy 9/7 DX 1.5 tumor stg I 9/13 margin not clear Double MX w/ expanders 10/8 Final tumor size 1.7, 0/3 + nodes AC-T chemo 11/8 - 2/21 TE/implant exchange 3/29 |
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Cinderwee
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Posted: Feb 08 2011 at 7:58pm |
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Spoke with my surg nurse, most of the tumor was removed during the stereotactic core biopsy, and <0.1cm during surgery, so best estimate of original tumor size is <1cm. Based on it having been triple neg and all the wonderful support and advice from all of you, I want the chemo. I just need to ensure the potency/accuracy of the recommended regimen, especially since the ER was weakly positive. I am doing that by getting a second opinion and will keep you posted.
As always - THANK YOU & GOD BLESS
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Cindy 46
DX 11/29/10 Stg1 G3 IDC ER-PR-Her2- <1cm,cln marg,0/1 neg No BRCA Lumpectomy 12/28/10 MammoSite rads 1/10-1/14 Taxol/Her x12 DONE! CVP/Her ev 3wks x4 begin 6/23 Continue Her Mar2012 |
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trip2
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Joined: Jun 03 2007 Location: Under Palm Tree Status: Offline Points: 8549 |
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Posted: Feb 09 2011 at 12:23pm |
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Hello and welcome.
We would be interested in hearing what your second opinion turns out to be, best wishes.
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Stage 2 2003
Stage 1 2007 BRCA 1+ |
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123Donna
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Joined: Aug 24 2009 Location: St. Louis, MO Status: Offline Points: 13510 |
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Posted: Feb 09 2011 at 2:38pm |
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Cindy,
I saw Steve post this under another thread and thought it may be useful information for you. (Steve, I hope you don't mind me doing this.) Prognostic Significance of Triple Negative Breast Cancer at Tumor Size 1 cm and SmallerEur J Surg Oncol. 2011 Jan 1;37(1):18-24, HW Lai, SJ Kuo, LS Chen, CW Chi, ST Chen, TW Chang, DR ChenTAKE-HOME MESSAGEBased on previous reports and this retrospective study from Taiwan, triple-negative tumor status is very likely an independent risk factor for small (<1 cm) node-negative invasive breast cancer. AbstractAims: The purpose of this study was to clarify the prognostic significance of triple-negative breast cancer (TNBC) with a tumor size ≤ 1 cm. Materials and Methods: Patients with primary operable breast cancer with a tumor size ≤ 1 cm were enrolled at Changhua Christian Hospital and National Cheng-Kung University Hospital. Tumors negative for ER, PR, and HER-2 were classified as TNBCs and compared with tumors with any receptor positivity (non-TNBC) for disease-free survival (DFS) and cancer-specific survival (CSS). Results: From 1995 to 2006, a total of 377 patients with tumor size ≤ 1 cm were enrolled. Compared with non-TNBC patients, TNBC patients with a tumor size ≤ 1 cm as a whole or in a lymph node-positive subgroup were not associated with a poorer 5-year DFS and CSS. In lymph node-negative patients (pT1a-bN0M0), TNBC was associated with a poorer 5-year CSS but not DFS. Compared with the hormone receptor-positive, HER-2-negative subgroup, TNBC was associated with poorer DFS and CSS. In the multivariate Cox regression hazard analysis, lymph node invasion was the most important cause of disease recurrence and cancer-specific death. Conclusion: TNBC is very likely an independent risk factor in small (≤1 cm) node-negative invasive breast cancer. With tumors 1 cm and smaller, lymph node invasion was the single most important prognostic factor. |
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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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SagePatientAdvocates
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Joined: Apr 15 2009 Status: Offline Points: 4748 |
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Posted: Feb 09 2011 at 3:08pm |
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Dear Donna,
I hope you are aware that everytime you do this under para 14.3, subchapter XXI of the addendum of the rules of message board engagement you owe me a hug, when we meet, so proceed at your own risk.. seriously, you are always free to transport my words...studies...I appreciate everything you do and your dedication to our TNBC family even in the midst of treatment is remarkable. You are truly an extraordinary woman.. your presence graces our board. all the best, Steve
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I am a BRCA1+ grandson, son and father of women affected by breast/oc-my daughter inherited mutation from me, and at 36, was dx 2004 TNBC I am a volunteer patient advocate with SAGE Patient Advocates
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123Donna
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Joined: Aug 24 2009 Location: St. Louis, MO Status: Offline Points: 13510 |
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Posted: Feb 09 2011 at 3:14pm |
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Steve,
Thanks for the laugh, it made my day. I know sometimes I feel like I'm going to get a ticket or something. However, I feel like valuable information is important in sharing, even if we do get in trouble. I'm living dangerously anyway, so what's the harm in feeling a little rebellious? Take care dear friend, Donna |
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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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Cinderwee
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Joined: Feb 05 2011 Location: AZ Status: Offline Points: 52 |
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Posted: Feb 13 2011 at 3:21pm |
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I am starting to get apprehensive about the unknown (and some of the
known) effects of chemo...yes I have the percentages of
with/without....but isn't chemo going to ravage my body? Destroy my
ovaries? Oh God why can't there be a guarantee that if I put myself
through this that this monster can't come back? I'm willing to/in the
process of changing diet, exercise, etc.... I'm strong...what if I
can't handle chemo and stop? I'm trying not to come from fear; I think
these are valid questions, really for my onco but he's going to give me a
MEDICAL opinion and yes I need to hear the second opinion (this week)...thanks....
Thanks and GOD BLESS |
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Cindy 46
DX 11/29/10 Stg1 G3 IDC ER-PR-Her2- <1cm,cln marg,0/1 neg No BRCA Lumpectomy 12/28/10 MammoSite rads 1/10-1/14 Taxol/Her x12 DONE! CVP/Her ev 3wks x4 begin 6/23 Continue Her Mar2012 |
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123Donna
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Posted: Feb 13 2011 at 4:13pm |
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Cindy,
Here's a link to some of the side effects for Taxol. Not everyone will experience them. You'll find some people going through treatment have some or no side effects, while others do. Everyone's journey is different. Weekly treatment may have reduced side effects than tx every 3 weeks. http://www.breastcancer.org/treatment/druglist/taxol.jsp Hope you get your answers during your second opinion this week. Please keep us posted. Donna |
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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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Cinderwee
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Posted: Feb 17 2011 at 10:53pm |
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Well...2nd onco wants an Onco DX on original biopsy. I believe the test was designed for ER+/PR+/Her2+, but since my ER was weakly positive at 5%, he still wants to do it. I will not let that alone change/make my decision but it will be interesting to see the results. I can have all the numbers there are, but at the end of the day I just need to be at peace with it and the rest is up to God....
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Cindy 46
DX 11/29/10 Stg1 G3 IDC ER-PR-Her2- <1cm,cln marg,0/1 neg No BRCA Lumpectomy 12/28/10 MammoSite rads 1/10-1/14 Taxol/Her x12 DONE! CVP/Her ev 3wks x4 begin 6/23 Continue Her Mar2012 |
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Cinderwee
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Posted: Feb 23 2011 at 9:11pm |
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Onco DX results should be in next week. In the meantime I've spoken with the pathologist (who conferred with 2nd opinion med onco and works at facility where initial biopsy path report created) and agrees that the Onco DX is a great idea to ensure accurate chemo regimen (IF? necessary). The path also says I am not 3NEG because my ER was weakly + at 5%, and am considered non-basal, luminal b and he's willing to speak with initial med onco. At this point I am just going to wait for the Onco DX results....needless to say I am FRUSTRATED. All I want is a clean, accurate, all inclusive path report so that accurate chemo (if needed) can be determined and I can move forward.
 In God's hands,
Edited by Cinderwee - Feb 23 2011 at 9:12pm |
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Cindy 46
DX 11/29/10 Stg1 G3 IDC ER-PR-Her2- <1cm,cln marg,0/1 neg No BRCA Lumpectomy 12/28/10 MammoSite rads 1/10-1/14 Taxol/Her x12 DONE! CVP/Her ev 3wks x4 begin 6/23 Continue Her Mar2012 |
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zoomommy2
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Posted: Feb 23 2011 at 10:22pm |
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Cindy,
Sorry you still don't have the answers you want/need yet. I'm not sure what % is considered still negative, but weakly positive. You definitely need to be able to move forward.
Lee in Denver
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dx6/09,stageII,gr3,(L)mastectomy 7/09,ACx4,Taxolx7,Avastin study,gall bladder surgery 1/10,4/11 Stage 4, mets to lung, 4/11 Started Taxotere and Xeloda, 5/11 Taxotere stopped, off Xeloda
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Cinderwee
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Posted: Mar 07 2011 at 11:28pm |
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Thank you. Well, the latest news is that due to there being <2mm of invasive tissue available, an Onco DX test cannot be performed. And, I mis-spoke earlier; the initial pathology report states "ER weakly positive at 5%' with which the 2nd pathologist concurs, according to "CAP guidelines". The radio oncologist and initial med oncologist reports state the ER as negative as it is <10%. So the 2nd med oncologist who has already conferred with both pathologists, is going to discuss with initial med oncologist who recommended TX 1x weekly, x12 weeks. Ultimately, the decision is mine. I let go for the time being; let's hear what is said at the end of this week. Meanwhile, my 3 month window is closing....faith, attitude and taking care of self will see me through regardless.
Edited by Cinderwee - Mar 14 2011 at 4:19pm |
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Cindy 46
DX 11/29/10 Stg1 G3 IDC ER-PR-Her2- <1cm,cln marg,0/1 neg No BRCA Lumpectomy 12/28/10 MammoSite rads 1/10-1/14 Taxol/Her x12 DONE! CVP/Her ev 3wks x4 begin 6/23 Continue Her Mar2012 |
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Cinderwee
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Posted: Mar 14 2011 at 2:52pm |
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Chemo to commence St. Patrick's day.
My med onco assures me HE (I insisted on only him, sorry no pass off to NP) will monitor me closely and if I so desire, I can have AC after and that the sequence does not matter; that in fact at MD Anderson (where he did his internship and my understanding one of the best facilities in the country) they administer TX first.
I can do this, in part because of all the awesome info and support here.
Many thanks
 Cindy Edited by Cinderwee - Mar 14 2011 at 2:53pm |
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Cindy 46
DX 11/29/10 Stg1 G3 IDC ER-PR-Her2- <1cm,cln marg,0/1 neg No BRCA Lumpectomy 12/28/10 MammoSite rads 1/10-1/14 Taxol/Her x12 DONE! CVP/Her ev 3wks x4 begin 6/23 Continue Her Mar2012 |
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