Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Suggest Treatment For Breast Cancer
Question: Hi, I have a brest cancer in right brest.
It is invasive ductal carcinoma grade 3,
3 cm tumor ,Her2+, E+, P+,Ki-67
I want to take a risk and only do
double mastectomy with skin & nipple
spearing, but refuse to do chemo,
Herceptin and Femara..because of
side effects, etc.
I want to see first if the cancer will
come back, because it may not..
What do you think?
Thanks for your help
It is invasive ductal carcinoma grade 3,
3 cm tumor ,Her2+, E+, P+,Ki-67
I want to take a risk and only do
double mastectomy with skin & nipple
spearing, but refuse to do chemo,
Herceptin and Femara..because of
side effects, etc.
I want to see first if the cancer will
come back, because it may not..
What do you think?
Thanks for your help
Brief Answer:
Please take other therapies
Detailed Answer:
You have cancer of the right breast. This has to be surgically addressed initially. Surgery for the other breast is NOT indicated. However, if you are a high risk, you can undergo 'prohylactic' mastectomy - by choice.
Waiting to see if cancer recurs is NOT advisable. Remember - in cancer 'the first hit' is the best. In addition, the 'tumor burden' is the least after surgery and that is the optimal time for 'adjuvant' therapy. The therapy at this stage is of curative intent. If you wait, and if cancer spreads to other organs like lung or liver or brain, the intent of therapy itsself would be 'palliative' and NOT curative. Do not wait for robbery to happen and then catch the thief; prevent theft!!
Your concern on side effects - agreed. However, in the overall interest, I suggest that you go through the suggested adjuvant therapy. Being scared of the side effects, DO NOT miss the bus!!
Hope I am clear.
Regards
Please take other therapies
Detailed Answer:
You have cancer of the right breast. This has to be surgically addressed initially. Surgery for the other breast is NOT indicated. However, if you are a high risk, you can undergo 'prohylactic' mastectomy - by choice.
Waiting to see if cancer recurs is NOT advisable. Remember - in cancer 'the first hit' is the best. In addition, the 'tumor burden' is the least after surgery and that is the optimal time for 'adjuvant' therapy. The therapy at this stage is of curative intent. If you wait, and if cancer spreads to other organs like lung or liver or brain, the intent of therapy itsself would be 'palliative' and NOT curative. Do not wait for robbery to happen and then catch the thief; prevent theft!!
Your concern on side effects - agreed. However, in the overall interest, I suggest that you go through the suggested adjuvant therapy. Being scared of the side effects, DO NOT miss the bus!!
Hope I am clear.
Regards
Above answer was peer-reviewed by :
Dr. Prasad
Thanks for your first answer.
So if you want me to take all therapies,
than what choice would you suggest :
A) to take 6 chemo first and therefore
to srink the tumor, than do lumpsectomy
and follow up with Herceptin for a year
and Femara for 5 years
B) remove tumor first, than radiation,
than chemo and all other treatment
C) because of 3 cm tumor... remove
all brest tissue ( other brest as
preventive) .. give all for biopsy
again to see if anything else has been
found during surgery, and than make
a final decision for treatment.?
And if I decide on chemo plus other
tratment I need to wait another 6-8
weeks, after healing process start after
surgery ( or even longer) to be able to
take chemo and other treatment.
However removing brest tissue we are
removing the first source when cancer
has started.
What option you think is best?
So if you want me to take all therapies,
than what choice would you suggest :
A) to take 6 chemo first and therefore
to srink the tumor, than do lumpsectomy
and follow up with Herceptin for a year
and Femara for 5 years
B) remove tumor first, than radiation,
than chemo and all other treatment
C) because of 3 cm tumor... remove
all brest tissue ( other brest as
preventive) .. give all for biopsy
again to see if anything else has been
found during surgery, and than make
a final decision for treatment.?
And if I decide on chemo plus other
tratment I need to wait another 6-8
weeks, after healing process start after
surgery ( or even longer) to be able to
take chemo and other treatment.
However removing brest tissue we are
removing the first source when cancer
has started.
What option you think is best?
Brief Answer:
consult your doctor
Detailed Answer:
All three options are practised.
Your tumor is 3 cm. For this size both option B and C are applicable. If cosmesis is important, lumpectomy and sentinel node biopsy/axillary dissection is one option. This may be followed by chemoradiation; the sequencing of latter depends on the pathology report. The other option is to remove the entire breast (you may also desire removal of contralateral breast for prophylaxis) and then follow with chemoradiation as in the previous option. Yes, you need to wait till the wound heals for further therapies. You are also right in thinking that the first source of cancer is removed.
The option A is usually practised for larger tumors where breast conservation is planned to reduce the size of tumor. It can be applied in your case also. However, since the tumor is 3 cm you can still be offered breast conservation upfront.
Regarding choice of options, it would be better to discuss with your doctor who is going to operate on you. After understanding the pros and cons, you could probably decide on the best option applicable to you.
As a guide, please understand that medicine is an evolving field. The comfort and experience of your treating surgeon, your own opinion, likes and dislikes after understanding the pros and cons determine the preferred option. But remember that none of the options are either superior or inferior to each other.
consult your doctor
Detailed Answer:
All three options are practised.
Your tumor is 3 cm. For this size both option B and C are applicable. If cosmesis is important, lumpectomy and sentinel node biopsy/axillary dissection is one option. This may be followed by chemoradiation; the sequencing of latter depends on the pathology report. The other option is to remove the entire breast (you may also desire removal of contralateral breast for prophylaxis) and then follow with chemoradiation as in the previous option. Yes, you need to wait till the wound heals for further therapies. You are also right in thinking that the first source of cancer is removed.
The option A is usually practised for larger tumors where breast conservation is planned to reduce the size of tumor. It can be applied in your case also. However, since the tumor is 3 cm you can still be offered breast conservation upfront.
Regarding choice of options, it would be better to discuss with your doctor who is going to operate on you. After understanding the pros and cons, you could probably decide on the best option applicable to you.
As a guide, please understand that medicine is an evolving field. The comfort and experience of your treating surgeon, your own opinion, likes and dislikes after understanding the pros and cons determine the preferred option. But remember that none of the options are either superior or inferior to each other.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you it was helpfull.
Now, what kind of anti - cancer
supplements, and anti - cancer natural
food and diet would you recommend
to help fight the cancer?
Also, have you heard about coffee
enemas for health purposes, and
what is your opinion? are they helpfull?
Now, what kind of anti - cancer
supplements, and anti - cancer natural
food and diet would you recommend
to help fight the cancer?
Also, have you heard about coffee
enemas for health purposes, and
what is your opinion? are they helpfull?
Brief Answer:
Fresh fruits and vegetables
Detailed Answer:
Vitamins and antioxidants are useful in detoxifying carcinogens. In that sense, fresh fruits and vegetables are useful. Dietary supplements of vitamins could also be useful. However, these are general suggestions like exercise and life style modifications. There are NO specific preventive measures.
I am aware of coffee enema but since I do not have any experience, I would rather refrain from commenting.
I have patient experiences about being positive on the outcome. Positive thinking and will to overcome the disease should help.
Fresh fruits and vegetables
Detailed Answer:
Vitamins and antioxidants are useful in detoxifying carcinogens. In that sense, fresh fruits and vegetables are useful. Dietary supplements of vitamins could also be useful. However, these are general suggestions like exercise and life style modifications. There are NO specific preventive measures.
I am aware of coffee enema but since I do not have any experience, I would rather refrain from commenting.
I have patient experiences about being positive on the outcome. Positive thinking and will to overcome the disease should help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I have one more question, please .
I have had already done special
sentinel node biopsy... and it came out
all negative!!
You have mentioned before the :
" axillary dissection" . Is it something
additional which will be done during my
surgery? or it has been done if I had
sentinel biopsy?
Also, if the all brest tissue will be removed
from right brest, with biopsy test which is done during surgery, and I will be able
to save the skin and nipple, do you
think I can avoid radiation?
And if all looks good after surgery, can
I just have only one or two round of
chemotheraphy plus Herceptin instead
of 6 rounds of chemo?
Or can I just decide on Herceptin only
and one chemo or not at all chemo?
I have had already done special
sentinel node biopsy... and it came out
all negative!!
You have mentioned before the :
" axillary dissection" . Is it something
additional which will be done during my
surgery? or it has been done if I had
sentinel biopsy?
Also, if the all brest tissue will be removed
from right brest, with biopsy test which is done during surgery, and I will be able
to save the skin and nipple, do you
think I can avoid radiation?
And if all looks good after surgery, can
I just have only one or two round of
chemotheraphy plus Herceptin instead
of 6 rounds of chemo?
Or can I just decide on Herceptin only
and one chemo or not at all chemo?
Brief Answer:
You need to take therapy
Detailed Answer:
Sentinel node is negative. This means you can avoid axillary clearance (surgery under the arm pit). This would prevent the potential arm edema. Since sentinel node is negative, axillary dissection is NOT required. On cancer outcome, negative axilla is a good sign.
For the disease of 3cm, if the whole breast is removed there is a high possibility of avoiding radiation. However, other aspects of closeness to chest wall and location of tumor and margins become relevant for administering or avoiding radiation. Your surgeon, pathologist and the radiation oncologist would be able to guide you. But remember that if you undergo only removal of lump, radiation is mandatory.
The number of cycles of chemotherapy are determined by the pathology report. They are not individualized. This means that all patients within a group categorized by the pathologic findings receive same drugs and same number of cycles. Hence the advice on number of cycles will not change for individuals.
As a rule you have to remember that each therapy is NOT a substitute for the other but complement to the other. Hence one therapy INSTEAD of the other is NOT a good idea.
You need to take therapy
Detailed Answer:
Sentinel node is negative. This means you can avoid axillary clearance (surgery under the arm pit). This would prevent the potential arm edema. Since sentinel node is negative, axillary dissection is NOT required. On cancer outcome, negative axilla is a good sign.
For the disease of 3cm, if the whole breast is removed there is a high possibility of avoiding radiation. However, other aspects of closeness to chest wall and location of tumor and margins become relevant for administering or avoiding radiation. Your surgeon, pathologist and the radiation oncologist would be able to guide you. But remember that if you undergo only removal of lump, radiation is mandatory.
The number of cycles of chemotherapy are determined by the pathology report. They are not individualized. This means that all patients within a group categorized by the pathologic findings receive same drugs and same number of cycles. Hence the advice on number of cycles will not change for individuals.
As a rule you have to remember that each therapy is NOT a substitute for the other but complement to the other. Hence one therapy INSTEAD of the other is NOT a good idea.
Note: For further queries related to kidney problems Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
