Question: Dear Doc

I was diagnosed with Invasive Ductal Carcinoma Grade II recently. In this regard, I was in contact with Dr. XXXXXXX Sundriyal (On-Line Oncologist at Health Care Magic) earlier regarding Lumpectomy vs Mastectomy. Based on his views (after reviewing all my reports) and suggestions from my Oncologist here in Pakistan, I opted for lumpectomy.

Attached herewith is my latest biopsy report after Lumpectomy which was done on 24th November, 2017 afternoon. The BIOPSY REPORT covers the CIST + LYMPH NODES. Please refer to Report attached: Subject: Final Biopsy No: 13A,13B & 13C - 3 Pages dated 29th November 2017 (Today)

Firstly please kindly share your general views regarding my previous reports (12 reports are attached in my dash board apart from 13A/13B & 13C). Basically I want to know if my cancer was diagnosed at stage 1 or say at a very early stage? I have learned from internet that 2 CM tumor with clear lymph nodes and margins at 2.00 O Clock position is known as Stage 1A? or is it Stage 1B?

The reason why I want to know if its Stage 1A or Stage 1B is that I have heard that in Stage 1A, sometimes Doctors opt to skip Chemotherapy and only rely on radiations

Now my main questions are:

1.     Is it mandatory to get “Chemotherapy” done in light of this report?
2.     Is there any other alternate treatment other than Chemotherapy?
3.     If Chemotherapy is a MUST, how soon it should start?
4.     Can we share the name of medicines my "Radiology Oncologist" will advise with
you for 2nd opinion?
5.     I understand that targeted radiation is a MUST after surgery but how soon it
should be done?

If targeted radiations on local area (affected area) are not possible in Pakistan, is it a good idea to get them done from Singapore? (coz' I can go there for short treatment). I cannot go abroad for Chemo coz' it will take a lot of time and I cant afford to be out of home for so long but for radiation I can go provided it's for a shorter period

I understand that normal radiations process will take 15 days plus / minus and there are no immediate side effects (as such) but in the long run the effects can be lethal? Thus targeted radiations should be considered over normal radiations as the chances of damages to lungs & heart are less with targeted radiations? And I assume that targeted radiations will take less time as compared to normal radiations

I am sorry for asking too many questions in one go but I dont want to disturb you again and again so thought i should put everything together

Please do review my last reports and my today's FINAL BIOPSY REPORT

Thanks for your support
Mrs XXXX

Hi Doc

Thanks for your reply. I have attached my latest report already - Its in my dash board. As mentioned earlier, please kindly check Report No 13A/13B & 13C. I am sending them by email again for your convinience

Accordingly let me know your views / replies on the below listed questions:

1. Is it mandatory to get “Chemotherapy” done in light of this report?
2. My HER2/neo is Evocable - Its not positive. What should be our next step?
3. Is there any other alternate treatment other than Chemotherapy? Can I get away from Chemo?
4. If Chemotherapy is a MUST, how soon it should start? My Doctor is saying 5 weeks after surgery - To me it sounds a bit too long?

I share the name of chemo medicines my "Radiology Oncologist" will advise with you for 2nd opinion?

Other questions:

Can I take 2 glasses of RED WINE at night? My surgery was done on 24th Nov, 2017 and now I have stopped taking pain killers as well. Is it safe for me to consume Red Wine? or White Wine?

Thanks Doc

Waiting for your reply
Mrs XXXX

Sorry I meant Equivocal (2+) - Its neither positive nor negative...

Thanks Doc for your reply

I forgot to tell you that FISH has been ordered today by my Doctor. But what if my FISH test comes as negative? In case of negative result, can I get away from Chemo? What will be the next step if FISH comes negative?

Regarding wine, I am a little confused. A standard glass of wine is usually 150 ML (basically 1/5th of a bottle). Therefore 60 ML means hardly 2 to 3 sips...Please don't take me wrong but this much quantity is way too less then my expectation so I better avoid taking wine for now. But can you advise me when I can start wine (like 2 glasses - say 250 to 300 ML - 11% alcohol) again? My surgery was done exactly 01 week ago

Also my Doctor confirmed that they will start chemo on 27th Dec - meaning 31 days after my surgery. Should I ask them to start earlier?

Thanks again
Awaiting

Mrs XXXX