Triple negative IDC risk

Dear sir

I am Eswar. My wife (39 years) found a lump in her left breast. Initial diagnosis(FNAC and trucut/core biopsy) resulted in Fibroiddenema. We are shocked to hear IDC when excision biopsy(lump removed) is done. Doc carried out further lab investigations which came out with ER negative, PR negative and Her2 negative. Also k67 is 80% declared as triple negative...further sentinel lymph node is negative which I heard good sign.she is now referred to onecoligist who suggested 8 chemo cycles every fortnight.

We may have to wait for second opinion to start chemo. Wife is very anxious as we heard cancer is IDC grade III where cancer cells r very active. Is it OK to wait for a week until second opinion or do v need to start chemo immediately. Tumour was 0.8 cm considered stage 1a

Any info in this case would be of great help. I look forward to hearing you.

Thanks

18 Replies

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  • Dear Eswar,

    Welcome to this forum.

    Sorry to hear about your wife being diagnosed with breast cancer this way.

    I ll awat Dr Sumeets opinion as to whether excision biopsy alone here is considered optimal surgically, or whether a wide local excision should be done here.

    With the given info 0.8 cm IDC Gr III, negative sentinel node, Triple receptor negative

    As per adjuvant online,

    A. DEATH as an endpoint

    Your wife has currently a 91% probability of being well and alive in 10 years time

    There is a 8% chance of dying from breast cancer, and 1% chance of dying from other causes

    With 2nd Generation chemotherapy treatment, we could alter this ratio a bit,

    by giving an absolute benefit of 3.5%, thus

    With adjuvant chemo, she may have a 94.5% probability of being well and alive in 10 years time (the best which can be done)

    There may be still a 4.5 % chance of dying from breast cancer, and 1% chance of dying from other causes )the latter remains unchanged).

    B. Relapse as an endpoint

    Your wife has a 77% chance of being well, and free of cancer in 10 years

    21.9% chance of relapse

    1% die of other causes

    With Adjuvant chemo, this ratio can also be modified by 10%, thus with chemo,

    there would be a 87% chance of being well, and free of cancer in 10 years

    11.9% chance of relapse (despite having chemo.... this is never going to be zero)

    1% die of other causes.

    You can wait for upto 6-8 weeks post surgery, with no detriment in outcome. You certainly have the time, to seek a second opinion, decide on whether to go for chemo or take your chances, read about the side-effects of chemo and how it may affect your lives, seek support from friends & relatives, and of course seek help and support from this wonderful forum members.

    All the best

    Dr Rohit Made MD, DNB, FRCR (UK)

    Consultant Clinical & Radiation Oncologist

    BNH HCG Cancer centre

    Dr Balabhai Nanavati Hospital

    Vile Parle, Mumbai

    India

  • Dear Dr Rohit...Thanks a lot for your advice. Do we need to do PET scan in her case of triple negative & sentinel limph node negatively ?

    Any permanent solution other than chemo like complete removal of breast?

    Hope one week delay of chemo due to second opinion not causing any risk of spreading cancer cells

  • Hi prakeshwar - welcome to our forum. Very very sorry to hear about your wife. Pl don't worry. We will wait for doctor's reply. Even if she is asked for chemo - though its tough but definitely can be managed very well with the help of medicines and proper diet. Take care

    Lets wait for our Doctors to guide

  • prakeshwar - Dr Rohit has already replied

  • Hi kontak, pl share diet plan which would be of gr8 help

  • No role of PET scan here. I recommend staging scans only for patients with positive lymph nodes.

    I m afraid the statistics provided are the Systemic risk Factors.

    If a breast conservation surgery is performed --> Adjuvant Radiotherapy is also recommended.

    Whilst is a Mastectomy is done --> No role of Adjuvant Radiotherapy.

    The recommendation and statistics for chemo, are after the above 2 factors are balanced (Surgery and Radiotherapy).

    Above mentioned statistics are from studies of over 10,000 women.

    You may be lucky to be one of the 91% survivor and claim blogs, that doctors recommended chemo and i believed in alternate medicine, and babas tonic and coenzymes and leaves and see even without chemo i m well and alive ,

    ..... Well all what i can say is Lucky You... the stars were in your favour.

    whilst there is a 8% chance you may not be so lucky and curse your luck, for having missed out on chemotherapy.

    ...... Well you were advised treatment , were nt you !

    In this medicolegal world, oncologists are of course obliged to offer treatments , explaining the benefits and side-effects and statistics... the call is yours ! ! !

    Laymen, do not understand these statistics, have little knowledge of the oncology science but are first to make blogs and claims, not knowing what impact it may have on other readers.

    My advice is to consult a qualified Medical Oncologist in a reputed hospital who can give you and your wife time for consultation, so that you make the right decision for yourself.

    Life is a gamble, and surely this decision is also a bit tricky;

    2 out of 10 patients may refuse chemo

    whilst 8 out of 10 patients may take chemo

    It is possible that those 2 patients who refuse chemo may not have a relapse, and it is possible that one of those 8 pts who took chemo may have a relapse.

    There is no way to predict this reliably.

    Its an unfortunate play of statistics and probablitites.

    With best wishes !

    Dr Rohit Malde

  • Dear Dr

    Thanks a lot for the suggestions and information's.

    I really appreciate your time contributed to us.

    I will update further developments.

    Hopefully we come out of it.

    Best regards

  • Dear Eswar,

    First of all, you need to be super strong. Your wife will need to draw strength from you... so be prepared...

    I will try and explain to you the next steps

    1. Get the slide and Block re-tested. Send them to Dr. Anita M Borges in Bombay for a second opinion. srlworld.com/article/8/21/c...

    2. If the 2nd opinion is the same as the first one, consult a good onco surgeon (I could share a couple of good ones - if you are interested) and discuss the need to do a wide-excesion cut (basically remove the margin areas of the tumour)

    3. for TNBC, the Gold Standard is dose dense (fortnightly) chemo of ACT (A-Adriamycin, C-Cytoxan given 4 cycles 2 weeks apart followed by T-Taxol weekly for 12 cycles)

    4. Once this is completed, there should be a gap of 3 weeks and then radiation therapy should be given. Note - that since this is the left breast, you should check the options of getting IGRT with Gating done.

    None of these are difficult if you, your wife and your family maintain a positive outlook... treat this as a passing phase... of 9 months in a very long lifetime... everything will be alright!!

    Thank the almighty for an early detection... and start enjoying the small things which God has to offer ...

    All the best... and Stay positive !!

  • Hello prakeshwar - after going thro the above guidance - the only decision is to go for a treatment. Do not try to avoid or delay

  • Sorry for my delayed reply. Was too held up last week.

    roxboxfox has already given all the details. The only thing I need to add is, I believe that a wide excision must have been done. With safe margins. Please discuss that with your Oncologist. Just an 'excision' is not adequate. A 'wide excision' is a must.

    Apart from that, I wish to add you wife will do fine, don't worry. This is a very early stage cancer and most patients in this stage do very well with a good survival.

  • Dear Dr

    Thx for the advice

    It was Wide Local Excision as per report & done by Dr Somashekar of Manipal Hospital Bangalore.

    I am not sure right procedure is done. It was done after the tru cut (core) biopsy which resulted as Fibroidenema.

    Please advice

    Thanks sir

  • Don't worry, since it is wide local excision, it's the right procedure which has been done. Start off the chemo and then finish the radiation. Your wife will be fine. Once her treatment is over, I suggest that she must undergo a genetic counselling. That will be helpful.

  • Thanks Dr

    First chemo completed yesterday.

    Dr rohit n Your advises brought us confidence n hope.

    I really appreciate your time

    Keep you posted on developments.

    Best regards

  • Wife managed first chemo...but she had loose motion for couple of days...after urine check found infection...oncologist postponed second chemo for five days...now she is having intermittent fever...weakness...

    Second planned for morrow...any such effects on any one?

    Appreciate expert suggestions...thanks

  • Prakash, these are so called chemo side effects and can be manage with medicine but u have take care for hygiene, personal care..that's the only way to keep away infection, always clean hand before taking any food, should use mouthwash after food, don't server stale food, drink lot of water at least 2 litters a day so these kind of things will help her.

    Regard,

    Manish

  • Thanks Manish...We were worried of fever during chemo. We will follow doc,s advise.

  • Hi ask doctor they will give medicines for reducing fever. It will take 2 to 3 days more and again she will on the way to recovery.

    See she takes fresh cooked food only, keep changing her towels, bedsheets daily so that she will not face any infection & she will feel fresh.

    Give her coconut water this will help a lot.

    Take care and keep posting

  • Thanks a lot

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