sumeet_shahAdministrator6 years ago

I can understand your situation.

It's not possible to give opinions without seeing a patient. I can tell you Tata Memorial Centre is definitely one of the best. Just go ahead with what doctors say, your mom will be fine.

When any doubt about any report, remember, TMC is final authority. So all reports reviewed in TMC, whatever TMC has said is the correct thing.

Your Mom will be fine soon, don't worry.

rsaran in reply to sumeet_shah6 years ago

Thank you so much DR. Shah, I want to know your views on Brachytherapy ! Is this pretty common in india? Is this safe? I guess they say that because my mom is overweight and its easeir to target with this therapy.

Do you think we should rather go with mastectomy than lumpectomy because they had given us this option?

Thank you so much for your time!

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kaarenorgaard in reply to rsaran6 years ago

Brachytherapy is in the UK only recommended for research (nice.org.uk/guidance/IPG268.... It is not used in Denmark either to my knowledge. Whether it is effective I don't know, the fact that it has been offered to your mother has started me off on some investigations. Can you get some words on why it has been recommended (as opposed to normal external beam radiation)?

If you go for mastectomy, and if the lymph nodes are clear, none of these options should be necessary - and they do have possible implications on the health (any radio therapy has).

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rsaran in reply to kaarenorgaard6 years ago

As per doctors external beam RT would pose challenges due to mom being overweight and large breast, that is why APBI with intra-op needle/catheter placement is preferable, but they also said if after surgery conditions are not favorable they wont do this.

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kaarenorgaard in reply to rsaran6 years ago

Do ask them why they consider brachytherapy in the light of NICE in the UK never recommending it. And they would have patients Iike your mother in the UK as well, in that same situation.

In the meantime I will investigat as well what there is to know about brachytherapy ...

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kaarenorgaard in reply to rsaran6 years ago

I have collected the following links about brachytherapy:

1: breastcancer.org/research-n...

It says that these are the criteria for suitability:

Size: Big cancers are unsuitable. Most put the threshold of "big" around 2 - 2.5cm

Type: Lobular is less suitable. Your mom's case is lobular

Hormone: HR- less suitable. Your mom's is HR+ (ER+ and PR+) so on this criterion it's OK.

Spread: Less suitable, and your mom's hasn't spread, at least that we know - depending on the lymph nodes.

But in conclusion your mom's cancer is not immediately in the target group.

2: redjournal.org/article/S036...

It says that the reason to hove radiation (to avoid local recurrence) is not met as well with brachytherapy as with external beam radiation: The 4.7% risk after lumpectomy is reduced to 2.8% with brachytherapy but to 1.3% with external beam radiation therapy (EBRT). And there are other drawbacks mentioned.

3: m.cancer.org/cancer/breastc...

If you scroll down, you see the same result as in #2. The article gives a good overview.

So, it may be offered for other reasons, e.g. EBRT equipment not good, or logistics problems of the many intervention visits for EBRT over 5 weeks:

4: ncbi.nlm.nih.gov/pmc/articl...

It seems to be a tradition in India...

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sumeet_shahAdministrator in reply to kaarenorgaard6 years ago

Very well explained! And with all the links. I thank you for your efforts.

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rsaran in reply to kaarenorgaard6 years ago

Thank you so much for taking all this time! My moms surgery is schedules in few days i will keep you all posted! Thank you!

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kaarenorgaard6 years ago

If it is ER and PR positive and CerbB2 (also known as HER2) negative, it is quite good, because the socalled endocrine medicine will be effective (due to ER and PR being positive) - and HER2 negative is also good, when ER and PR are positive.

This combination has the lowest risk, more important than size and grade.

Since the tumor is more than 2 cm, the doctor will probably add chemo therapy - and will do so in any case if the lymph nodes are involved (which is known after the surgery, unless they take a biopsy of the axilla, but it is usual to wait for the surgery, then they inject a fluid into the tumor, find the "closest" lymph node by seeing where the fluid goes, and test this lymph node; if it is cancer free, then the rest are as well, and it couldn't have spread.

But still - even if it hasn't spread, you want to kill those invisible cell that might be in the body. For sure the endocrine medication (aromatase inhibitors for postmenopausal women, or tamoxifen for all) will contribute to that job, and she will have to adhere to this medication for 5 years (tamoxifen recommended for 10 years in some areas).

Whether chemo therapy also is added - as a set of weeks of therapy, before the endocrine therapy is started - depends a lot on the doctor, and it is in any case advisable, if the lymph nodes are affected.

Radio therapy comes into play, because she is signed up for a breast conserving surgery (the lumpectomy). If she accepts to remove the whole breast ("mastectomy"), and if lymph nodes are clear, then there is no radiotherapy. But lumpectomy is the usual thing today. Radiotherapy is because they want to make sure that there are no surviving cancer cells in the vicinity of the tumor (where the medication works on the full body on cells having escaped the local tumor). And in case of mastectomy they are sure, but for lumpectomy, they must reduce the risk of "local recurrence" by a factor 2 using radio therapy to come to the same overall risk of recurrence as for mastectomy.

Whether chemotherapy should be added, if lymph nodes are not affected - which is likely for that size of tumor - can be determined by a genomic test of the tumor, which your mom seems to be in the target group for. Please ask the hospital how they go about that. Some tests are very costly (USD 4,000 and performed in the USA) - but that is my interest to see if a hospital in India is able to measure the expressions of 21 genes, then I possess an algorithm to determine, if the gene information is such that chemo therapy should be omitted (it is costly and impairs the health a lot).

The overall risk can be assessed and depends on the lymph nodes involvement. In the UK (and in India?) they use the Nottingham Prognostic Index.

Best wishes.

Kaare (from Denmark)

sumeet_shahAdministrator in reply to kaarenorgaard6 years ago

Again, very aptly and well explained. Nothing much for me to add at all.

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anderach6 years ago

I know how it feels too. My mum has the BRCA 1 gene and I'm only 14 years old. 80% is breast cancer 60% is ovary. Even worse, i have Autism Spectrum disorder with anxiety and depression plus i live in Australia not UK.

rsaran6 years ago

Hello everyone,

Just a update and a question, my moms surgery was on 7th and went really well they checked 5 lymph nodes and they came negative..they could not perform brackeytherapy, so now we are waiting for the reports and then we will go and see a radiation oncologist.

At the area where lymph nodes where removed she has staple stiches, those stiches are hurting now with a burning sensation, is that normal?

Thank you !!