Breast Cancer (R) with Stage 1A/1B (T1b N0/N1 / M0) + Invasive Ductal Carcinoma Grade II + 1.5 cm Tumour size... Need further suggestions...

[dineshcjd]

Dear Friends

My Mother diagnosed with Breast Cancer (right breast). She is 52 yrs old.. 3 childern... passed menopause 7 yrs back.... breastfeed for all 3 atleast 3 to 5 months... only my grandmother ( My fathers mother) had Breast Cancer compliant... (But not sure.... based on symptoms explained .. happened in 60s) .. She also diagnosed with hepatitis b reactive....

Based on core biopsy its referred as Invasive Ductal Carcinoma Grade II...

Based on PET CT Scan, following observation as mentioned...

1A/1B (T1b N0/N1 / M0) ... doctor mentioned that its small tumor, not much involvement in lympnodes and not spread to other part of body..

Then she undergone mastectomy .... after 3 week and based final biopsy test, following points are referred..

Invasive Ductal Carcinoma Grade II.

1.5 cm size tumor

No perinerural invastion

12 Right anxilary lympnodes .. free of tumor..

Then ER PR HER2 Test report ( IHC ) as follows

ER - Negative; PR - Negative ; Score (0 for both)

HER2 - 2+

Then doctor suggested for FISH test and report will take 8 to 10 days...

And also doctor suggested to start chemo as follows

FEC X3 -> DOCE x3

Totally six session with 3 week break...

Based on FISH test report, he plan to add another drug herceptin ....

NOW MY CLARIFICATION ARE

1. With full mastectomy and there is no anxilary lympnodes are affected with cancer cell, chemo is necessary ??

2. If chemo necessary whether prescribed drug combination are okay??

3. For these FEC and DEC drug, they will charge 20K to 25K.. and no insurance coverage under TN CM health insurance... is it right??

4. What is the advantage of adding herceptin and additional cost associated with it??

5. Any complication of these Chemo treatment with hepatitis b reactive??

6. Precautions recommended...

Thanks ..

[kaarenorgaard]

Hi there,

The chemo therapy is necessary, because for any invasive cancer something should be done in terms of a so-called "systemic treatment", i.e. medication attacking the small and currently in-detectable clusters of cancer cells that may be all over the body. There are for sure no big clusters (or metastases), then the lymph nodes would have been affected. And since it is ER and PR negative, then anti-hormone therapy will not work (the so-called "endocrine therapy") ... so we are left with chemotherapy.

If it is HER2 positive as well, which the FISH analysis will determine (because the initial assessment of HER2 was "borderline" with 2+), then Herceptin should be added. It always comes together with chemotherapy. If it comes into question, then the Herceptin has to be taken for a year - starting during chemo therapy.

Herceptin (or a cheaper equivalent in India) must be taken, it turns an otherwise poor prognosis into a good one, because the HER2 positivity is one more handle on the cancer that can be used to attack and kill it (still targeting whatever may exist in terms of small clusters around in the body).

Radio therapy does not come into question for a mastectomy with no lymph nodes affected.

If your father's mother had breast cancer, it has no effect genetically on your mother (they aren't related). But usually it has an effect on choosing mastectomy, which was done anyway.

The chemotherapy is also used here in Denmark (EC -> Docetaxel, not with the "F" component). A relevant link for FEC is: breastcancercare.org.uk/inf...

The hepatitis B I cannot comment yet (I may try to find out about it) - I assume your oncologist has known this when selecting the chemo therapy?

Kind regards

Kaare (from Denmark)

[roxboxfox RadiationOncologist]

Triple Receptor negative breast cancer in someone Age 52 with the histology given.

The benefit of Adjuvant Chemo is 6.4% at 10 years

Sequential FEC-T is one of the standard and well recognised 3rd Generation chemotherapy regimen in many places.

You will have to discuss the costs with your oncologist

If your mom does turn out to be Her2 +ve, she will need Herceptin for x 1 year.

Again your oncologist should be able to discuss the different brands available and its associated costs.

Your oncologist will of course keep a close eye on your Liver function tests

There is no known great association of Re-activation of Hep during this particular chemo.

But there remains a Hypothetical risk as her immune system will be down, but I m sure your oncologist would offer you upfront Growth factors (GCSF).

All the best !!

[dineshcjd]

Thanks for valuable reply. Now my mom undergoing FEC 100 3rd cycle. During surgery she diagnosed with Hepatitis B and followed viral load test reveals 1.75 lakhs IM/ML. Based on this report Gastrologist doctor suggested for TENVIR 300MG for 3 months. Now my concern is whether while taking this medicine, Chemotraphy is safe?? Expected side effects or issues ?? Kindly suggest to make it clear. Thanks.

[dineshcjd]

Dear All, Now my mom has completed 6 cycle of FEC + DOCE. As i told earlier she is Her2+ and doctor recommended trastuzumab for 1 year. She also diagnosed with Hepatitis B and taking TENVIR 300MG for last 3 months along with these chemo. With the 6 cycle of chemo itself my mom was too tried n not want to continue any further treatment.

Now my query is

1. Is it any improvement possibilities with 6 cycle of FEC + DOCE taken?? How to know?

2. Is it trastuzumab is mandatory for my mom's condition?

3. If not taking trastuzumab, what will be the issues?

3. How to improve her health without trastuzumab with Hepatitis B issues??

Request your valuable opinion. Thanks.