Why is a Mastectomy Needed?

[Bhalla]

I was diagnosed w Stage 3 BC with axillary lymph node involvement tumour size 6cm in LHS breast HER +. Reccomended treatment 6 rounds of chemotherapy/ targeted therapy, radical mastectomy and then radiation.

I have had 3 rounds of treatment so far with Perjeta/Herceptin/ Taxotere. Tumour has completely shrunk away so far.

My question is if there is no sign of an active tumour at the end of the 6 rounds then why is a mastectomy needed?

I am 46 yrs old.

[kontak TeamBCI]

In this case do ask your oncologist. He will talk to you in details as he is having your full case history. Take decision after due consideration

[Bhalla in reply to kontak]

Thank You

[sumeet_shah Administrator]

we will surely guide you. But before that, could you please ask your Oncologist the reason for mastectomy and not BCS. Once he tells you, let us know and we will help you out.

[Bhalla in reply to sumeet_shah]

Thank you for the reply 😀Had a talk w my oncologist today and he feels a mastectomy is better than BCS as the original tumour was spread in two quadrants of the breast and after all calcification is removed not much breast tissue will remain and cosmetically a full removal and reconstruction might be a better aesthetic option

My original question however is if there is no active cancer shown why does either BCS or mastectomy need to be done? My oncologist mentioned that current protocol dictates this is the best option however studies are being conducted that perhaps if excellent outcomes are achieved with modern targeted therapy this might change current recommended protocol followed.

Also on a different point today's blood test ( done every week) showed an increase in CA 15.3 (unit IU/ml) reading 15.95. This is week 7 of chemotherapy. The tumour marker in week 3 of chemotherapy was 6.3. Prior to the commencement of chemotherapy the Tumour marker was 7.7. Should I be concerned ?

Thank you once again for taking the time to reply and your support on this site🙏🏽

[roxboxfox RadiationOncologist]

There is an unsually high relapse in patients who did not have Breast surgery. When i was in UK, there was a thought belief and few British senior Oncologists gave neoadjuvant chemotherapy and in select group of patients with good to excellent response, they did not offer surgery to these women, and directly had Radiotherapy. A high proportion of these women came back with relapse and when they learnt that surgery was not offered, they sued the NHS and the doctors Medical license of that doc was cancelled (but he had almost taken Voluntary retirement) when this scandal broke. The women who were still alive were compensated out of court settlement.

You still need surgery, whether its Breast conserving or Mastectomy depends on the expertise and experence of the surgeon and of course Patient and tumour related factors.

Pertuzumab, Trastuzumab, and Docetaxel results in 39% probability of achieving pathological complete response. But how would you know, whether the cancer is gone or not. As 61% of the times, you still have the cancer when seen in the microscope , nobody talks of radiological or clinical Response, as its subjective and has never been a clinical endpoint in any of the Neoadjuvant clinical trials.

You are doing well and on the right track. All the Best !

[Bhalla in reply to roxboxfox]

Thank you ever so much for that sensible and informative reply. It makes things a lot clearer for me.

I appreciate your time and effort

[Bhalla in reply to roxboxfox]

Would you have any answer to the the CA 15.3(IU /ml) tumour marker rise despite outward signs that the tumour has shrunk ( not sure about the affected lymph nodes).?

It's been playing on my mind a bit

TY

[roxboxfox RadiationOncologist in reply to Bhalla]

The reference range of serum CA 15-3 is less than 30 U/mL.

All her readings look normal to me.

My CA 15.3 reading may be 7

Your neighbours reading may be 16.

They are all normal.

Don't worry. She is certainly doing well. You are on the latest path breaking STD treatment as of 2017.

[Bhalla in reply to roxboxfox]

Thank You

[sumeet_shah Administrator in reply to roxboxfox]

As usual, Rohit, a crystal clear, lucidly worded and brilliant reply from you. You are an asset to this forum.

[pprabhu in reply to sumeet_shah]

sumeet_shah roxboxfox Really you both the doctors are such a asset to all of us on this forum. Thanks Doctors for taking some time and help people on this forum

You both Rock!