I am 38 yrs old, was diagnosed with Invasive ductal carinoma, Radical Mastectomy done, awaiting chemo. ER+,PR+, HER2- with one node positive

[Ami1510]

Hi, I was diagnosed with INDC in my left breast and had Radical Mastectomy last month. My reports are attached below. Tumor is Er and PR+ (97%& 95%)and HER2-, node positive(1/23nodes removed). Extensive Intraductalcomponent is present, Lymphovascular emboli seen, cancerzation of lobules seen, perinuerial invasion seen, bloom score 3+3+3=9. One of the medical Onco suggests direct chemo for 20cycles and another one suggests Oncotype DX test. My confusion is with my parameters should I consider ONCO test or just start the chemo. Also do I need 20cycles of chemo?

[sumeet_shah Administrator]

I am not sure what is 20 cycles. I know of 16 in which first four cycles are of one type (EC) and the next 12 are of another type (T). Technically, even these 12 cycles are actually 4 cycles only. They have been divided into 12 to reduce the side effects.

As for Oncotype DX, there are some Medical Oncologists who believe in it and some who don’t. My suggestion is, select your doc first. Once you have faith that this is my doc, follow what he says.

Since I am a Surgical Oncologist and I don’t give chemo, I would not be the right person to actually guide you, for opinion on chemo and Oncotype DX. But my gut feeling is, just close your eyes, take a deep breath, and take the chemo. Don’t bother much, don’t listen to too many people around. You are young, your chemo will go reasonably smooth, don’t worry.

[Ami1510 in reply to sumeet_shah]

Thank you Dr. for your reply. Yes, it is 8 cycles (20 weeks).

[Ami1510 in reply to Ami1510]

One more question I have is, I had my surgery on 27th nov. but my drain is still not going below 70ml. It’s more than 22 days now. Is it normal or anything I need to worry or check with my surgeon.

[Ami1510 in reply to Ami1510]

Dr. Summet, I am worried my fluid drainage today measured m around 150ml. Yesterday it was below 80ml.

[sumeet_shah Administrator in reply to Ami1510]

It’s perfectly normal. Don’t worry. Fluid will go down soon.

[Ami1510 in reply to sumeet_shah]

Hi Dr. Sumeet, the drain fluid measure is still not coming down and fluid has a slight smell today. Anything to worry?

[sumeet_shah Administrator in reply to Ami1510]

Nope. I suggest you meet your operating surgeon for a better clarity. Without knowing details or seeing myself I can’t guide you. Your doc would know your axillary clearance which he has done, he knows what to expect. So it’s best if you consult him once.

[Ami1510 in reply to sumeet_shah]

Thanks dr Sumeet. Met with my surgeon, the drain has got infected and now am on antibiotics to treat it. He took out 23 node at the time of surgery, does the no. of nodes taken out affect the fluid drain for prolonged period..

[roxboxfox RadiationOncologist]

You are eligible for Oncotype Dx test, to determine whether you would benefit from Adjuvant Chemotherapy or not.

If you test Positive, you should be willing to undergo Chemotherapy and with special access scheme you get some 40-50% refund of the Oncotype Dx cost.

However, if you test negative (low Score) u can very safely avoid Chemotherapy (in which case you don't get any refund)

The Test costs nearly 2.9-3 lakhs which is not reimbursed by any Insurance and hence it's difficult and does not have much popularity in India, as it's cheaper to get all your 20 weeks of Chemotherapy at half the cost .

Hence both Medical oncologists have given you pragmatic and virtual options. It's you who has to decide ?

[Ami1510 in reply to roxboxfox]

Thanks Dr. Have decided to go with Onco test. Also in my case how likely is it that I will need radiation?

[Ami1510 in reply to Ami1510]

And what is the time period within I need to start Chemo after surgery?

[sumeet_shah Administrator in reply to Ami1510]

By 3rd to 4th week from day of surgery.

[Ami1510 in reply to roxboxfox]

Hi Dr. Rohit, I had some what anxiety about the recurrence of metastasis breast cancer in HR positive and HER negative breast cancers after 10years. I know I am thinking very ahead of time, but unable to calm my nerves after thinking of it.

[roxboxfox RadiationOncologist in reply to Ami1510]

You have a 94% chance of being well and alive at 5 years and 88% chance of being well and alive at 10 years.

Having a recurrence is not equal to death. That relapse can be tackled based on where its detected. Locoregional mets are well salvaged these days. Oligometastatic disease is also being managed aggressively these days, i m sure in 2030, there would be plentiful of discoveries and newer methods of detection and newer modalities to treat those metastasis. There are currently billions of dollars worth of research going on in Cancer, so be Positive and live life fully. Ensure you keep all your Follow up appointments and have faith ....

The entire Breast Cancer Healthunlocked team is with you. Stay Positive.

[Ami1510 in reply to roxboxfox]

Thank you Dr. Rohit. I do have these phases of ups and downs in my thoughts. Trying to be positive but some days fail miserably.

[Fighter18]

Hi,

Since I am just another patient, what I can say here is if you and your doctor decides chemotherapy for you, don't worry. Nowdays side effects are well managed with medicine and proper diet. I am not saying it will be easy but managable. I finished my treatment in July and I had 8 cycles (4 + 12 weekly)

Hugs and love

[Ami1510]

Thanks Fighter18, I am positive and am sure that if onco results comes back that I need Chemo, I will go through it positively and be cancer free soon.

[roxboxfox RadiationOncologist]

You will certainly benefit from Adjuvant Radiotherapy as well as per the Lancet 2014 Meta-analysis which concluded that women who have underwent Mastectomy irrespective of Chemotherapy, if they have Positive node (1-3 nodes) significantly benefit. This benefit is same whether 1 node was positive or whether 2-3 nodes were Positive.

The Sequence you should follow is

Surgery

Start Adjuvant Chemotherapy if Oncotype Dx score high (Positive)

Within 4-6 weeks of Surgery

Then

Start Adjuvant Radiotherapy (within 3-4 weeks if Chemo) or if Oncotype Dx is negative (within 6 weeks of Surgery)

Lastly

5-10 years (more data emerging for 10 years) of Hormone Therapy Treatment

All the Best

Dr Rohit

[TKBB]

This is my first post here....but I read all your posts daily and thankful I found this site. I was dx March 2018 4.5 cm tumor. ER+, 7/15 lymph. postive, lumpectomy 8/18 then masectomy 9/19. I started AC in June to shrink tumor in attempts to save as much breast as possible. ....right before I started AC I went to Standford for a 2nd opinion. Had the ONCO test But had no peace in the treatment or team I met with at Standford. My ONCO score finally came back at 12 (though I was already 3 treatments into AC) My score indicated that chemo would have a Zero effect on my tumor. By the end of AC tumor had shrank 33%. I still had to have a Macestomy but it showed me that for me a premenopausal woman this score was not a for sure test....it was obvious the chemo had

Worked. I have no regrets in moving forward with chemo. Praise God that he gives me the strength to get through each day. I'm now on Taxol 12 treatments and only 1 more to go December 26 in my last treatment. Lol....I'm counting down days now and looking forward to the 4 week break before starting Radiation. My praise is to our amazing Father. He continues to bless me and give me the strength through this journey. Cancer will not steal my joy!!

[sumeet_shah Administrator in reply to TKBB]

@TKBB, yes indeed, I concur with you. Its am important point you have shown that in spite of low score, you saw s response to chemo. It is not without a reason that the entire breast cancer team at one of the premier institutes in India does not believe in Genetic profiling tests, especially in grade 3 tumours which are also node positive. It’s not that they find it biased. There are many early stage cancers where it is definitely useful to determine whether chemo may benefit or not, and there they do use it, for sure. But in a lot of cases, where the tumour is high grade and nodes are positive, the decision is so obvious in the histopathology report, that doing those tests are unnecessary financial burden to patient, when we are almost sure of the result

We wish you a speedy recovery.

[Nav_Onco]

Hello Ami - in support of your journey.

I would restrict myself to the discussion on Oncotype Dx. This test definitely is determinant of the usage of chemotherapy.

Along with Oncotype Dx report and the suggestion of medical oncologist, there are chances that you could avoid chemotherapy.

There is a less expensive version of this diagnostic test, validated on Indian patients and developed by an Indian company - OncoStem Diagnostics. The test is known as CanAssistBreast - it costs about 1/5th of Oncotype Dx.

[MsLockYourPosts TeamBCI]

Cheaper is not always better! Given Dr. Shah's comment about doctors questioning the value of genetic testing, I would go with his advice to find a doctor you trust and then make your decision based on discussions with your doctor about your specific case.

[Ami1510]

Hello Dr. Sumeet and Dr. Rohit, my Onco score came back and it’s 22. Now my Medical Onco have given us two options of Tc and Ac+T. I am confused which one should I go with. My Onco recommends TC 4cycles..

[roxboxfox RadiationOncologist]

I would go for easier recommendation made by your Oncologist.

Your Med. oncologist is there to help you, not to harm you.

Have Faith in these highly qualified Superspecialists who have in depth knowledge

[Ami1510]

Hi Everyone, My Oncotype Dx came back, with the score of 22. Started my Chemo in 2nd week of Jan 2020. TC regime. (6 cycles). No major complications. Radiation will be discussed after I finish my chemo in April end. I am not looking forward to radiation, but if need what kind of schedule is preferred, if anyone can advise.