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This question was answered on Thu 12, Feb 2009 09:55am by K S Saini, MD, MRCP (UK), DM

breast cancer


    
Asked by terry21 0 on Thu 12, Feb 2009 08:06am

My name is theresa moore. I was diagnosed with stage 2 breast cancer in my left breast 17 years ago at 42 years old with a 1.5cm tumor and 3 positive lymph nodes. i had a lumpectomy , radiation and chemotherapy including adriamycin. I am now 62 and calcifications found in a mammo in oct. in the same left breast found a cancer. Pathology revealed a ductal carcinoma -in-situ (DCIS) -0.5cm. and an invasive cancer -tumor size 0.7 cm. (Er negative, PR negative and Her2 positive (3+). Margins not involved. Sentinel lymph nodes were clean. It has been two months since my surgery and the oncologist i saw ( the doctor who treated me agressively 17 years prior) at first told me that i required no additional treatment- as he was hesitant to treat me with more chemo as I have high blood pressure taking toprol XL100mg and Benicar HCT and was treated with adriamycin previously. He said he was concerned about heart problems and leukemia. After he consulted with another oncologist he decided that I should be treated very aggressively with taxotere, carboplatin, and herceptin. Chemo every 3 weeks for 6 mos. along with herception once a week for a year. What also puzzles me is that he said if my tumor was 0.6cm I would not require treament and sometimes the pathologist are in error and the tumor might have been larger than they are reporting. Has it been too long a time period for treatment or do i really require treatment as he first stated?

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Answer by K S Saini, MD, MRCP (UK), DM  on Thu 12, Feb 2009 09:55am:

Hi Mrs Moore, You currently have DCIS, size 0.5 cm, surgery done, margins clean. You also have invasive cancer, size 0.7 cm, surgery done, margins clean, sentinel lymph nodes uninvolved. Does this require chemotherapy? Yes. For Her2 positive invasive tumors larger than 0.5 cm, there is clear consensus (in America and in Europe) that chemotherapy is necessary. There is difference of opinion with regard to need for chemotherapy in Her2 positive invasive tumors 0.5 cm or smaller. In this situation, European guidelines (framed at the St Gallen Consensus Conference 2005-07) favor giving adjuvant chemotherapy, while American guidelines (framed by the National Comprehensive Cancer Network, 2007) do not recommend adjuvant chemotherapy. The ER and PR status is negative, and Her2 is positive; this pattern of receptor expression mandates more aggressive therapy. Your oncologist is following established recommendations by advising Herceptin and taxane based chemotherapy. It has already been two months since surgery was done. You must begin the chemotherapy as early as possible. All the best, and God Bless!

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