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daughter858

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Reply with quote  #1 

My mother was newly diagnosed with tnb.  Her tumor is very aggressive 9 on proliferation scale and grade 3.  It was measured on the MRI two weeks ago being 2.5 cm but in the last two weeks it seems to have grown to 4.5cm (this is just by the drs feeling it).  The dotors are recomending a lupectomy, but my mother feels that she would be more comfortable with a double masectomy (just her preference).  Here is my question.  After meeting with 3 drs for different opions, they all have told her that she will not be given radiation with a masectomy.  This concerns me because of the aggressivness of this tumor and the location of it.  (It not connected to the chest wall, but is butted right up against it.)  I've heard that tnb should always be treated with radiation regardless of lumpectomy or masectomy.  Do you all agree with this?  Should I really push for the radiation, or is it not necessary?  I just want to be sure we are being as aggressive as we can since.  Any thoughts on this would be appreciated.


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Mom DX 2-6-09
metaplastic (no not metastatic) triple negative breast carcinoma
2.5cm 2/13/09 but now seems to be 4.0CM (by feel)??
grade 3
edge

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Reply with quote  #2 

Daughter858:

 

You have already received typically excellent advice fro Gina, so I will restrict my attention to three point, two related to the issue of risk, and the last a brief commentary on the issue of post-mastectomy radiation therapy (PMRT):

 

  1. First, metaplastic BC (I refer to  this as "mBC" to distinguish it from metastatic breast cancer, referred to as "MBC") within triple negative tumor biology provides, for researchers like me attending to molecular clues, some provisional therapeutic guidance: most mBC has been found to be basal (above 90 - 95%), with EGFR expression or amplification, and is associated with molecular factors of CAV-1 and  p63.  This collectively, especially within the early high-risk years of triple negative breast cancer (TNBC), suggest relatively elevated risk. 
     
  2. Second, as you note, mBC is predominantly high grade, with  high proliferation (mitotic count), and if in addition  it may have grown, subject to radiological confirmation, to approximately 4.5cm, that further suggests high growth velocity.
     
  3. Third, re the issue of PMRT (post-mastectomy radiation therapy), if indeed the tumor is pushing 4.5cm, then your mother is on the borderline of the ASCO/ASTRO PMRT guidelines which advocate the use of PMRT in patients at high risk of chest-wall recurrence, which is taken as primary tumors greater than 5 cm and/or four or more positive axillary lymph nodes  (I should note that the >= 4 node-positive cutoff is not to my mind decisively settled, as the 20-year follow-up data from the British Columbia Postmastectomy Radiation Trial (BCPRT) has demonstrated a survival benefit associated with PMRT for all node-positive patients, including those with only one to three positive node).  So although not quite > 5cm, the tumor may already be pushing that cutoff, and your mother's case may be in not  wholly determinant territory, but one point to consider is the aggregate weight of the above factors I enumerated, principally  the fact of triple negative tumor biology, indeed TNBC falling within the early high-risk phase, along with basality, and high-grade mBC with high proliferation activity, which might suggests additional elevated risk , although there is unfortunately at present no hard survival data to push the decision over to PMRT, as noted also by the just published recent (this month, 2009) review of this question by Andreas Makris and colleagues [Vilarino-Varela M, Chin YS, Makris A.  Current indications for post-mastectomy radiation. Int Semin Surg Oncol 2009 Feb 9; 6(1):5.] 

  


Constantine Kaniklidis
Breast Cancer Watch
edge@evidencewatch.com

momof4stars

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Reply with quote  #3 
I am a trip neg as well & am not getting radiation. In simplest terms my Dr. could give me the rsik out weighed the benefit. I still thought otherwise btu researched what he said & now feel he is right. Here are my stats & why I won't get rads.

I had a dbl mast.
I had a sent. node biopsy & 2 of 2 nodes were clear.
My tumor was a grade 3.
It was an 8 out of 9 on the hist. scale
My tumor was 3-3 1/2 cms (less than 5)
my tumor was 2 cms or 20mm away from the chest wall & they only want it to be more then 2mm.
My tumor was more then 5mm from my skin.
All my margins were clear
My tumor was non-vascular (less chance it traveled in the blood)

The only reasons to give rads were that I am young 38 & had triple neg cancer. Not a good enough reason to risk damage to my lungs, heart, or a future cancer that rads can though rare cause.

Hope this helps. 

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DX 10/23/08
IDC 3 cm
Grade 3
Non vascular
0/2 nodes
Bi lateral mast 11/08
Fec-D chemo
No Rads
Indigoblue

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Reply with quote  #4 
Momof4STARS,

That makes sense to me. Triple Negative, as well.  My tumor was like an Octopus, and was 2 mm. from the chest wall.  IDC, Grade 3, 4 of 4 nodes clear, margins undifferentiated w/o cancer cells.  The bad thing, cancer cells were present in the circulating vascular blood.  So, I did have A/C, Pailtaxel, and 32 (33?) Radiation Treatments at the INSISTANCE of the Sureon & Chemo Oncologist.  I was a Stage 1b, or 1c, depending on who you talked too.  Triple Negative Basal Subtype was the deciding factor on most of the treatment recommendations.

Daughter,  I hope all is going well with your mom.  Constantine is a valuable source for finding out substantial, trusted, and well-researched information.  You can't go wrong when you are well-informed.  And this is a great place to learn!

Love,
Indi
Limner

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Reply with quote  #5 
Indie, Let's go to Ireland & Wales.  Basal bloody well be damned!  Capt. Jack Sparrow must have been from the isles....  Maybe he will take us in his ship, just for all we have been through.    I got free cable TV and the first thing I found on St. Patrick's Day was a helicopter flying over Ireland.  Incredible and HEALING, just to see it.
 
"The bad thing, cancer cells were present in the circulating vascular blood" - What test indicates this?  What is the deal about the chest wall proximity?   My surgeon even took some of the muscle, the report says. 
 
I'm not going to worry about it tonight - sweet dreams of the olde Sod -  M

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Dear friend, theory is all grey, and the golden tree of life is green. - Goethe
momof4stars

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Reply with quote  #6 
"The bad thing, cancer cells were present in the circulating vascular blood" - What test indicates this?  What is the deal about the chest wall proximity?   My surgeon even took some of the muscle, the report says. 

They know if your tumor is vascular or not by if it has blood vessels running through it or not. If it does this means it is more probable that it
has traveled through your blood.

As for the chest wall if it is too close to it then cells are more probable to have traveled to your lungs so they want it to be a minimum distance from the chest wall or they are more likely to do radiation.

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DX 10/23/08
IDC 3 cm
Grade 3
Non vascular
0/2 nodes
Bi lateral mast 11/08
Fec-D chemo
No Rads
lady4law

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Reply with quote  #7 
Your mom's BC sounds a lot like mine. I had a tumor the size of a golf ball, and it came out of nowhere. It was not there when I left on my 3-week vacation, but was a few days after my return.
Like your mom, my tumor was sitting right above my rib. It was located in the area where the bottom band of a bra rubs against the body. Originally I was told I could have a needle biopsy or have the entire tumor remove, similar to a lumpectomy.

After the surgery I was informed that the cancer had spread to my lymph glands, My choice was a more severe lumpectomy,or single mast, with rads or a bi-lateral without. I choose the bi-lateral without rads and with reconstruction. I had 3 chemos prior to the mast and 2 more following. I am triple negative and have the BRAC gene.

What ever your mom decides, please encourage her to have it done quickly. Like I said my tumor grew at unbelievable speed. I can only image how large and involved it would have been if I waited a month or two.

Side note: My mast showed no sign of the original cancer spreading, not even to my lymph glands as I was told prior to surgery.  I was a "9" like your mom and my tumor marker was 89 (very bad).


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Dx 6/07 IDC, 5cm, Stage 3b, Grade 3 TNBC, Lump 6/07, Chemo-TC , Mast /rec 9/07, Chemo 10/07, 2 surgery 4 infections 11/07 12/07, Exchange 3/08, surgery (repair elbow damaged in mast) 5/08, Wrong implants, 2nd Exchange 10/08, Nipples and areolas grafted, PET/CT 5/09 lesions on thyroid, kidney, sinus, mastoid, "activities" in spine and hip, #small strokes. 3rd "Re-do" 8/09, Spinal nerves severed (pain) 9/09
Jennine

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Reply with quote  #8 
After my surgery, the surgeon told me he got it all. He also said there was no lymph node involvement and that he got clear margins. He also said he will know positively once the pathology report comes back. My question is, if there was vascular invasion, he would have known right?  He didn't say anything to me about vascular invasion. Only that if I wasn't triple neg I probably wouldn't need chemo. But he did say I would need radiation. Hmmm
My tumor was 1.8 cm grade3  hist/ 8 Stage 1 TNBC

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MicheleS

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Reply with quote  #9 
Did you have a lumpectomy?  I was told that a "lumpectomy + radiation = mastectomy" by my surgeon.  I had a 1.4 cm tumor and was told the same thing regarding chemo that you were told.  Basically, ANY size TN tumor gets chemo anymore.  So... I'm in the midst of chemo right now.  And, as hard as it is, I'm glad I'm doing it.  (I just come here lots for the support and positive vibes.)

You can do it!!!
Michele

Jennine

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Reply with quote  #10 
Yes Michele I had a lumpectomy on April 10th. I haven't had treatment yet, but am getting ready for it. I am stressing too. I have had RA symptoms for a while..although it is not severe and usually pain and stiffness in the morning, it bothers me to no end. I can't help but think it's all related to this cancer. I've been to a doc and he tells me my levels for arthritis is only slightly elevated so it does not even warrant a specialist. But I know something is not right. My brother and niece have cyliac's and I thought maybe I have it too. Cyliac's can cause RA in some people. My sister also has a sensitivity to wheat. I make myself crazy sometimes..but for the most part I live my life and don't obsess about it. Gina gave you valuable advice as did the other ladies...All WE ALL have is today. Not only ones diagnosed with BC, or any other disease for that matter, but everyone who walks the planet.

Sometimes I think worry is part of the genetic code, I swear...

Anytime you want to talk about your worries or fears, please PM me.

Love and faith...always,
Jen

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A mind that is stretched by a new experience can never go back to its old dimensions. - Oliver Wendell Holmes
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