Saturday, February 20, 2010 Naushad asks

Q: Radiation after Mastectomy

Hi,

My mom has recently been diagnosed with IDC grade 2, invasive tumour in dermis and all first 8 lymph nodes tumour free with TNM: pT1, pN0, pMx. The tumour size is 0.8x0.7cm. The epidermis of skin is tumour free however tumour is identified in lower dermis. Tumour cells express E-Cadherins and are ER/PR positive and HER +2. The doctor has done Mastectomy and now advicing us that she would have radiation therapy for 4 weeks, may or may not with chemothrapy or 5 years medicine. I don't have any idea what to do as i can't understand why radiation is needed after mastectomy. If radiation is necesaary, what type is right for this kind of cancer (external or internal) and what dose is recommended? Further, why chemotherapy is needed in this case? Early suggestions would help.

Thank you all.

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Answers (1)

PJ Hamel, Health Guide

2/20/10 6:36pm

Hi - The "E-Cadherins" expression would possibly be the reason to suggest chemo - as it indicates a more aggressive cancer. However, I'd suggest she get the Oncotype DX test, to assess how much good chemo would do her, before she seriously considers it. As for radiation, her radiation oncologist would suggest internal or external; depends on what the hospital offers, as well as whether she's even a candidate for internal. Having radiation after a mastectomy is often done if the tumor was close to the skin or chest wall, to ensure it didn't get a foot hold in either of those places. Hop this helps - good luck. PJH

Naushad

2/20/10 8:30pm

But i don't understand why doctors are recommending these treatments as no lymph node is involved and its grade 2 without any metastasis and TNM: pT1, pN0 and pMx. Is it because of ER+. Her HER2 test scoe is 2+ due to which FISH is recommended. What do you think about it? What do you think about the recovery after these treatments? Would the radiation dose be high?

Thanks for immediate response. This certainly helps.

PJ Hamel, Health Guide

2/20/10 9:30pm

I think she'd probably recover very easily from the radiation; most women do. The dose would be determined by the doctor; of course, it would be the lowest dose possible to do the job, so it would depend where the irradiated area would be - close to the surface, farther in, etc. Good that she's getting the FISH test to determine HER2-neu receptivity. If she is indeed HER2+, then she'd take Herceptin for a year, and she'd also probably have chemo, as HER2+ is more aggressive and that, along with the previous results you mentioned, would probably push her over into the "better have chemo" category. PJH

Naushad

2/21/10 6:30am

Yes, the report says there is no lymph nodes involved and epidermis is tumour free however tumour is identified in lower dermis. Inititally the size was 0.8x0.7cm which has been removed by mastectomy.

You are such a helpful fellow, i don't have words to thank you..

May God dive you all the happiness in your life.

Cheers

PJ Hamel, Health Guide

2/21/10 7:05am

Thank you, and may God be good to you and your mom, too, Naushad- PJH

Naushad

2/21/10 8:06am

i read that E-cadherin is also used by pathologists to diagnose different kinds of breast cancer. When compared with invasive duct carcinoma, E-cadherin expression is markedly reduced or absent in the great majority of invasive lobular carcinomas when studied by immunohistochemistry. but in my moms case it is present. What is the differnece. I m sorry i m asking alot.

PJ Hamel, Health Guide

2/21/10 2:39pm

Sorry, Naushad - wish I could help you, but I have no medical training. I'm simply a woman who's survived breast cancer. Hopefully your mom is under the care of an oncologist, who I'm sure would be glad to answer this question for you. Good luck - PJH

Naushad

3/10/10 12:43pm

Hi again,

My mother i Her2 negative a FISH has confirmed and ER/PR positive but doctor is still asking her to take chemothery followed by radiotherapy. Is it actually ok for my mother?

PJ Hamel, Health Guide

3/10/10 2:02pm

Not sure what you mean by "is it OK"? Do you mean, is this a reasonable treatment plan? Yes, probably. You might ask the oncologist if an Oncotype DX test would be useful, as it would assess how well chemo will work for her. If chemo's not going to do her much good, she'd probably like to avoid it... PJH

Naushad

8/26/10 8:07am

Hi PJH,

Its me again. So now my mother has got all treatment including breast removal, chemo and radio (4 rounds). Now the doctor has given her Femara for 5 years. What do you suggest about it? any experiences? is it good enough considereing my mothers cancer was not in lymph nodes and just the tissues.

regards,

Naushad

PJ Hamel, Health Guide

8/26/10 3:59pm

Yes, Naushad, Femara is a reasonable and common treatment for your mother's type of cancer. And most women do very well on it, with few side effects. Hopefully this will be her experience. Please read our post on aromatase inhiibitors (Femara, et. al.) for further informaiton. Good luck to you both - PJH

Q: Radiation after Mastectomy

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