I recently had a lumpectomy that had an excellent outcome. Basically, while there was a bunch of DCIS, the IDC portion was only 1 mm in diameter, and I was node negative. In fact, they got the larger portion (3 mm) in the biopsy. Given the small size of the tumor, my surgeon is recommending I go to the radiology oncologist and start the radiation. I have since learned I am ER+ (22%), PR- and Her2 +. The pathology has shown this was rather an aggressive tumor and I was very lucky to catch it so early. My question is this, despite the surgeon's point of view, should I seek the advice of a medical oncologist and ask for the Oncotype test, or is this over kill ?
Has anyone experienced a similar situation and then regretted it later by not at least checking out the medical angle ?
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embmom Joined: Feb 2008 Posts: 58 |
Aug 31, 2008 06:01 am
embmom wrote:
In my case I went from my GP who ordered the original mammo to the breast surgeon. I knew I had a lump so I was sent to the BS immediately. The BS set me up after the biopsy came back with an oncologist (medical) who is the person I see as the head of my team. After discussing with me the outline of my care--chemo, surgery, then rads..I then had a clear idea of what I was up against. So far I have had the chemo and surgery and have just gotten ready to start my rads on Tues. The onc sent me to the rads onc for a consult before beginning to have her explain to me why I needed the rads. He said I needed them but he wanted her opinion also. The med onc is the person I will return to for my follow up appointments after completing rads. I really liked him from the very beginning and feel as tho we have a good relationship and are on the same page as far as treatment goals. Good luck on your journey! |
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azsunn Joined: Nov 2007 Posts: 84 |
Aug 31, 2008 10:03 am
azsunn wrote:
I would see the medical oncologist too. It's my feeling you can never have enough information. Would the radiology oncologist be responsible for getting you Herceptin? I thought that was standard of care with any HER2+ cancer? Maybe 22% isnt considered enough to be in need of Herceptin? I don't know the answers, but I'd have a consult to make sure I was comfortable with their answers. Good luck! ~Kath, dx 11/2007, IDC, 1.8cm, grade 3, ER/PR+, HER2 +
Dx 11/20/2007, IDC, 1cm, Stage Ib, Grade 3, 0/4 nodes, ER+/PR+, HER2+ |
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Brenda_R Joined: Dec 2006 Posts: 295 |
Aug 31, 2008 11:26 am
Brenda_R wrote:
If you're Her2+, you should see a medical Onc, and should get Herceptin. The Her2+ makes it an aggressive and fast growing cancer. Herceptin is now available to early stage bc, so you shouldn't have a problem getting it. Positive Internal mammary node, 3.7cm bi-lobed tumor
Dx 12/12/2006, IDC, 3cm, Stage IIIa, Grade 3, 1/17 nodes, ER-/PR-, HER2+ |
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sandee107 Joined: Apr 2008 Posts: 20 |
Aug 31, 2008 01:13 pm
sandee107 wrote:
jill323 I had a very similar diagnosis to yours. I was just diagnosed in April and had my lumpectomy in May. I am currently on Femara for I am 90% ER+ and I just finished radiation (33) 2 weeks ago. I have a med onc and a rad onc. The rad onc only deals with the radiation aspect of treatment. The med onc deals with the chemical aspect of treatment. I also had DCIS and IDC and my med onc told me because most of it was DCIS and the tumor was very small and was all removed in the original biopsy (lumpectomy showed no cancer) that I would not need chemo or Herceptin. The benefit would be minuscule as opposed to the risks and that is because DCIS is often her+ but it hasn't the same significance as it does in IDC. Because I am so highly ER+ I am on Femara for at least 5 years. My surgeon also concurred with these findings so I am pretty satisfied with the decision not to do chemo/herceptin, although the fear of recurrence will always be there. Hope this helps answer some of your questions. Sandee Dx 4/22/2008, IDC, <1cm, Stage I, Grade 2, 0/1 nodes, ER+/PR-, HER2+ |
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otter Joined: Jan 2008 Posts: 2560 |
Aug 31, 2008 01:41 pm
otter wrote:
It would be nice if all our onco specialists worked together, to coordinate our care--right? Then we wouldn't need to debate whether it should be this person or that person to oversee our care, and whether we needed to see this or that person in the first place. Some of the bigger cancer centers do use a team approach, but it's far from universal. I'd say, yes, talk to the med onco before you start rads. There is some feeling that even small tumors (even tiny tumors) can sometimes spread quickly, necessitating more aggressive treatment than we might predict. A med onco could advise you on whether or not Herceptin or other tx would be helpful in your situation. otter Dx 1/14/2008, IDC, 1cm, Stage I, Grade 2, 0/3 nodes, ER+/PR-, HER2- |
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jill323 Joined: Aug 2008 Posts: 112 |
Aug 31, 2008 02:15 pm
jill323 wrote:
Thanks to all who have given me advice on this ! This is terrific. I have decided to follow it and request a medical onc. even if for additional peace of mind if nothing else. I will get back on here once I finally meet with the oncologist and let you all know where it came out ! Thanks again ! Jill Dx 8/7/2008, IDC, <1cm, Stage I, Grade 2, 0/6 nodes, ER+/PR-, HER2+ |
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jill323 Joined: Aug 2008 Posts: 112 |
Aug 31, 2008 02:19 pm
jill323 wrote:
Sandee- Thanks for your response. It appears our cases are very similar with the exception that my ER score was not nearly has high as yours. But, you are the first person I have talked with so far that is ER+/PR- and Her2+. That does not appear to be a "common" combination. Just had a follow up question for you if you don't mind. Did they test the IDC portion of your biopsy result for the Her2 result of both parts ? Your comment about DCIS often being Her2+ intrigued me. I cannot find on the pathology report which portion they tested. Is it typical to test both ? Thanks again for your response. I found it very helpful. And congratulations on finishing your rads ! Jill Dx 8/7/2008, IDC, <1cm, Stage I, Grade 2, 0/6 nodes, ER+/PR-, HER2+ |
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sandee107 Joined: Apr 2008 Posts: 20 |
Aug 31, 2008 05:36 pm
sandee107 wrote:
Hi Jill, in answer to your question. I'm not sure but I believe they tested the whole sample for the her2+. I'm not totally sure but that's the way it looks on my biopsy. It didn't even say what part was DCIS and what was IDC, only that carcinoma was present in 20% of the calcifications they took which the onc said amounted to about 1/2 a cm. The slides taken without the calcifications had carcinoma in less than 1% which was also said to be DCIS and IDC which is like less than a mm. It is very uncommon to see ER+/PR-/Her2+. I only met one other person on this board who had that and hers was very early and mixed DCIS and IDC too. I'd be interested to hear what your medical onc recommends. Good luck whatever treatment path you take. Sandee Dx 4/22/2008, IDC, <1cm, Stage I, Grade 2, 0/1 nodes, ER+/PR-, HER2+ |
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Jennywren Joined: Jun 2008 Posts: 66 |
Sep 4, 2008 08:23 pm
Jennywren wrote:
This is odd to me as well! We had almost the same thing.Mine did not show on mammo or galactogram. I had a duct excision and the biggest IDC was 1.7 MM YES that is millimeters. I had a SNB with nice clean margins and neg sentinal node.They are still looking up the ER/PR scores.I saw a medical oncologist 1st. He turned me over to a rads guy.He said even IF the ER/PR was negative there would be a 5% benefit to chemo, worst case scenario.He thinks it will be lower. He asked me what % I would consider chemo and I said 10%.He was very ok with that.Everyone is different and I must stress that.Some ppl want to go through chemo for 1%..Mine was a VERY early cancer and it took 3 paths to find it. I have no problem with the rads, he knows my stance on chemo and may later reccomend it, right now the benefits outweigh the risks at least for me. |
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