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Need advice on radiation decision

innakap
innakap Member Posts: 12

Hi everyone,

My mom, 75 y/o, was diagnosed with invasive ductal carcinoma Grade 1. She did a lumpectomy and decided against dissecting her sentinel nodes.

Now we have a dilemma of whether to do: 1) radiation on a full breast only OR 2) full breast including axillary nodes OR 3) just a small part of the breast where the cancer was found.

Also, the radiologist said the treatment can be a 5 or 6 weeks course. We are stuck and not sure what to do. Hoping that you can provide some suggestions and ideas!


A few stats from the operating report:

* left breast mass, 2:00, 7cm from nipple

* modified Bloom and Richardson score 5 of 9

* Size of invasive carcinoma: 1.9cm. Size of DCIS: spans 2.2cm.

* HER2 : negative

* ER >95%; PR 60%

* Ki-67: 20%

* BRCA: negative

* The doctor said Oncotype is good but didn't give the number.

* The lymph nodes were not dissected/checked during the lumpectomy.


Thank you so much! Appreciate your time and help.


Comments

  • alicebastable
    alicebastable Member Posts: 1,933
    edited October 2022

    Not sure why the doctor agreed with not checking at least the sentinel node. I had a lumpectomy four years ago for a similar-sized invasive tumor, no DCIS, also highly ER & PR positive, Her2 negative, and they automatically removed the sentinel node - and to the surgeon's and oncologist's surprise, I had a micromet. The original radiation plan was 22 whole breast sessions, which is the pretty basic one. That got changed to 33 sessions of whole breast, axilla, and clavicle, with the last 5 sessions being boosts to the tumor area. If you are in the U.S., the information on the Oncotype is your mother's and has to be made available to her. But going by some of your terminology, I guess you live in another country, and I don't know what laws you have.

    I was 68 when I had surgery, and I'm 72 now. I make my own medical decisions, not my family. They can give an opinion, IF I ask for one. If your mother is incapacitated in some way that affects her mental capacity or reasoning, then of course you would help her decide.

    Not knowing if she had any micromets makes the decision tough, but personally (and knowing what mine was gives me a bias), I'd be cautious and go for the wider-ranging radiation.

    Oh, if you're worried about her age - my mother underwent surgery and the same course of radiation I had when she was 88, and she drove herself to all her sessions in a different town. Her only reaction was getting a bit tired by the end of the full course of sessions, and a tan breast. Same with me, except mine was light pink. Good luck to your mother.

  • innakap
    innakap Member Posts: 12
    edited October 2022

    Thank you for a quick reply, Alicebastable!

    The doctor actually said that they don't biopsy sentinel nodes with lumpectomy. They can remove the nodes, if my mom wants it, but the chances are very slim that they have cancer in them, based on her biopsy report. So my mom decided against it because it would require a general anesthesia vs local.

    We will ask for the Oncotype. If it is low, would you still go for a wider-ranging radiation that includes axilla?

    Would the MRI be able to evaluate lymph nodes?

    I hope you are doing well after your treatment and staying cancer free! Take care!

  • alicebastable
    alicebastable Member Posts: 1,933
    edited October 2022

    My nodes weren't biopsied, but the one was removed during surgery. As I said, both the surgeon and oncologist were surprised that a micromet was found because I had a low grade based on the tumor biopsy. Biopsies give estimates, and they're certainly not always perfect prognosticators of the whole picture. If your mother doesn't have a node removed, I have no idea if the radiologist would do a wider swath of radiation. The lumpectomy surgery was pretty easy, even with the node removal.

  • innakap
    innakap Member Posts: 12
    edited October 2022

    Thank you!