IDC - Stage 1 - Will I need either chemo, hormones or both?
Hi,
Just diagnosed with IDC Stage one on Friday. Waiting on my markers has induced a whole new level of panic. From what I've read, it sound like either I'll:
1. Need awful hormone blockers if I'm Estrogen/Progesterone postive (I take Prozac for OCD which would interfere with hormone blockers. Effexor isn't an option. Plus I have terrible insomnia)
2. 6-12 month chemo if I'm HER2
3. A bunch of other stuff if Triple Negative
4. So the big mysterious question keeping me awake is - is there a 4th outcome where I wouldn't be needing either 6-12 month chemo, hormones or Triple negative treatment?
The other panic is, I was supposed to start working overseas in mid-April for three months. Can I just assume there is no chance ot that?
Thank you kindly in advance,
JH
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Hi janehicks. I can't answer your question about a 4th way, other than to say that if it is hormone positive, depending on circumstances, you and your oncologist might be comfortable with you declining hormone blockers. Unfortunately there's no good way to know that until the typing comes back, and likely after surgery, too. After-surgery pathology provides more complete information on the size and scope and typing of the tumor.
As to working overseas, the timing stinks! Again you'll know more soon and be able to consult with your doctor about this, but yeah, probably the chances of leaving mid-April are very small. Assuming no chemo needed prior to surgery, it's best to have the tumor removed within 8 weeks of the diagnosis. So scheduling it and recovery, depending on your options for surgery type, will probably put you out a ways on the calendar.
In the meantime, don't freak out. Breast cancer treatment can be a major upheaval in a life, but you just get through one step at a time. Other people tell you what to do and where to be and when to be there. You don't have to be brave. You just have to show up. Good luck.
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Hi Jane,
You don't know what your treatment will be until you know what your tumor markers are. Did you have clean margins? What was the tumor size? If these are favorable and you are ER+/HER2- the treatment could be radiation and/or hormone blockers. Since you can start radiation up to 20 weeks after surgery it might be possible to do the overseas assignment if your doctor thinks it is safe. Many women begin hormone blockers after radiation in order to help identify the cause of any side effects. If you only need hormone blockers you can take them anywhere and could delay their start until after you return. Not everyone has intolerable side effects. I assume you would be able to get medical treatment overseas if necessary or telehealth with your US doctor. However, if you would prefer to remain stateside for peace of mind you should opt out of working abroad. If you are triple negative or HER2+ (a less likely diagnosis with AD/radial scar) you would most likely have chemo meaning the overseas work would probably be out.
Treatment for bc is difficult for the planners among us because there is always some uncertainty involved. Try not to stress too much while waiting and think about the relative importance of what sounds like an exciting job opportunity and your comfort level with being away. Be sure to get your doctor's advice before deciding anything. Good luck!
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The radiation start date might vary by facility and radiologist. Mine was adamant about starting no more than 12 weeks after surgery, so please don't assume anything until you've discussed this with your own radiation oncologist.
Mine was ILC, but stage 1, and I stopped the anti-hormonals after about 9 months. I'm doing fine almost 5 years later.
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If you take an ovarian blocker and an AI instead of tamoxifen you'll be fine staying on prozac. You'll only need an AI if post-menopausal. As far as the rest of your questions, I don't know but the chances of you escaping some kind of treatment beyond surgery isn't high. For optimal results there is always something offered although you always have a right to refuse.
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I don't know of a situation where doctors would recommend neither chemo nor hormone therapy, except perhaps if a patient is pretty elderly or has some serious comorbidity.
But there are two other options that you didn't list.
The first is that your side effects may not be so bad. Not everyone has bad side effects, or side effects at all, from hormonal drugs. Some women are able to work through chemo. It doesn't make sense to borrow trouble.
The second is that the final decision about treatment is always up to you. Doctors should give you clear information and advice to help you with the risk benefit analysis, but even if they recommend hormone therapy and/or chemo, you don't have to do it.
Whether you can work overseas or not probably depends on what access to healthcare you'll have at your destination, the nature of the work, and how much sick time you can take there. If you need just a lumpectomy and radiation, some women get through all that with only a few days off of work. Some people can work through chemo.
But yeah, cancer gets in the way of other life plans.
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I know it doesn’t help much, but I understand some of your frustration. I was supposed to move to Europe for a few years for work, but got diagnosed a few months before we were supposed to leave and we had to cancel our plans. I was more devastated about canceling the move for a while — then I had to deal with cancer.
What everyone else has said is correct though. Your treatment will depend on the pathology, but surgery is a given, radiation is likely, and there are a bunch of other possibilities as well. But it’s all doable, even if it sucks.
One note about HER2 though — treatment is a year, but it’s not 12 months of chemo. It’s usually 3-4 months of chemo, followed by infusions of targeted therapy that aren’t nearly as horrid as chemo.
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Thanks so much for your response. Yep, timing stinks. It's interesting to know about the fourth option. I guess since it's early days I should definitely be taking one step at a time. I'm not great with uncertainty but this will be a good place to start accepting that.
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Hi janehicks,
I am sorry to see your diagnosis. You will know much more once your treatment plan is in place. The "waiting for results" is the hardest part. Once your doctors know your hormone, HER2 & Oncotype, you can move forward with a surgical and treatment plan. There are so many different ways it can go. Stressing the unknowns won't change a thing except adding turmoil to your days and nights.
On the work travel in April…the same answer. Who knows until you start planning with your doctors? It is definitely a talking point you can bring up during the planning. Cancer has an unwavering ability to throw a wrench in already-made life plans. It certainly does not ask you ahead of time if you mind sitting out to complete treatment. It just smacks you unexpectedly, and you maneuver to the best of your ability to set all of your plans around cancer. Cancer is a challenging inconvenience, and it certainly doesn't apologize.
Don't feel bad about seeking a therapist or venting to your support crew if you get overwhelmed.
I wish you success with your treatment.
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Thank you everyone for your responses! (I'm still figuring out how to respond to individuals in a group setting here. This was so helpful. I'm clearly getting ahead of myself and trying to gain a sense of control by thinking ahead when this might be one of those situations where that can backfire and just cause additional anxiety.
What a great group of people you are! I'm so sorry all of you have had to go through this.
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Thanks for Wondering44, that helps a lot! You are so right about all of it. A diagnosis is certainly one way to learn to accept the unknowns in life.
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I saw that you sent me a PM, which is fine — but the site won’t let me actually read the dang thing right now. I was hoping it would be resolved by now, but apparently not. I’ll keep checking, but I wanted to let you know I wasn’t ignoring it.
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