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Topic: Stage IIB Positive in Two Nodes Treatment Questions

Forum: Stage II Breast Cancer — Meet, share and support others with Stage II Breast Cancer

Posted on: Nov 23, 2021 12:58PM - edited Nov 23, 2021 02:07PM by Debbie_R_MI

Debbie_R_MI wrote:

I am hoping to get feedback from others on treatment decisions for someone in my situation. Diagnosed at 51 years old, I am stage 2B, with two positive axillary nodes. I had left mastectomy with axillary node dissection four weeks ago. Post surgical pathology shows left breast invasive carcinoma with mixed ductal and lobular features (2.6 cm tumor) along with ductal carcinoma in situ, and intermediate and metastatic carcinoma in two of five lymph nodes examined. Two positive nodes showed macrometastasis and extranodal extension present. Overall tumor grade was 2. I am ER/PR positive, HER2 negative, post menopausal, and I don't have genetic markers for breast cancer but have had some family history of it.

Initially I was told I would have chemo, radiation (to nodes only) and endocrine therapy. Now there is a question about whether chemo is beneficial and whether radiation even to nodes is wise due to my auto immune condition, Scleroderma. I am waiting Oncotype results and have set up a second opinion appointment. I do not want to go through chemo but I wonder if I bypass chemo and can't have the radiation due to the auto immune condition what risk does that put me at with recurrence down the road since cancer was in two nodes? What choices have others made? From what I have read, ER/PR positive, HER2 negative early diagnosis patients do well first five years. However, it appears recurrence in years 6-15 is a concern. The RXPonder study (taking into account OncoType score) from what I can tell, is looking at statistics for first five years and then estimates the rest of the years.

Any feedback on what decisions others have made as far as skipping chemo and radiation based solely on Oncotype score would be appreciated.

Thanks.

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Nov 23, 2021 01:48PM - edited Nov 23, 2021 01:50PM by ctmbsikia

Hi Sorry you are here. I also had mixed diagnosis. I only had a micromet in 1 sentinel node, 2nd one was negative so I did not have any aux. nodes taken. I think you can't really decide or know the percentages until you have that oncotype score back. It's good you are having 2 opinions. I would also consult with a radiation oncologist as well. Hope you can skip chemo too. Let us know how it goes.

Dx 12/14/2017, DCIS/IDC, Left, 4cm, Stage IIB, Grade 2, 1/2 nodes, ER+/PR+, HER2- Dx 1/16/2018, LCIS, Right Surgery 1/30/2018 Lumpectomy: Left; Lymph node removal: Sentinel Radiation Therapy 4/10/2018 Whole-breast: Breast Hormonal Therapy 6/25/2018 Arimidex (anastrozole)
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Nov 23, 2021 01:52PM wondering44 wrote:

Debbie_R_MI

Sorry, you have to go through these decisions with additional concerns for treatment options for other reasons.

I initially was told chemo and rads. After the Oncotype came back at an 8, two MOs explained that doing chemo more than likely would do more harm than good to my body without changing the cancer outcome. I understood with the explanations that the new research came out on 12/2020. Chemo can risk long-term damage to the body, and if it can be avoided, it should be. I had to assume the researchers and doctors knew the best path. I cross my fingers they are correct.

I did opt to do six weeks of radiation. I had more fear of not doing it than the SEs that could come with the treatment. I do not have any underlying conditions, so my decision was probably much more manageable than yours.

I think your decision to get a second opinion is an excellent way to go. If you get the same information from both MOs/ROs, it may alleviate some of the worries in the treatments you choose.

I wish you the very best in your care and health.

"I don't get to control my cancer. I do get to control how I choose to live each day with cancer." - Me Dx 7/8/2021, DCIS, Right, 1cm, Stage 0, Grade 3 Dx 7/8/2021, IDC, Right, 2cm, Stage IB, Grade 2, ER+/PR+, HER2- (FISH) Surgery 8/18/2021 Lymph node removal: Right, Sentinel, Underarm/Axillary; Mastectomy: Right Dx 8/23/2021, IDC, Right, 6cm+, Stage IIB, Grade 3, 0/4 nodes, ER+/PR+ Dx 8/23/2021, DCIS, Right, 6cm+, Stage 0, Grade 3, 0/4 nodes Radiation Therapy Whole-breast: Breast, Lymph nodes
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Nov 23, 2021 03:14PM - edited Nov 23, 2021 03:16PM by brittonkb

I was also Stage IIB. 4.5 cm IDC with 3 nodes positive including one with ENE. I was 48 at diagnosis. Despite both a low oncotype (9) and mammaprint at low risk, my doctors at Ohio State preferred I go forward with chemo (AC-T) and radiation. My doctor cited a study (I can't remember it off the top of my head) that he thought was too new to risk not taking an aggressive approach due to my age and positive nodes especially with ENE. Everyone is different of course and who knows if I'll ever have a recurrence, but I am really glad I threw everything at it that I could.

Dx 4/29/2020, IDC, Right, 4cm, Stage IIB, Grade 3, 3/13 nodes, ER+/PR+, HER2- (IHC) Surgery 5/20/2020 Lumpectomy; Lymph node removal: Sentinel Surgery 7/6/2020 Lymph node removal: Underarm/Axillary Chemotherapy 8/3/2020 AC + T (Taxol) Radiation Therapy 1/20/2021 Whole-breast: Breast, Lymph nodes Hormonal Therapy 3/24/2021 Arimidex (anastrozole) Surgery 4/23/2021 Prophylactic ovary removal
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Nov 23, 2021 09:11PM Debbie_R_MI wrote:

Thanks everyone for the responses. It's good to hear from those experiencing similar situations. I think the study mentioned is the RxPonder study which was released Dec 2020. From what I've read, the OncoType test in the past was only used as a tool with node negative patients. However, in Dec2020, they released results showing those with 1-3 nodes may be able to use the results as well to avoid chemo. It seems like such a new study, not a large study size, and I don't think they have accurate data yet at 6+ years and what affect not having chemo would have for recurrence. It makes me nervous to forgo chemo based on Oncotype alone, especially if I can't get the radiation. I certainly don't want chemo if I don't need it but would rather throw everything at it now (as someone mentioned) at my age rather than when I am older. I guess we just don't get clear cut answers with this cancer sometimes. Thanks again everyone.

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Nov 23, 2021 10:00PM LillyIsHere wrote:

Debbie, I am stage 2 with 2 nodes positive. I asked 4 different opinions and I was told no chemo since it is lobular and no radiation for some reason. I will be in letrozole for a very long time for sure. I had 5 nodes removed, and I regret not asking to have them all removed. There are guidelines but each individual is unique and guidelines keep changing every few years.

“Within five years, cancer will have been removed from the list of fatal maladies.” That was the optimistic promise to U.S. President William Howard Taft in 1910 when he visited Buffalo’s Gratwick Laboratory, “What’s taking so long?” Dx 7/31/2019, ILC, Left, <1cm, Stage IIA, 2/5 nodes, ER+/PR-, HER2- Surgery 9/19/2019 Lymph node removal: Sentinel, Underarm/Axillary; Mastectomy: Left, Right; Prophylactic ovary removal; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 11/29/2019 Femara (letrozole) Targeted Therapy

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