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Topic: Mastetomy for 93 year old

Forum: Diagnosed and Waiting for Test Results —

Share with and support others all waiting for test results from CAT scan, PET scan, Oncotype tests, Mammaprint, FISH, IHC, and other diagnostic tests.

Posted on: Sep 10, 2021 08:26PM

Sandy5Pat wrote:

I have survived BC twice but I am seeking info to help my 93 year old mother who was just diagnosed for second time with BC - I think it is estrogen, progesterone dependent. She had lumpectomy only 3 years ago. Now her surgeon is recommending mastectomy for this new or reoccurring cancer. My siblings and I are questioning whether this is a good idea at her age and want to get input and ask more questions about alternatives before she goes forward. Does anyone have any insight on mastectomy or radiation in a 93 year old?

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Sep 10, 2021 08:42PM ShetlandPony wrote:

My goodness. I would get a second opinion. There is a field called geriatric oncology, and it would be great to consult someone in that sub-specialty. I would want to know how aggressive this cancer appears to be, whether there could be a trial of a new drug with monitoring, whether a second lumpectomy is an option. Do women in your mom's family generally live to be 99? How is her health overall? What does your mom think about it all?

2011 Stage I ITCs sn, premenopausal, Oncotype 16. 2014 Stage IV mets breast,liver. TaxolNEAD. Ibrance+letrozole 2yrs. Fas+afinitor nope. XelodaNEAD 2yrs. Eribulin,Doxil nope. SUMMIT FaslodexHerceptinNeratinib for Her2mut NEAD Dx 2011, ILC, 1cm, Stage IA, Grade 1, 0/1 nodes, ER+/PR+, HER2- Dx 2014, ILC, 2cm, Stage IV, metastasized to liver/other, Grade 2, ER+/PR+, HER2- Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Radiation Therapy Whole-breast: Breast Surgery Lumpectomy
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Sep 10, 2021 09:20PM moth wrote:

on the flip side, surgery is curative for the majority of pts and plenty of 90+ sail through surgeries. I'd probably really push for another lumpectomy if possible just because of way smaller/faster surgery but still, I'd consider it. This would give her the opportunity to die years later from something else.

Of course lots depends on her health otherwise and outlook on life, activity level etc.

I take weekends off

Initial dx at 50. Seriously?? “Sometimes the future changes quickly and completely and we’re left with only the choice of what to do next." blog: Never Tell Me the Odds

Dx 12/2017, IDC, Left, 1cm, Stage IA, Grade 3, 0/5 nodes, ER-/PR-, HER2- (IHC) Surgery 12/12/2017 Lumpectomy: Left; Lymph node removal: Sentinel Chemotherapy 2/13/2018 AC + T (Taxol) Radiation Therapy 8/13/2018 Whole-breast: Breast Dx 2/2020, IDC, Stage IV, metastasized to liver/lungs, Grade 3, ER-/PR-, HER2- Chemotherapy 3/18/2020 Taxol (paclitaxel) Immunotherapy 3/18/2020 Tecentriq (atezolizumab) Chemotherapy 11/25/2020 Abraxane (albumin-bound or nab-paclitaxel) Radiation Therapy 12/8/2020 External Dx 12/9/2020, IDC, Right, Stage IV, metastasized to lungs, Grade 3, ER+/PR-, HER2- (IHC) Hormonal Therapy 12/15/2020 Femara (letrozole) Dx 1/28/2021, IDC, Left, Stage IV, metastasized to bone Radiation Therapy 3/2/2021 External: Bone
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Sep 10, 2021 09:23PM jhl wrote:

Sandy,

I'd have a serious heart-to-heart with your sibs, an anesthesiologist & your mom. I really believe your mom's cancer is irrelevant in this circumstance. It is her brain that is the problem. She may physically recover from the surgery but her brain might not recover. I have seen this far too many times.

Jane

Dx 11/15/2019, IDC: Cribriform, Right, <1cm, Stage IA, Grade 2, 0/2 nodes, ER+/PR+, HER2- (FISH)
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Sep 10, 2021 10:42PM Sandy5Pat wrote:

Thanks so much all. We just got hit with this and I am heartbroken thinking of my mom dying of MBC but that is probably not going to be the case. Jane, she has a bit of dementia which the surgeon may not be aware of so would that increase the brain risk and be a no go if surgeon knew? They live in a small area so I doubt there is a geriatric oncologist but will check. She is still mobile and very alert and aware and an eternal optimist but now that you mention it we don't see her making it to 99. Has high blood pressure (treated). She told me she wants to make it to see all grands married but that may not be realistic. Thanks for helping me start to think about this.



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Sep 10, 2021 11:04PM ShetlandPony wrote:

You and your mom could probably do a second-opinion consultation by telehealth, especially with an oncologist in the same state as you. (I am guessing you are in the USA. If you want to post here or private massage me your state I will see if I can get you started with a couple resources.)

2011 Stage I ITCs sn, premenopausal, Oncotype 16. 2014 Stage IV mets breast,liver. TaxolNEAD. Ibrance+letrozole 2yrs. Fas+afinitor nope. XelodaNEAD 2yrs. Eribulin,Doxil nope. SUMMIT FaslodexHerceptinNeratinib for Her2mut NEAD Dx 2011, ILC, 1cm, Stage IA, Grade 1, 0/1 nodes, ER+/PR+, HER2- Dx 2014, ILC, 2cm, Stage IV, metastasized to liver/other, Grade 2, ER+/PR+, HER2- Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Radiation Therapy Whole-breast: Breast Surgery Lumpectomy
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Sep 10, 2021 11:05PM Chicagoan wrote:

Did your mother also receive Hormonal suppressant therapy? I knew a woman who was diagnosed with BC at 91. She did not have surgery or radiation, just hormonal therapy. She lived until 96 and did not die of cancer. Definitely suggest a second opinion b/c a mastectomy sounds so extreme at her age.

Dx 9/21/2016, IDC, Left, Stage IV, metastasized to bone, Grade 1, ER+/PR+, HER2- Radiation Therapy 9/26/2016 Hormonal Therapy 10/5/2016 Femara (letrozole) Targeted Therapy 10/26/2016 Ibrance (palbociclib)
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Sep 10, 2021 11:09PM Cowgirl13 wrote:

jhl, I'm not sure I understood what you were saying re: dementia. Did you mean that existing (early) dementia can be exacerbated by the surgery? Thanks.

Be the kind of woman that when your feet hit the floor each morning the Devil says: 'Oh crap! She's up! Dx 5/28/2009, IDC, Left, 2cm, Stage IIA, Grade 3, 0/4 nodes, ER+/PR+, HER2+ Surgery 6/17/2009 Chemotherapy 8/3/2009 Carboplatin (Paraplatin), Taxotere (docetaxel) Radiation Therapy 12/21/2009 Hormonal Therapy 2/23/2010 Arimidex (anastrozole)
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Sep 10, 2021 11:09PM jhl wrote:

Sandy,

You & your sibs are really faced with a difficult proposition. Yes, anesthesia will indeed make an impact on your Mom's brain. It affects all of us but younger brains can adapt easier than the elderly. For now, you have a very happy, Grandma who has a goal - to see her grandchildren marry. Is she in any discomfort? I would encourage you to speak with her oncologist. The course of her illness may not end up as dire as you think and the prospects of an elderly person who must undergo surgery, rehabilitation & who knows what in this era of COVID is worrisome. My own mother had treated BC when she was in her 50's. In her 80's she had uterine cancer, treated. But, she said she would no longer test nor treat anything else. She passed away in 2020 at the age of 101 of old age, not cancer.

I will keep you and your family in my thoughts,

Jane

Dx 11/15/2019, IDC: Cribriform, Right, <1cm, Stage IA, Grade 2, 0/2 nodes, ER+/PR+, HER2- (FISH)
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Sep 10, 2021 11:13PM Sandy5Pat wrote:

She had a lumpectomy 3 years ago. No further treatment. We are kicking ourselves now for not questioning that at the time.

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Sep 10, 2021 11:15PM jhl wrote:

Yes, Cowgirl, pre-existing dementia can indeed be exacerbated by anesthesia. This is a review article on the risks of surgery in patients with varying degrees of dementia:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC60290...

Surgery is not easy for anyone & the risks, both physically & cognitively are real. The best advisors are the physicians who care for you or your loved one.

Dx 11/15/2019, IDC: Cribriform, Right, <1cm, Stage IA, Grade 2, 0/2 nodes, ER+/PR+, HER2- (FISH)
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Sep 10, 2021 11:22PM jhl wrote:

Sandy,

Can you recall what your Mother indicated at the time of her lumpectomy? Did you ever discuss what her choices were? Is she cognitively intact enough to express her desires? Please, do not worry about choices in the past. AI's probably would not have made a significant difference and chemotherapy/radiation might have been far more than she was willing to do and perhaps not indicated. The last 3 years have been 3% of her life. Hopefully, she'll have lots more happy and fulfilling years ahead with you, your sibs & the grands. But, really, ask her what she wants. It would be best if her surgeon gives her a complete disclosure of all the pros and cons. Let her make her choice of what she wants done. Even with a bit of dementia, she may still have agency with which to express her own desires.

Best of luck,

Jane

Dx 11/15/2019, IDC: Cribriform, Right, <1cm, Stage IA, Grade 2, 0/2 nodes, ER+/PR+, HER2- (FISH)
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Sep 10, 2021 11:39PM - edited Sep 11, 2021 12:36AM by sbelizabeth

My 93-year-old mom was active and (mostly) sharp when she fell and broke a small bone in her pelvis. She was given anesthesia to place a pacemaker. She never walked again, and her mild dementia immediately escalated to the point where she needed skilled nursing in a memory care unit.

Is your mom's new cancer particularly aggressive? Are her physicians concerned it will cause intractable pain or break through the skin?

It's a risk-benefit decision, and if factors are described clearly and simply to your mom, hopefully she can be the one to decide.

pinkribbonandwheels.wordpress.... Dx 10/20/2011, IDC/IBC, Left, 1cm, Stage IIIB, Grade 2, 6/28 nodes, ER+/PR+, HER2- Chemotherapy 12/15/2011 Adriamycin (doxorubicin), Cytoxan (cyclophosphamide), Taxotere (docetaxel) Surgery 4/18/2012 Mastectomy: Left Radiation Therapy 5/21/2012 Breast, Lymph nodes Hormonal Therapy 7/19/2012 Femara (letrozole) Surgery 4/15/2013 Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap
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Sep 11, 2021 01:25AM Cowgirl13 wrote:

jhl and sbelizabeth, thank you for responding. I had no idea.

Be the kind of woman that when your feet hit the floor each morning the Devil says: 'Oh crap! She's up! Dx 5/28/2009, IDC, Left, 2cm, Stage IIA, Grade 3, 0/4 nodes, ER+/PR+, HER2+ Surgery 6/17/2009 Chemotherapy 8/3/2009 Carboplatin (Paraplatin), Taxotere (docetaxel) Radiation Therapy 12/21/2009 Hormonal Therapy 2/23/2010 Arimidex (anastrozole)
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Sep 11, 2021 06:39AM ShetlandPony wrote:

https://www.cancer.net/navigating-cancer-care/older-adults



2011 Stage I ITCs sn, premenopausal, Oncotype 16. 2014 Stage IV mets breast,liver. TaxolNEAD. Ibrance+letrozole 2yrs. Fas+afinitor nope. XelodaNEAD 2yrs. Eribulin,Doxil nope. SUMMIT FaslodexHerceptinNeratinib for Her2mut NEAD Dx 2011, ILC, 1cm, Stage IA, Grade 1, 0/1 nodes, ER+/PR+, HER2- Dx 2014, ILC, 2cm, Stage IV, metastasized to liver/other, Grade 2, ER+/PR+, HER2- Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Radiation Therapy Whole-breast: Breast Surgery Lumpectomy
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Sep 11, 2021 07:06AM Rambros wrote:

My 99 year old grandmother recently had a 2nd lumpectomy. She was originally diagnosed at 90 - lumpectomy & radiation but no pills taken due to her age. Unfortunately the cancer came back around 95 and due to her age & non-aggressive cancer it was decided to skip surgery and just take anti-hormone therapy. Unfortunately the tumor ended up being 2 tumors which slowly grew (she tried all the variations of AI’s, tamoxifen, and faslodex). We were concerned it would break through her skin so had to do surgery. The surgeon did a lumpectomy as quickly as she could - no real concern for margins or aesthetics - just get the cancer out quickand close. I do think the anesthesia affected her brain unfortunately - she was very confused afterwards and hasn’t been the same since. She aged a lot between 93 and 99 though, thinking back 6 years ago I think she could have handled a 2nd lumpectomy just fine back then. Good luck with your family’s decision- I know it’s not easy.

Dx 10/8/2014, IDC, Left, 3cm, Stage IIB, Grade 3, 1/10 nodes, ER+/PR+, HER2- (FISH) Surgery 11/17/2014 Mastectomy: Left; Prophylactic mastectomy: Right Chemotherapy 1/6/2015 AC + T (Taxol) Hormonal Therapy Femara (letrozole) Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone), Zoladex (goserelin) Surgery Prophylactic ovary removal Radiation Therapy Lymph nodes, Chest wall
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Sep 11, 2021 11:56AM bcincolorado wrote:

I have been diagnosed with dementia my self and would seriously question going under anesthesia again at this point. I am on medication to help preserve my memories and speech at this point and they do affect brain function already. If I were to be diagnosed again with another cancer I do not know I would treat it. My primary doc would not even consider the relaxing medicine for a colonoscopy and said was not necessary at this point and did the kit instead you send in. I would talk to her doctors about your concerns. f you do not have a medical POA I would recommend you get one as well for your mom because of HIPPA.

Dx 8/2009, IDC, Left, 5cm, Stage IIA, Grade 1, 0/2 nodes, ER+/PR+, HER2- Surgery 1/6/2010 Lumpectomy: Left; Lymph node removal: Left Hormonal Therapy 1/14/2010 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Hormonal Therapy 1/29/2016 Femara (letrozole)
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Sep 11, 2021 12:43PM sbelizabeth wrote:

bcincolorado, I'm sorry to hear of your diagnosis. My SIL also has early dementia but is not on meds. Have you noticed that they are helpful?

As a side note, you make an excellent point regarding medical POA and HIPAA. I'm mostly retired but I still do data extraction for prehospital cardiac arrest incidents. It happens distressingly often that an elderly individual, or someone with an end-stage terminal disease, collapses at home and the family has no idea what their wishes would have been. There's no written documentation anywhere. Paramedics are obligated to provide resuscitation attempts (CPR, sometimes intubation, IV starts, meds) that are almost always futile. Cardiac arrest resuscitation care for the very ill or elderly is undignified, very invasive, distressing for the onlookers, and unnecessarily interrupts what should have been a peaceful transition from life.

Everyone, everywhere should have an advanced directive and a medical power of attorney (POA). Young, old, big family, no family...everyone should have written directions as to what medical care should be provided if they're unable to decide for themselves.

Those who are elderly or in frail health should also have a POLST (Physicians Orders for Life Sustaining Treatment) https://deathwithdignity.org/polst/. This document takes the place of a Do Not Resuscitate (DNR) order, although both are valid. A POLST provides more detailed information as to an individual's wishes for end-of-life care. These documents vary from state to state, so look it up online for your own state's requirements.

pinkribbonandwheels.wordpress.... Dx 10/20/2011, IDC/IBC, Left, 1cm, Stage IIIB, Grade 2, 6/28 nodes, ER+/PR+, HER2- Chemotherapy 12/15/2011 Adriamycin (doxorubicin), Cytoxan (cyclophosphamide), Taxotere (docetaxel) Surgery 4/18/2012 Mastectomy: Left Radiation Therapy 5/21/2012 Breast, Lymph nodes Hormonal Therapy 7/19/2012 Femara (letrozole) Surgery 4/15/2013 Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap
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Sep 11, 2021 12:58PM AliceBastable wrote:

Sandy5Pat, How large is the tumor and where is it located in her breast? If it's small and not too deep, would the lighter anesthesia be possible? I don't remember what it's called, but it was used when I had a small hernia repaired and also for my lumpectomy resection. It's just done through a vein and I was brought out of it while still in the OR both times as the doctor was finishing up. What little grogginess was there vanished in just a few minutes. I don't think there was even any recovery room time - I know for the resection I was home before 11:00 a.m.

Endometrial cancer 2010, basal cell multiples, breast cancer 2018, kidney cancer 2018. Boring. Hope it stays that way. Dx 5/2018, ILC, Left, 2cm, Stage IA, Grade 1, 1/1 nodes, ER+/PR+, HER2- Surgery 7/10/2018 Lumpectomy: Left; Lymph node removal: Sentinel Surgery 8/7/2018 Radiation Therapy 10/28/2018 Whole-breast: Breast, Lymph nodes
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Sep 11, 2021 02:17PM LillyIsHere wrote:

A second opinion would make sense, especially from a general doctor. Also, mastectomy may be helpful as cancer goes however, a bigger picture of overall health is as important. I would never think estrogen-positive cancer can start in a woman her age where estrogen is already less than most of us who take anti-estrogen medications.

“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 11/30/2019 Femara (letrozole) Targeted Therapy
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Sep 11, 2021 02:53PM ThreeTree wrote:

bcincolorado - Are you sure the Femara isn't causing some of your cognitive problems? It can do a real number on your brain and I think that some of the consequences of it could be mistaken for early or mild dementia. Just a thought.

sandypat - I would really ask your mother what she would like to do if it is at all possible. I would also underscore the things sbelizabeth has said about POST forms, etc. I work in an area that brings me in contact with POLSTS quite often, and they do help, although what I have found is that often when a crisis event occurs, a whole new picture can emerge and what seemed sensible with the POLST might not be anymore. I work in guardianship and sometimes we need to change them on the spot when the doctor calls with a crisis issue.

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Sep 11, 2021 04:10PM Sandy5Pat wrote:

Thank you all so much. I am working thru all this info, web site and testimonies. It is so helpful. And I'm starting to communicate with sibs (5 of us scattered around but all willing and able to go home to help). I realize I need to know about POST etc. I think Mom and Dad and two other sibs have that well in hand. I got recruited now because I am the BC survivor in the family. I wasn't very involved 3 years ago because I was a triple negative survivor and Mom's cancer was different. Thank you and bless you all and I will no doubt be in touch.

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Sep 11, 2021 05:12PM LivinLife wrote:

Soooo feel for you going through all of this with your mom! I agree with many of the other comments about either anesthesia negatively impacting your mom's brain and/or the surgery and recovery process impacting your mother's dementia....these are separate processes. even a hospitalization for someone with mild dementia can be disorienting and worsen dementia. anesthesia as we get older puts us at greater risk for delirium which the hospital then thinks is the dementia though it's different - went through that with my mom others.... the large changes just push their brains too much and they can't deal with such change with dementia.

I had an aunt whose breast cancer came back for a 3rd time. She was 93 or 94 and it was already in her lymph nodes. They didn't do any surgery or chemo. They (aunt and cousin) did some palliative care radiation (not treatment radiation) to help with her arm pain and went the palliative route. Your mom is not metastatic at this time though - I really like the suggestions of geriatric oncologist and telehealth to make that possible!!!

with expansive comedo necrosis & weak ER/PR Dx 7/2020, DCIS, Left, 2cm, Stage 0, Grade 3, 0/1 nodes, ER+/PR+ Surgery 8/31/2020 Mastectomy: Left; Prophylactic mastectomy: Right
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Sep 11, 2021 09:05PM Irishlove wrote:

I just wanted to add my grandmother's story to this conversation. She was 93 when she was diagnosed with breast cancer. Overall, she was in fairly good health and thrived in her environment. The surgeon felt that a lumpectomy would suffice. She was put under a general anesthesia and did wonderfully well, living another 6 years. She passed from old age/heart failure. Grammy never showed signs of dementia both before and after surgery, but then again it doesn't seem to run in the family. Her b.c. was hormone positive. Hard to believe as she had a complete hysterectomy 60 years before. I, too had hormone positive b.c., even though I had a complete hysterectomy 30 years before my diagnosis. She never rec'd hormone replacement therapy. I did, low dose climara patch for 15 years.

Given the choice of dying of breast cancer or old age/heart failure, we both picked the latter.

Surgery 2/27/2019 Lymph node removal: Sentinel; Mastectomy: Left Dx 3/14/2019, DCIS/IDC: Papillary, Left, 1cm, Stage 0, Grade 2, 0/4 nodes, ER+/PR+, HER2- Surgery 5/7/2019 Prophylactic mastectomy: Right
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Oct 13, 2021 07:37PM - edited Oct 13, 2021 07:45PM by Sandy5Pat

Hello all! I'm sorry I haven't gotten back to you. Mom had a lumpectomy last week. They were able to get one lymph node and clear margins around tumor. It was outpatient surgery due to C. According to SIL who was with her, Mom was pain free and back to her regular routine as soon as she got home! She is open to starting Tamoxifen and hopefully that will be enough to get her through this life without reoccurrence. Thank you all for your knowledge and sharing the experiences of your elderly loved ones. It was soooo helpful. She/we could have made a big mistake if we hadn't questioned the surgeon's initial plan. Mom made the decision after her 3 daughters and 2 dils discussed and presented her with the possibilities. Mom wanted us to all be on the same page which we were and then she decided from there. The POST etc are all up to date. Anyway, thanks again and take care.

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Oct 13, 2021 10:27PM bcincolorado wrote:

i am not hormonal bc meds at this point and my MO stopped mine early because of side effects of bone loss for me was getting to point I needed Prolia regularly. Hormonal meds did not cause my dementia issues at all.

trishlove I'm glad the famly was there for her and supported her.


Dx 8/2009, IDC, Left, 5cm, Stage IIA, Grade 1, 0/2 nodes, ER+/PR+, HER2- Surgery 1/6/2010 Lumpectomy: Left; Lymph node removal: Left Hormonal Therapy 1/14/2010 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Hormonal Therapy 1/29/2016 Femara (letrozole)
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Oct 13, 2021 11:10PM - edited Oct 13, 2021 11:10PM by ShetlandPony

Sandy5Pat, thank you for posting to tell us what your mom decided. It sounds like an appropriate treatment plan and great family support. I'm so glad your mom is feeling well after her lumpectomy. Tamoxifen is not expected to cause bone loss in postmenopausal women -- may actually improve bone density -- and chances are good your mom will do fine on it.

2011 Stage I ITCs sn, premenopausal, Oncotype 16. 2014 Stage IV mets breast,liver. TaxolNEAD. Ibrance+letrozole 2yrs. Fas+afinitor nope. XelodaNEAD 2yrs. Eribulin,Doxil nope. SUMMIT FaslodexHerceptinNeratinib for Her2mut NEAD Dx 2011, ILC, 1cm, Stage IA, Grade 1, 0/1 nodes, ER+/PR+, HER2- Dx 2014, ILC, 2cm, Stage IV, metastasized to liver/other, Grade 2, ER+/PR+, HER2- Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Radiation Therapy Whole-breast: Breast Surgery Lumpectomy

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