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Aug 2, 2019 08:35AM
Don't be sorry for having questions. It's much better to be prepared!
1. If it turned out to be her2 negative , is there any chance that treatment will be hormonal only ? When can this happen ?
Yes, absolutely. If HER2-, then after surgery (usually either a MX with or without Rads, or a Lumpectomy with Rads), it is possible that endocrine therapy might be the only additional treatment. This depends in part on the size of the tumor and whether or not there are many positive lymph nodes. This is where the Oncotype test score would come into play. The test is done on a sample of the cancerous tissue removed during the surgery. A low to intermediate score would indicate that there would be little benefit to chemo and hormone therapy alone would be the recommended treatment plan.
2. If reconstruction with silicone implant was done immediately after mastectomy and then radiation was needed , do they dry out or can hide cancer cells ?
I have never heard a concern about an implant or expander (a 2-step implant reconstruction process) hiding cancer cells. It is true however that having rads after an implant or expander has been placed does increase the risk of complications. That said, this is being done more often these days. The following article explains in detail the risks associated with radiation and each type of reconstruction, with the conclusion being that "With growing evidence supporting the benefits of PMRT (post-mastectomy radiation therapy), the optimal integration of postmastectomy reconstruction with PMRT is of utmost importance. The risks and benefits of immediate versus delayed as well as autologous versus implant-based reconstruction must be considered for each individual patient. There is no level 1 evidence indicating an optimal strategy, and this complex decision process involves consideration of quality of life, surgical outcomes, history of radiation therapy, cosmetic outcomes, and life expectancy." Breast Reconstruction and Radiation Therapy
3. One doctor worried my mother saying that taking a biopsy led to spreading of cancer cells and that surgery should be followed immediately , he is wrong , right?
It does rarely happen that some cancer cells might be left in the needle track from the biopsy. That doesn't mean that these rogue cells will start spreading - they are just as likely to just sit there. Most cancers are slow growing, so this very small risk doesn't mean that the patient needs to rush into surgery. A 4-6 week wait between diagnosis and surgery is normal, and often the wait is longer. If the delay is longer because chemo is given prior to surgery, it's the role of the chemo to attack and kill off cancer cells in the breast (and any that might have moved into the body). It's not uncommon that after neoadjuvant chemo, no cancer remains in the breast.
4. Emotionally , how to take care of my mother during this time ?
There is no easy or single answer to this one. We're all different, so the right support for one person might be smothering for someone else. It's often hard for patients to ask for help or to say exactly what we need. My advice is to ask your mother what she needs and how you can help, listen to her, and particularly, read the subtle signs and follow her lead in terms of what seems to make her comfortable and what she seems to want to do. What not to do is push and force on her support that she doesn't want.
5. I'm afraid of lymphedema development , how can we prevent it , she is a housewife and uses both her hands quite often in lots of things , I don't want to see her unable to do what she is used to do .
Here's a place to start: Reducing Risk of Lymphedema6. Is it possible that the enlarged lymph nodes that appeared on ultrasound be reactive or any thing else rather than metastatic ?
Yes, it is possible. The role of the lymph nodes is to catch infection and keep the infection from moving further into the body. Nodes that are swollen are simply doing their job. Even a small infection or cold can make lymph nodes swell.
Hope this helps!
“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke