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Category:

Chemotherapy

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Question:  #571 5/26/2006		Q:	I am postmenopausal, age 59, T1cNOmx, er+, pr+, her2/neg, moderately differentiated breast tumor. I had an oncotype dx test, score 21. I am scared of chemo (CMF). What should I do? Suggestions?
		A:	talk through with your medical oncologist who is scaring you about chemo. chemo gets a worse senario than sometimes it deserves... most women tolerate chemo, especially CNF, quite well.
Question:  #572 5/25/2006		Q:	Has JH been doing any testing with Femara? They are using it as the gold standard at Vanderbilt Ingram Cancer Center
		A:	femara is one of the hormonal therapies we and others use. not sure what is meant by gold standard though.
Question:  #573 5/25/2006		Q:	Have you ever heard of herbal chemotherapy for cancer?
		A:	no i have not.
Question:  #574 5/25/2006		Q:	Would you recommend chemo for a patient whose oncotype dx test result is 18 with 12% chance of rec. . My path report was I.D.C. .5 cm grade 1 stage 1 er+ 90% pr+ 60% c-erb - (T1a,NO,MX) 10 nodes removed all neg. I had bilateral mastectomy 3-27-06 my choice. Could have had lumpectomy with rads . I had ductal hyperplasia in both breast .Glad I had mastectomies.
		A:	you'd need to see us for a formal consultation to get that answered. these things aren't cut and dry as many people assume they are. other factors for example are your age, if you are taking hormonal therapy or plan to, other medical issues you may have.
Question:  #575 5/25/2006		Q:	My husband, 48 was diagnosed with breast cancer 3 weeks ago- a biopsy indicated-invasive ductal carcinoma, T4.A modified radical mastectomy showed 17 lymph nodes clear.further tests have shown GradeII, modified RB score 3+2+2, desmoplasia is noted, ER negative, PR positive score 6, HER 2/neu negative.. the doctors say that when they see a PR+ they take it as an ER + also, since tests can be incorrect.they are recommending- tamoxifen and letrozole. Also 6 cycles of chemo- FEC. woud you agree with the line of treatment since he is HER 2 neu negative and ER-. we are getting a lot of contradictory advice. he is undergoing a bone scan and an USG, but will that help to make a more informed decision. also is a CEA or CA 15.3 or 125 necessary at this stage? Thanks.
		A:	sometimes hormonal therapy is offered for PR positive tumors. however request that the ER test be repeated at another pathology lab.
Question:  #576 5/25/2006		Q:	I am starting AC 7 weeks after a lumpectomy. The tumor was 4cm, grade 3, no nodes, ER+/PR+/Her2-. What is the recurrence rate if I only do the 4 doses of AC they are recommending along with radiation and not tamoxifin? I am very worried about my small, veins that have been difficult to access my entire life. I really want a port, but my oncologist says it would be unnecessary for only 4 doses. I know they'll try to use the veins in my hands which is painful. I've heard the veins collapse after one dose. Can I insist on a port? Thank you for answering my questions. I really appreciate this service.
		A:	ask your doctor to show you by using www.adjuvantonline.com also remember that you tumor was large so risk of recurrence is higher than for small tumors. tamoxifen reduces risk in general by 47%.
Question:  #577 5/25/2006		Q:	My daughter-in-law age 35. No family history of BC. Tumor 1 centimenter. No node involvement. because of implants no clean border!!! Stage one. Grade 2. Estrogen positive. One doctor says chemo, another says no benefit to chemo. Second doc also recommend Brachy..local radiation (not whole breast) is this still experimental? then temoxifin.
		A:	with that much contraversy its time your case was presented to their weekly tumor board. so request this to be done. the result should be a group concensus for you. brachy is still research.
Question:  #578 5/23/2006		Q:	We are deciding between Epirubicin and Taxol vs. TAC. Excisional biopsy showed IDC 1.5 cm. Quadrantectomy done and 9 lymph node positive out of 24. Where can I find an article comparing the 2 chemo cocktail? Radiation will follow chemo. ER/PR+, Her2 initially positive (faint), then retest is equivocal, and using CISH method is negative. Thanks.
		A:	possibly at www.nexcura.com
Question:  #579 5/22/2006		Q:	i am getting ready to start Taxol after AC. i've heard that taxol is a lot worse with side effects. is this correct? also i heard a lot more people are allergic to taxol. is this correct? i am really worried about this. thank you for your help on this site
		A:	its a curious thing. women who have side effects from AC usually doe great with Taxol and women who don't have side effects from AC usually struggle through taxol. no one knows why.
Question:  #580 5/22/2006		Q:	I just submitted my question about my concerns over lumpectomy when the tumor was 4 cm. I also asked questions about getting 4 doses of AC when I had a large tumor and am heavy. I forgot to mention that I just turned 40 years old and am premenopausal. I know this is a factor in determining the aggressiveness of treatment. Thanks.
		A:	you are right. aggressiveness is what you want...
Question:  #581 5/22/2006		Q:	I had a lumpectomy followed by a re-excision to clear the margins. My stage is T2 N(zero)-size was 4cm and grade 3. I am concerned that I should have chosen mastectomy due to the size of the tumor, and my surgeon was very aggressive in the re-excision. I am at least a cup size smaller. (The lumpectomy specimens were 11.0 x 8.0x 1.0 including 8 cm of skin, 7.5 x 6.0 x .5, and 5.5 x 4.0 x .5). I am really concerned that he took too much tissue. My surgeon ignored my signs of cellulitus until I ended up in the ER. The trust is about gone now. My oncologist is recommending only 4 doses of AC followed by radiation and Tamoxifin for 5 years. Is this standard protocol? I have also read that large women often do not get adequate amounts of chemo due to the doctors not wanting to harm them with the amount needed based on their body surface area. How do I ask my oncologist not to hold back? Do I have a greater risk for recurrence just based on being significantly overweight? Thank you so much.
		A:	time for a formal second opinion... if you breast looks notably different than the other, then you may still have the option of doing mastectomy with reconstruction after chemo is done and before radiation. large tumor so inquire about being "aggressive" with chemo. this too warrants a second opinion. don't be shy.
Question:  #582 5/22/2006		Q:	my mother just had her lumpectomy on 5/12/06 and this week we found out the results...3cm size, clean margins, 3 out of 14 lymph nodes positive, ER +/ PR +/ HER2 +/ grade 3/(Bloom-Richardson score 8), she has Kaiser Insurance and they haven't been the most pro-active in getting things done (after losing the mammogram for 3 weeks and after the biopsy was + it took 3 weeks to get in for surgery) I want to be sure we move quickly as the tumor was aggressive, the pathology report also stated it was in the vascular system?? I'm not sure what this implies either. I am trying to get in to talk to the oncologist but want another opinion on when chemo should be done...should radiation be done first? and what other tests do we need to insist be done to be sure it hasn't spread.
		A:	usually chemo gets underway within 3 weeks of surgery being completed. they will need to do some scans to stage her and ensure that to the best of their ability the disease hasn't gone elsewhere. she should anticipate a discussion about hormonal therapy and herceptin too. radiation is after chemo.
Question:  #583 5/22/2006		Q:	I have been participating in a clinical trial - the first part consists of receiving AC six times instead of the usual four given for dose-dense - also it is my understanding that the dosage is higher as well. I have had three treatments 2 weeks apart. This regime will be followed by Taxol given once a week for 12 weeks. Unfortunately after three treatments, I am so ill and fatiqued, I know I cannot do three more. The clinical research specialist said my severe symptoms would allow for the next dose to be reduced by 20%, but that the doctor really doesn't like to do that. I wanted help other women by being on this trial, but I just don't think I can go on. If I can manage one more treatment, taking me to four, it will be a miracle. How bad is it to drop out of a clinical trial? I know they will be disappointed, and I feel embarrassed about it, but I just don't see how I can go on. Thank you.
		A:	don't feel embarrassed at all about needing to drop out. you have been great in signing up. your information to date still may be helpful even if yuo can't complete the clinical trial.
Question:  #584 5/22/2006		Q:	5 weeks after chemo and red blood count is still low. What is wrong?
		A:	not that unusual. give yourself and your body more time. eat red meat too.
Question:  #585 5/22/2006		Q:	I am supposed to start Herceptin after Completing TAC x 6. I understand that Herceptin is not recommended for more than one year and can be damaging to the heart. My ? is I have seen some prescribed for weekly and some every three weeks and some getting it 12 weeks once a week then switching to every three weeks. What do the clinical trials and manufacturer say is the best schedule? I am post lumpectomy stage 1 grade 3 no lymph node and er/pr neg.
		A:	there are several different clinical trials so ask your oncologist which one he is recommending for you. you are correct that some regimens are spaced 3 weeks apart and others are for every week for a year. you will probably be a candidate for both.
Question:  #586 5/22/2006		Q:	Have you ever heard of this specific chemo combo being used for Stage IV HER+ breast cancer--gemzar/taxotere/5FU/leucovorin/herceptin? Thanks in advance.
		A:	other patients have written me saying that they were on the same regimen.
Question:  #587 5/22/2006		Q:	What is the risk of cancer recurrence following a mastectomy of a right breast with a 1.1 cm invasive apocrine tumor Grade 1 pT1c (5 of 9 pts) in one quadrant, both sentinel nodes negative, 1.5 cm clear margins plus in situ apocrine in another right breast quadrant and a left breast biopsy of tissue with ductal hyperplasia, papillomatosis for a healthy 68 year old post menopausal woman negative for estrogen, progesterone and HER-2/neu and what reduction in risk would result from a 6 month CMF or other chemotherapy regimen?
		A:	risk of local recurrence is 1%. risk of distant recurrence would be around 5%.
Question:  #588 5/22/2006		Q:	I am a 62 year old radiologist, strong family history of breast cancer, of Askenazi descent. On my yearly screening, May 9, 2006, I had new suspcious calcifications in the upper outer right breast. Stereo biopsy showed DCIS, high grade , 2 foci of invasion 1.5 mm each.At excision done on 5/17/06 good margins , DCIS 9 mm, with a 1 mm focus microinvasion. No vasular or lymphatic invasion. Unfortunately, the estrogen and orogesterone receptors are negative. The Her-2-nu equivocal.Fish pending.I know I need radiation, but now with negative ER and PRreceptors, what is the role of chemotherapy , if any in a Stage one tumor like mine.
		A:	low probability that chemo would be recommended for you given the invasive component is so tiny. consider pursuing genetic testing though before embarking on radiation. if you tested positive for a gene you may want to be more aggressive and proactive from a prevention of recurrence perspective. more women who are hormone receptor negative with strong family history and askenazi descent are gene positive.
Question:  #589 5/17/2006		Q:	I would like to find out what is available to treat the side effects of taking Xeloda. My feet and hands are cracked, sore, bleeding. Anything available to relieve the pain and soreness?
		A:	ask your doctor what he recommends. don't try anything self prescribed over the counter unless approved by him. sorry you are battling with this.
Question:  #590 5/17/2006		Q:	Just had bilateral mastectomy with immediate reconstruction. Pathology report shows extensive DCIS and 2 tumors (1.3cm & 2mm - grade 3). Margins were good. ER Positive 97%. Radiation not recommended. Hormonal therapy recommended. Sample to be sent out for Oncotype test to determine recurrence. What about chemo? Surgeon says close call right now, so Oncotype will help make decision. This seems to be an area where the recommendations are moving away from chemo and maybe towards hormonal therapy only in these circumstances. What do you think?
		A:	this is a gray zone. that's true. and there is movement afoot based on recent breast cancer national meetings to consider doing hormonal therapy instead of chemo and hormonal therapy. wait and see what the oncotypeDX test shows as it will provide some additional information for you and your doctor to decide. there is no magic formula here.
Question:  #591 5/17/2006		Q:	I've been given Apo-Prochlorazine to use after chemo to prevent and treat nausea (as well as kytril). After I take the Apo I feel extremely dizzy and also distraught and depressed. Could you tell me what kind of drug it is? Have you heard this from other people? I'm also on effexor and am wondering if it's somehow interacting badly with effexor. As the Apo wears off my distress reduces noticeably. Thanks a lot
		A:	I'm not familiar with this drug. ask your local pharmacist though because he can look up interactions for you.
Question:  #592 5/17/2006		Q:	Hi. I'm receiving FEC chemotherapy every three weeks through a portacath. After it was inserted, the whole area broke out in little bumps that were filled with pus. The nurses said I was allergic to the bandages, so we removed those and the situation improved considerably. However, the skin right on top of the port and slightly around it continues to be very red, irritated and itchy. It's been over a month now like this. Hydrocortisone cream doesn't help. I'm having trouble with my arm veins and had hoped to have all my bloodwork etc. done from the port, but the nurses won't, saying it looks too irritated to be used. Do you have any idea of what might be causing this? Could I be allergic to the port itself? Thanks for your help.
		A:	sounds like you had a local infection (puss) and that your body is still trying to heal from it. point this out to the medical oncologist at the time of your next appointment.
Question:  #593 5/16/2006		Q:	It has been two weeks now since my mom has started fraction-dosed Taxol. She has been complaining she feels very cold. This isnt just once in a while, but all the time. We live in Southern California where we have 90 degree days now so weather isnt an issue. I am concerned as to why she feels so cold all the time. Thank you for your response.
		A:	not sure.. haven't heard this as a symptom/side effect. so call her doctor and ask him about it. also make sure she isn't experiencing chills (that would imply she has a fever. check her temperature.)
Question:  #594 5/16/2006		Q:	HI, I am currently on weekly doses of taxol and herceptin, 7 of 12 completed. About the second week I started developing facial acne which is getting worse. I spoke to the nurses at treatment and they were not familiar with this as a side effect. Have you heard of this with either of these drugs? could it be that I have gotten too much sun? The acne can get painful especially on my nose, any suggestions on how to treat it? Thanks A
		A:	wow. haven't heard of this as a side effect either.
Question:  #595 5/16/2006		Q:	My wife, age 48, pre-menopausal, was diagnosed with Stage 2A ILC in January. The tumor was 4cmx3cm at the time; nodes negative, HER2 negative, Estrogen 92%, Progesterone 70% positive. Pre-surgery, she had 4 rounds of dose-dense AC with good tumor shrinkage, and was in the middle of her second of four pre-surgical Taxol treatments on May 5 when the oncologist came over and said that the sonogram taken two days earlier showed a slight tumor regrowth since Taxol; so they stopped Taxol instantly, and the surgeon performed lumpectomy yesterday--surgeon says the lump was even smaller than it looked on sonogram--about 1 cm or less. We await the grading of the tumor and the margin report from pathology. The oncologist suggests trying Taxotere post-surgery as adjuvant treatment, along with radiation and tamoxifen. She had quite a bit of muscle and bone pain with the Taxol, and is not thrilled with trying the similar Taxotere; and wants to get away from more chemo if reasonably possible. My sense from research is that, with her highly ER and PR positive tumor, the tamoxifen or aromatase inhibitor (if the chemo-induced menopause is permanent) along with radiation, may be the best adjuvant treatment; and that if Taxol didn't work, Taxotere is unlikely to add much benefit in relation to the side effects. The oncologist & surgeon seem to suggest that the Taxotere should be tried in any event, just to be sure. If the tumor grade is low, does Taxotere seem worthwhile in this scenario?
		A:	they are following protocols which match her pathology... consider getting a second opinion formally before deciding and don't assume that if taxol doesn't work that taxotere won't either, or that the side effects would be the same. great she is hormone receptor positive but this was a big tumor-- 4cm. and she is young so that's why they are steering toward aggressive treatment probably.
Question:  #596 5/16/2006		Q:	I have a friend who has breast ca that has spread into the bone she is on chemo and just had her 4th treatment and is having some yellowish pus coming out of her eyes, nose and in the arm pit area is this common or not?
		A:	no not common and needs to be reported to her doctor asap.
Question:  #597 5/16/2006		Q:	I am taking accelerated AC/Taxol I have olready had 4 AC and 2 Taxol although my doctor has given me vitamin B pins and neadel sensation does not end by day 5 of the cycle and my feet get very uncomfortable if I walk or stand more than 20 min. Is there any thing else I can do, how long might this last after I have completed my treatment, how long does the Taxol stay active in my body.
		A:	ask him if you ever recommends using neurontin or not.
Question:  #598 5/16/2006		Q:	Hi, my mom is 63 years old and had a partial mastectomy for stage 1, grade 3, ER/PR-, 0/SLNs, 3mm cancer approximately 2 weeks ago. She had two tumors in her right breast, one was cancerous and the other one was not. The cancer was located/identified on her biopsy. My understanding is that the lab did not find any cancer in the tissue removed during surgery because all the cancer had been removed with the biopsy. (The 3mm measurement came from piecing the biopsy pieces of the cancer together). As stated, my mother already had the surgery and will be having radiation. We are currently trying to decide whether she should or should not have chemotherapy as well. From what I understand, with her situation she could choose either option. The surgeon did not want to give his opinion. My parents will be meeting with an oncologist next week. I would like to hear your opinion and find out what the normal course of action for her situation is. Since I'm not completely clear on which factors in her report are important, and I don't completely understand it, I'm including most of the details from her report after my questions. I want to make sure my mom makes the best possible decision with her treatment and would be extremely grateful for your answers to the following questions. MY QUESTIONS: 1.What is your opinion on chemotherapy in my mom’s situation? 2.What is normally done in her situation? 3.What is the likelihood that all the cancerous cells were removed during biopsy and surgery? 4.The doctor who performed the surgery stated that without chemotherapy there was a 22% chance of recurrence and with chemotherapy there was a 17% chance of recurrence within ten years. Does the recurrence rate apply to recurrence in the breasts or anywhere? In this situation, if it were to recur would it be more likely to recur in the breast tissue or is there no way of telling (there is no family history of any type of cancer)? 5.Are recurrences always harder to get rid of or does that depend on several factors? 6.What are the potential complications/side effects of chemotherapy? My mom is 5’6” tall and weighs 108lbs. 7.Why would chemotherapy be necessary if the doctor successfully removed all the cancer and it has not spread? If you can never really be certain that all the cancer has been removed, should you always have chemotherapy after being diagnosed with a cancerous tumor? The SURGICAL PATHOLOGY REPORT DIAGNOSIS reads: 1)Sentinel Lymph Node, Right Axillary #1, Lymphadenectomy: One lymph node negative for metastatic carcinoma (0/1). 2)Sentinel Lymph Node #2, Right Axillary, Lymphadenectomy: One lymph node negative for metastatic carcinoma (0/1). 3)Breast, Right, Lateral Margin, Excision: Breast parenchyma negative for in situ or invasive carcinoma. 4)Breast, Right, Wire Directed Partial Mastectomy: Ductal carcinoma in situ, high nuclear grade with comedo necrosis. Cancerization of lobules noted. No residual invasive carcinoma identified in resection specimen, entirely submitted. Invasive carcinoma measures 0.3 X 0.2 cm as measured on previous core biopsy slides, Nottingham Grade 3 (3+3+2). Duct carcinoma in situ extends to within 1.0 mm of inked margin of resection with cautery artifact at margin. Previous biopsy site changes identified. See synoptic report and comment. 5)Right Axillary Tissue, Excision: Three lymph nodes negative for metastatic carcinoma(0/3). The MACROSCOPIC report reads: Specimen Type: Wire directed partial mastectomy. Lymph Node Sampling: Sentinel lymph node(s) with limited axillary dissection. Specimen Size: Greatest dimension 9.5 cm and additional dimensions 5.2 and 4.2 cm. Laterality: Right. Tumor Site: Upper outer quadrant. The MICROSCOPIC report reads. Histologic Type: Infiltrating ductal carcinoma, NOS (present on needle core biopsy only). Primary Tumor (pT): pT1a > 0.1cm, < or = 0.5cm Lymph Node Pathologic Classification (pN): pN0 No regional lymph node metastasis histologically, no additional examination for isolated tumor cells. Distant metastasis (pM): pMX Presence of distant metastasis cannot be assessed. Histologic grade of infiltrating carcinoma: Grade III, poorly differentiated, total score 8(based on evaluation of core biopsy) Tubule formation 3. The SURGICAL PATHOLOGY REPORT DIAGNOSIS reads. Nuclear Grade:3 Mitotic Count:2 Necrosis Within Invasive Component: None Angio-Lymphatic Invasion:(large/small vessel invasion) Not identified. Associated In Situ Component: Present, ductal carcinoma in situ, extensive. Architectural Patterns of In Situ Component: Solid, Comedo. Nuclear Grade of In Situ Component: High grade. Surgical Margins: Surgical margins are negative, Ductal carcinoma in situ is absent from the surgical margins and is located <0.1cm from the inked margin(margins not further specified). Lymph Nodes: Sentinel lymph node biopsy, Negative for metastatic carcinoma by H&E staining: (0/2) lymph nodes, Axillary contents dissection, Negative for carcinoma: (0/3) lymph nodes. Locations of Calcifications: Insitu carcinoma, Benign lesions. Non-neoplastic breast: Biopsy site changes, Epithelial hyperplasia, usual type Additional studies ordered: ER/PR immunohistochemistry was ordered, c-erb2 (HER2/neu) immunohistochemistry was not performed. The COMMENT section reads: The invasive carcinoma in this patient was apparently small and completely removed on the core biopsy. The entire resection specimen was submitted for histologic examination and there is no evidence of residual invasive carcinoma. Extensive ductal carcinoma in situ is identified present on seven slides and too scattered to provide an accurate measurement for the same. Previous biopsy site changes are identified to suggest that the needle core site has been resected. The template for invasive carcinoma is based on the measurement of the tumor on the previous core biopsy.
		A:	it does require a formal consultation to determine recommendations for chemotherapy. it would be unusual to have chemo though for a tumor only 3mm. since it was so tiny, its not surprising that additional cancer wasn't found residually at time of surgery. surgery was still needed to ensure clear margins before beginning radiation.
Question:  #599 5/16/2006		Q:	For the past 2 weeks I have been recieving fraction-dosed Taxol. Since my doses are broken up, will I be experiencing the same side effects? Will the fatigue be less? Also,will it take longer for my hair to grow back?
		A:	don't know.. each patient reacts differently. it should not take longer for hair to return though.
Question:  #600 5/15/2006		Q:	How long would you suggest waiting before starting chemotherapy after a breast lumpectomy, about 3 and half inch incision acoss breast, into the breast. ? I wonder why I cannot start chemo right away, even with the stitches. I will see my surgeon tomorrow and ask him too, but as i have a grade 3 idc of course I want to get started to insure no other cancer in other parts of my body. What is your opinion? I certainly dont want my stage 2a cancer to get any worse, waiting. Thank you,
		A:	stitches need to be out and incision well healed because when chemo starts healing stops. 3-4 weeks usually.