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Category:

Chemotherapy

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Question:  #1171 8/8/2005		Q:	I am 46 yrs old with strong family history of bc (mom & grandmo). In July Dx with stage 1 IDC, 1.5cm and .4cm (4mm)masses removed via lumpectomy, no nodes, stage 3. Er/Pr- her 2 +++ Started 1st session of chemo AC for 4 rounds every 3 weeks then taxol/herceptin followed by herceptin to equal 1 year. I will also receive radiation after the AC is finished. Do you think this is aggressive enough to prevent a reoccurance or am I a sitting time bomb for state IV? Any other treatments I should be considering? Thank you so much.
		A:	am not sure why you think this is stage 3?? what you've described is stage 1.
Question:  #1172 8/8/2005		Q:	I am a 33 year old. My right breast had mucinous carcinoma with intraductal carcinoma. The tumor size is around 2.5 x2 cm. I just had mastectomy on July 19. I am ER 90% positive, PR 30% positive and her2+ negative with no vascular,lymphatic or nerve invasion present. The doctor suggested FECx6. He said I can also pick ACx4 or TACx8 if I really wanted (not suggested beacuse he think it too much). Is ACx4 is effective as FECx6? or TACx8 is more effective? Which one will affect my fertility the most? Thanks.
		A:	If we knew for sure that one was more effective than another we would frankly only offer one... so he is saying you have choice. if you can participate in a clinical trial, consider doing so. TAC would be the hardest on the ovaries but usually each of these regimens results in ovaries resuming activity afterwards. you mentioned however being hormone receptor positive-- then hormonal therapy will probably be discussed with you that may impact fertility.
Question:  #1173 8/8/2005		Q:	I had both breasts removed due to breast cancer (1990, 1999). I underwent chemo treatment in 1999 for 4 months. In 2004, I developed a swelling just below my left neck. I had a biopsy that confirmed cancer. I have been undergoing chemotherapy for 1 1/2 years now, from Navalbine to Gemzar to Taxotere that started on Thursday, Aug. 4th. I am very concerned about the side effects of Taxotere. I have heard horror stories about them. Could you tell me more about this drug? I have also been on herceptin since the beginning. Thank you for your attention and anticipated reply.
		A:	taxotere actually comes from the bark of a green tree in Africa. it is in the taxane family. some women have virtually no side effects and others get quite sick. no way to predict. how a patient does with the first treatment usually sets the stage for the others to follow. the most common complaint is joint pain following the treatment.
Question:  #1174 8/5/2005		Q:	Hello - I am 48 years old was just diagnosed with Stage 1 Invasive and In-Situ Ductal Carcinoma. My tumor was removed via lumpectomy and my sentinel node biopsy showed my cancer to be node negative. Tumor size 1.4cm., grade 3, necrosis: absent, lymphovascular invasion: not identified, Margins: clear, Microcalcifications: absent. I am also ER & PR positive and HER2/NEU negative. What is the proper course of treatment in my situation? I've heard that ER/PR positive patients don't really benefit as much from Chemotherapy as ER/PR negative patients and of course I would like to avoid Chemo and go with radiation and tamoxifen if at all possible. My breast surgeon is pushing chemo and one the oncologist I have met with thus far is pushing it as well. Any advice on this issue would be greatly appreciated.
		A:	risk of recurrence is higher for hormone receptor negative patients usually. that's the point. you fall in the gray zone for chemo but should have a healthy discussion about it. ask the oncologist if he plans to do the oncotypeDX test to get more information about your cells.
Question:  #1175 8/5/2005		Q:	Hello I am a 35 year old with a 7mm tumor er/pr- her2+ negative nodes, no vascular,lymphatic or nerve invasion present. I have just completed a bilateral mastectomy. It has been suggested that I pick between two chemo regimines ACx4 or FECx6. My question is two fold...which type of chemo is more effective? Is chemo a given and what would my chances or recurrance be with out it? Thanks
		A:	you are young so it is reasonable to discuss chemo with you. the doctor can use www.adjuvantonline.com to show you graphs of your survival with and without chemo. both chemo regimens are good. one not being better than another as far as we know. (if one was better than the other they would have only offered you the better one.)
Question:  #1176 8/4/2005		Q:	Do you have information about any recent studies that are suggesting that reoccurrence and metastasis may be lessened if chemotherapy is given in addition to Tamoxifen to BC patients whose pathology results typically just indicated a Tamoxifen treatment? My path results indicated that I could be treated just with Tamoxifen but I sometimes feel insecure that maybe I did not do all I could do to kick cancer’s fanny. Some of my results of the characteristics used to determine if I should have chemo. or not were “borderline.” I was diagnosed with Infiltrating tubulolobular carcinoma with prominent ductal carcinoma in-situ and had a skin-saving mastectomy/reconstruction in 2/05. The tumor size was 1.2; ER + (80%) and PR+ (40%); HER.2 - (1%) . No nodes were involved and the margins were clear within 1 cm. The K1-6 ratio was 9%; S phase factor 5% and Histologic Grade of 2. My total Nottingham score was 6 and the Ocotype test indicated a low range (but in the high/low area) of reoccurrence. Recent CT/MRI and blood work (after 6 months) showed no signs of metastasis. I’m feeling good now and am walking 30+ min a day on a treadmill , eating a low fat diet etc. etc. and would prefer to put this year behind me...but I catch myself worrying. Thank you very much for all that you do.
		A:	there is a new test that helps to answer this question to some degree, or has potential to do so. oncotypeDX. ask your medical oncologist about ordering it.
Question:  #1177 8/4/2005		Q:	My friend is a newly-diagnosed breast cancer patient (51, otherwise healthy, tumor between 0.1 and 1.0 cm in both breast and lymph nodes, 4-9 nodes involved). Her surgery was on June 9, a month later met with an oncologist at a local center center, and she still doesn't know what chemo she'll have or when. Shouldn't things be moving faster?
		A:	based on lymph node involvement, yes, time to get a move on. when cancer is found in the nodes usually a staging work up is done to help determine the type, amount and frequency of chemo she will need. then proceed with chemo administration. she needs to be assertive and speak up.
Question:  #1178 8/4/2005		Q:	Thanks for your response to the previous question; I had seen that answer before and I knew all of that; but I really wanted to know: If there are diagnostic/laboratory tests to determine if neuropathy was related to one of the paraneoplastic comdition or an autoimmune disorder, or what? I saw something on Hu anti-bodies or Ri antibodies; that sort of thing. Is there one test for this? Can these tests be requested? I am trying to get to the bottom of the neuropathy at this point; I have resolved that I have cognitive issues through the cognitive testing. Thanks again, sorry if I was not clear. (Chemobrain:-)
		A:	there is not one test for this that I'm aware of.
Question:  #1179 8/4/2005		Q:	I finished 6 cycles of FAC 2 years ago in May. Bilateral Ducatal Cell Carcinoma. I have had cognitive deficits (working memory and frontal lobe consistent with exposure to a toxin) documented by neuropsych testing as compared to pre-cancer scores (I was fortunate to have some on hand). Also cognitive deficits do not match those to be found in someone at my educational level and profession, without being specific. So these issues are there. this has been a challenge, especially since I have begged and begged for cognitive therapy! (My house is becoming more organized that Martha Stewart's just so that I can keep my makeup straight!) It takes me about two hours to get ready in the morning. I am very slow with these things. However, most disturbing now, I am also getting increasing worse and worse neurological pain and numbness bilaterally in my arms, hands, fingers, lower legs, back, face, soles of feet. It is VERY uncomfortable and seems to be getting worse! I have been to the oncologist to rule out problems. They have done EMG on my right leg, which becomes weak on me and they are normal. They have run screening tests for lupus and that is normal except for positive ANA...which they tell me means nothing. I have been positive for an abnormal sleep architechture with no REM. I also have no "sense" of time. BP readings show my right leg more hypertensive than my left. (I have a hx of long recovery from anesthesia, FYI...when they tested serum cholinesterase it was actually a bit high.) I am having some pretty severe pain in my thoracic spine and my cervical spine. MRI's: brain normal. Back depending on the scan might have bulging discs but they didn't seem to think that was the problem. The tingling in my lower legs gets worse when I lie on my back. I am at my wits end on this because I am VERY uncomfortable, fatigued, in pain ALL of the time with no relief, being told that this is "subjective" and it is downplayed...meanwhile; I accidentally cut myself with scissors, run my right side and leg into the wall, get bitten by "yellow flies" when I go outside at night and I can't feel them until it itches, drop objects like screws, spill drinks or some liquid almost daily, am a clutz, have difficulty making my hands do what my brain is thinking for them to do (In drawing a picture, for example), have difficulty retrieving words, cannot do mental math greater than one step, don't remember locations I am driving to even though I have been there many times, have problems focusing. What tests or differential diagnoses would you recommend to deal with the neuropathy and the PAIN???? I have read where there are some neurological antibodies that can be evaluated, for example? Can you recommend specific articles on this with regard to my treatment chemo? These are very real to me, and I need help for these things; but the docs just drop it because they do not know what to do to help. Can you recommend a knowlegable doctor that will not just blow me off and disregard my issues? PS It was this site that advised me to go to the doc back when I first felt a suspicious area:-) I did so, and the rest is history...
		A:	there is some information about cognitive functioning issues and chemotherapy on our website at www.hopkinsbreastcenter.org/artemis (use search feature) and also at www.breastcancer.org there is still more research to be done though before definitive answers are known. some women have reported memory problems following a diagnosis and treatment of breast cancer too and they never had chemo at all.
Question:  #1180 8/3/2005		Q:	I was diagnosed with breast cancer last September, had a lumpectomy and then mastectomy, followed by 4 rounds of AC chemo, which I finished in February. My question is this: I always had healthy, low blood pressure, around 112/70. I exercise a lot regularly, eat well, am not overweight. Suddenly, after this whole experience, my blood pressure is borderline high, between 130 and 145 usually over 80-90. My doctors here say it shouldn't have anything to do with the chemo or cancer. Do you know anything about this? Have you seen this happen in patients there? I really don't want to go on medication, so I am waiting to see if this is just a temporary reaction of my body to everything. It seems too conincidental that this has changed so much right now. I am 51 years old and in excellent health otherwise. Thank you for your response.
		A:	listen to that doctor. would be unusual to be related to the treatment or the disease. time to see your family doctor.
Question:  #1181 8/3/2005		Q:	I had a mastectomy with reconstrution in Jan 1998 with 12 positive lymph nodes. I was in trouble. I did 6 months of chemo every two weeks Cytoxin, Adrianmycin, Taxol. then tamoxifin. In July, 2000, my tumor markers CA15 went high and I was put back on chemo. Taxotare and Herceptin. After 28 treatments of Taxotare I was just on Herceptin and Arimidex. Then after almost two yrs taken off Herceptin and sit and wait. Just Arimidex. Aug, 2004, tumor markers went up again. CAT scan and PET scan confirmed. Put on Taxol and Herceptin. March, 2005, PET scan showed normal. Had pneumonia in hospital 3 days and not put back on Taxol just Herceptin. Sit and wait. July, 2005, tumor marker CA 15 up to 70. Put back on Taxol/Herceptin. I have had 4 treatments of Taxol/Herceptin and just had a CAT scan which showed mm size nodules in chest and liver. The recent PET scan showed normal. I'm waiting for a new CA15 report. Talked to my Oncologist today and when he gets the latest CA15 he will decide to up the Taxol. Even though the PET scan didn't find what the CAT scan did. Is CATscan better than MRI. I thought PET scan was the best to detect cancer. Please answer.
		A:	one isn't necessarily better than another... they are sometimes all used to help decipher staging information.
Question:  #1182 8/3/2005		Q:	In 1997 i was diagnosed with breast cancer i went thru a course of chemo and then radiation and was put on tamoxifn I recently had a brain mri done and they saw 2 brain lesions The neurologist feels this is MS since i had optical neuritis in 1994 my question is could the brain lesions come from the chemo treatment i had?
		A:	not likely related to your chemo treatment.
Question:  #1183 8/2/2005		Q:	I am 49 and pre-menopausal. A 1.1cm tumor was found by a routine mammogram. Needle biopsy confirmed it was cancer.I had a lumpectomy (with clear margins)w/SLN Biopsy. 2 nodes taken 2 nodes positive. Progesterone Rec.positive, Estrogen Rec. positive, HER/2 Negative,DIAG: Invasive moderately differentiated ductal carcinoma. I then had a port installed and an auxillary node dissection, 22 nodes, removed from the same side as the 1st surgery...all nodes negative, CT scan of chest, Abdomen, and bone scan are all normal...what is the 'norm' of treatment for this..just radiation or chemo w/follow up of radiation...what are the differences in survival/return rate on these treatments?
		A:	it wouldn't be one (chemo) vs the other (radiation). doesn't work that way. chemotherapy is systemic treatment to address any cells that might have gone to other organ sites. given that 2 nodes were positive, chemo is probably in your future. radiation is given always when lumpectomy is done and is considered local treatment to help prevent local recurrence of the disease in the breast.
Question:  #1184 8/1/2005		Q:	What new drugs are being developed for hormone negative cancers?
		A:	not sure what is in the works in that area. some research is being done however to see if there are ways to "convert" cells into being hormone receptor positive, thus making hormonal therapy an option. still at the lab level.
Question:  #1185 7/31/2005		Q:	5 days ago I started my first cycle of ACx6. Didn't have any nausea (Emend and Kytril), but got completely tired out and slept almost all of day4. Aside from the minor aches of the portacath surgery and the neulasta shot, I only seem to be tired. Should I expect this same type of reaction the next cycle? Does it intensify with each cycle? Are the effects only felt for the first few days after chemo - or does it last for the whole 21 day cycle? I read somewhere to keep a diary so that I would have an idea of what to expect for the next cycle - is that a valid thing to try? Thanks for being here!
		A:	pretty much expect the same reaction. good for you...
Question:  #1186 7/31/2005		Q:	I am 62 years of age and postmenpausal. I found a lump in my breast by self inspection. Mammogram confirmed lump. Needle biopsy confirmed tumor: Progesterone Receptor positive, 80%, moderate to strong HercepTest (DAKO) Negative, 20%, 1+/weak Diagnosis Right breast, at 10 O’clock 16 cm from nipple, (Biopsy): INFILTRATING LOBULAR CARCINOMA. See comment. COMMENT: Case discussed with DR W on 6/9/05. Material submitted for breast prognostic studies. IMMUNOHISTICHEMISTRY Estrogen Receptor Positive, 70%, weak to moderate I was operated on and to pathology report is below. SP Final RPT SPECIMEN RT AXILLARY TISUE LYMPH NODE DISSECTION RT LUMPECTOMY BREAST BREAST LUMPECTOMY DISGNOSIS 1. LYMPH NODES, RIGHT AXILLARY, (DISSECTION) : EIGHT LYMPH NODES (0/8), NEAGTIVE FRO MALIGNACY. 2. BREAST, RIGHT (LUMPECTOMY): A. HISTOLOGIC TYPE: INFILTRATING LOBULAR CARCINOMA B. HISTOLOGIC GRADE: TOTAL NOTTINGHAM’S HISTOLOGIC SCORE= 6 OUT OR 9 POINTS. C. TUMOR SIZE = 1.9 CM IN GREATEST DIMENTION D. MARGINS: 1. SUPERIOR MARGIN – NEGATIVE FOR TUMOR. AT LEAST 1.O CM AWAY FROM THE MASS. 2. INFERIOR MARGIN - NEGATIVE FOR TUMOR. AT LEAST 1.O CM AWAY FROM THE MASS. 3. SUPERFICIAL MARGIN - NEGATIVE FOR TUMOR. AT LEAST 1.O CM AWAY FROM THE MASS. 4. DEEP MARGIN - NEGATIVE FOR TUMOR. AT LEAST 0.5 CM AWAY FROM THE MASS. 5. MEDIAL MARGIN - NEGATIVE FOR TUMOR. AT LEAST 1.O CM AWAY FROM THE MASS. 6. LATERIAL MARGIN - NEGATIVE FOR TUMOR. AT LEAST 1.O CM AWAY FROM THE MASS. E. DCIS COMPONENT: NOT IDENTIFIED. F. ANGIOLYMPATIC INVASION: NOT IDENTIFIED. G. NO MICROCALCIFICATION IDENTIFIED. H. ER, PR AND HER2/NEU STUDISE ALREADY PERFORMED ON PREVIOUS BIOPSY CASE SO5-6057 STAT DIGNOSIS: 7/18/05 GROSS DIAGNOSIS: RIGHT AXILLA, (DISESSECTION): AT LEAST (15) FIFTEEN LYMPH NODES IDENTIFIED. I have been given the choice of having Chemotherapy or not. My first question is: HOW IS ONE DETERMINED TO BE AT RISK FOR DISTANT METASTASES? The drugs recommended for consideration are Cytoxan, Methotrexate, 5-FU (CMF), or Adriamycin and Cytoxan (AC). Question 2. Are these chemotherapies specifically for Breast Cancer? After Chemotherapy, there will be a course of radiation. Then the oncologist is recommending ten years of hormonal therapy, either Tamoxifen or Arimidex. My problem is that I have taken HRT therapy and it made me sick. Question 3. What is the increased risk of just taking the radiation therapy, without either the Chemotherapy or the hormonal therapy.
		A:	so stage 1, but nearly stage 2 based on tumor diameter. great it is node negative and hormone receptor positive. clear margins. all good news. her2neu negative. also goo. this is a good case for considering doing the oncotypeDX test to determine the risk of your specific cancer cells recurrence later so ask about that. also ask to be shown www.adjuvantonline.com to calculate chemo benefit.
Question:  #1187 7/31/2005		Q:	I'm 44 and I've just finished all my treatments for BC. X4 A/c and 36 rad. I'm glad it's all over but I'm having a very difficult time with the hotflashes. I can't get a decent nights sleep. Someone suggested Primerose oil & Vit. E. I tried that but it messed with my stomach. Is it possible that my period will return and this will go away or am I stuck with this for years to come?
		A:	ask your medical oncologist then about possible taking effexor.
Question:  #1188 7/31/2005		Q:	Hi, My mother who is 57 years old was recently diagnosed with a breast ca and treated with simple mastectomy.Sentinel nodes were negative. She has no other medical history except NIDDM which has been stable with Metformin and Gliclazide. Her HPE report shows a 2x 1.3cm ,Grade 3 infiltrating ductal ca with 100% ER and PGR status.Hertonium status 1+. The oncologist there adviced for 6 sittings of FAC. I would be grateful if you could guide me about the appropriateness of this therapy and the major adverse effects and the prognosis of this type of breast cancer. Thanks a tonne,
		A:	this is one of several chemo regimens that are offered today and are quite effective in prevention of distant recurrence of disease. she has stage 1 breast cancer. good for her. he will also talk about hormonal therapy afterwards. hair loss will happen. possibly some nausea. we hope she does well.
Question:  #1189 7/31/2005		Q:	I have just finished 4 fac then going to have 8 taxol weekly can you please tell me how do you know if chemo has been succsesful? Also do you know if there is any data on taxol given weekly for 8 weeks I can only find people who have had taxol for 4 sessions given 3 weekly and i am having it weekly thanks
		A:	check with 1-800-4-CANCER regarding your data request, or www.cancerfacts.com The only way to know is time... time validating that no disease is found elsewhere.
Question:  #1190 7/29/2005		Q:	My mother is 89yrs. old; just had a right breat mastectomy. She has only 0ne kidney that is functioning at 60%; history of light heart attack; she is currently on 9 different medications. Her path report at time of surgery showed 2 out of 10 under arm lumph nodes positive (HERS2 cells). Inspite of the above she seems in generally good health. Does chemo (Taxotere and Herceptin) seem feisible? Thank very much for a response.
		A:	based on age and her other cormorbid conditions it would be unusual to embark on chemo... ask about her hormone receptor status.
Question:  #1191 7/29/2005		Q:	I took tamoxifen for 5 years and was fine. Then they put me on femara and since on that I seem to have a memory problem. I repeat the same thing more than once and have a hard time remembering what I did at work the day after. I was never like that before, but do have stress both at work and at home. My husband does not work due to side effects of radiation and has both a trach and feeding tube and does little to knowthing at home. I keep thiking also stress could be a big part of my problem.
		A:	not heard of this from other patients.... so you may have guessed the cause--- sounds like you have a lot to be dealing with at home, and maybe at work too. consider talking it through with a therapist. you were not meant to deal with all of this alone.
Question:  #1192 7/29/2005		Q:	Hai, My mother has recently been diagnosed as having breast cancer...further went on to have a simple mastectomy and the sentinel nodes were negative.HP report shows 100% receptor status for ER and PR with Her-2 negative.She also has NIDDM. Otherwise medically fit n well. I was just wondering if u could give me some advice on the best chemotherapy possible and further details regarding the same. Thanks a million
		A:	probably first they need to determine if she needs chemo. the tumor diameter will influence that, and her age. great news she is hormone receptor positive, so hormonal therapy may be discussed for her too. there are many different clinical trial chemo options. rely on the medical oncologist to see which one(s) she recommends for her, if chemo is needed.
Question:  #1193 7/28/2005		Q:	This is for a friend who lives in Bolivia and has been told she has breast cancer. She is 56 y.o. The problem: She is going to a public hospital where the care is at least 20-30 years behind. Any thoughts about how she can be helped?
		A:	ideally she would then leave and get care elsewhere if things are that far behind. you want to make sure that she gets the care she needs... if that isn't possible then mail her educational literature about breast cancer treatment so she can empower herself with information and hopefully play an active role in her own treatment and decision making.
Question:  #1194 7/28/2005		Q:	Last September, at the age of 34, I was diagnosed with invasive ductal carcinoma, 1.0 CM (with a small area of DCIS nearby - 6 mm), ER+, PR+, HER2+, Grade 3 (Total score of 8 -- miotic was 2), and BRCA negative (my mom had Stage II breast cancer at the age of 38 -- that was 20 years ago and she has never had a recurrence). I completed 4 rounds of A/C, radiation, and had my ovaries removed. I am currently taking Arimidex and am also doing Herceptin for at least a year (I started it a month after completing radition due to clinical trial results). I am quite worried about my risk of recurrence after using the Adjuvant! program option for Oncotype scores. What would appear to be a good prognosis (about a 5% recurrence rate)based on my pathology using the traditional program, by plugging in a high Oncotype score, my prognosis is significantly worse (about a 15% recurrence rate). I'm assuming that my Oncotype score would be high as I had a high grade tumor and am HER2+. Is this assumption correct? Also, would there be any value to getting the test now? I realize that its usually used only for treatment decisions (i.e. chemo or no chemo) but wonder if anyone gets it for "peace of mind" type reasons. Thank you for your assistance.
		A:	You may want to have your tissue formally processed for the onccotypeDX test to see how it measures out. you have been aggressive with your care and still are being so i would hope that would provide you some peace of mind.
Question:  #1195 7/28/2005		Q:	I'm a 55 y/o with stage 1 invasive interductal breast cancer in both breasts. Just had bilateral mastectomy. Tumor sizes 1.1 cm on left, 1.4 cm on right. Estrogen receptor positive. Nodes on the left, negative. Could not find any nodes on the right (no info here concerns me). Trying to decide whether to do hormonal therapy only, or a combo of chemo and hormonal. Oncologist stated that the decrease in reoccurance is only 3% by adding the chemo therapy. Not sure if the chemo risk and other downsides are worth it. Your thoughts?
		A:	consider requesting that the oncotypeDX test be done to help further determine the benefit or lack of benefit of doing chemo in your case.
Question:  #1196 7/27/2005		Q:	I had a lumpectomy and sentinel node biopsy on 7/11/2005. The pathology report stated: SLN Negative, Invasive Ductal Carcinoma tumor of .9cm, ER, PR & Her2R all negative. The tumor was high grade (III). Thre was extensive in situ carcinoma found both adjacent to the tumor and in randomized selected portions of the breast tissue. The margins are involved. I am now planning to have a simple mastectomy. I met with my oncologist today and she recommended chemo. Is the probabilities of reoccurance significant if I forego the chemo? Thank you.
		A:	let's distinguish between the purpose of each treatment. the mastectomy is due to margins not being clear after lumpectomy. this is considered local treatment and is to get rid of the source of the disease. it is unrelated to the potential need for chemo.chemo is systemic treatment to treat the rest of your body in the event a cell got away and traveled elsewhere. Being hormone receptor negative they won't be recommending hormonal therapy as a way to prevent distant recurrence. local recurrence would be 1% with mastectomy. but the chemo is for distant recurrence.
Question:  #1197 7/26/2005		Q:	I am 64, good health, no medical problems until diagnosed with infiltrating poorly differentiated duct-type carcinoma, grade 3, er+, her2/-, with a dominant 3 x 4 cm mass in the left breast, mutiple additional nodules up to 1.5 cm, diffuse skin thickening, including retropectoral lymphadenopathy. I am currently going through a series of 4 a/c chemo treatments, and my oncologists and radiologists are recommending a masectomy, followed by 2 treatments of taxotere(taxol), and then radiation. I am concerned whether or not this is the best treatment options. I am concerned whether I should have a masectomy or just the treatments for fear of cancer spreading once it is cut into. Also if I were to have the masectomy, should I have the right breast removed as well, as the have found some thickening of the skin, although the doctors do not seemed concerned now. Thank You.
		A:	its an old wive's tale that breast cancer spreads from being cut into. so don't fret about that. you want to make sure that the source of this disease is gone and surgery will help attain that goal. hang in there.
Question:  #1198 7/26/2005		Q:	Hi I am 36 years old and have recently had a lump removed and 20 lymph nodes removed. The tumor was a 20mm infiltrating ductal carcinoma grade 3 with no lymph node involvement both ER and PR negative. I am awaiting radiation therapy, would you recommend chemotherapy as well?
		A:	2.0cm is stage 2. you are young so anticipate a healthy discussion about chemo. worth seriously considering.
Question:  #1199 7/26/2005		Q:	I have an anal fissure which bleeds about once a month and is chronic. I am scheduled to begin CMF and I am concerned about sepsis or an infection. I need the chemo but fear complications. What are your thoughts?
		A:	yikes. it may make it worse. make sure your oncologist is aware of this.
Question:  #1200 7/25/2005		Q:	I have been having a difficult time in obtaining information about the potential for cancer recurrance as a result of chemotherapy treatment for breast cancer in a Li-Fraumeni Syndrome (familial p53 tendancy) patient. I am 25, diagnosed with grade 3 infiltrating ductal carcinoma with the tumor size at 1.2cm. I had a radical mastectomy and axillary lymph node dissection one month ago, and the pathology report indicated that all nodes are negative and margins are within 3mm. Also, pr-, er 10%+, her2neu+++. Two other in situ carcinomas were found in that breast, one attached to the infiltrating tumor. I am currently awaiting my reviewed pathology report which should show the ratio of infiltrating to in situ of this tumor. I had cancer nearly 20 years ago, related to the Li-Fraumeni familial tendancy (giant cell tumor in my foot - treatment was surgery only). My paternal side of the family has been identified as having the p53 mutation, and most of my relatives on that side of the family have passed away due to cancers that have been related to the mutation. I am scheduled to begin chemotherapy in three weeks - 4 tx AC, then 4 tx taxol. I will be on herceptin during the chemotherapy, continuing for a total of a year. My oncologist indicated that due to genetic damage that can be caused by the chemotherapy, I may be at a higher risk of recurrance. He was not willing to specify as to what this risk might be. Coupled with the Li-Fraumeni status, I am very concerned that I might do more damage then good by taking chemotherapy. Conversely I don't want to risk recurrance by not going through treatment. I feel very confused. The Li-Fraumeni Syndrome seems so rare worldwide that I am having difficulties in locating a knowledgeable specialist here in Canada. I am currently awaiting word as to if I might see just a different oncologist for a second opinion. If you have any information whatsoever on the rates of recurrance in high risk individuals, or anything even more specific to this situation, I would greatly appreciate it. I thank you very much for providing this important informational service, and am extremely grateful for your consideration. Sincerely, Lindsey Ireland
		A:	haven't heard about chemo increasing risk including for someone in your situation. you would be well served by meeting with a medical oncologist who specializes in genetics of breast cancer to get your questions answered about your risk of recurrence. local recurrence should be around 1% given you had a mastectomy done. the questions are risk for the other breast in your case and risk of distant recurrence.