ask: Is chemotherapy necessary in invasive ductal breast cancer where the tumor is over 2 cm?
I have just been diagnosed with Invasive Ductal Breast Cancer. I was misdiagnosed 8 months ago and now the tumor has grown to 2.2 cm.
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Hi, SJ, and welcome to EmpowHer. I'm so glad you found us.
You've had a tough time recently, haven't you? I'm so sorry about your diagnosis, and especially about your misdiagnosis.
Tell me, SJ, how did the misdiagnosis occur? Are you still with the same doctor or have you since switched? Do you have a breast specialist or an oncologist?
In the meantime, I'll do some research for you and get back with you soon.
July 21, 2009 - 9:28amThis Comment
SJ,
As I'm sure you've found, there's a ton of information on the web about breast cancer in general and invasive breast cancer in specific. Let's see if I can be of any help to you.
You have the most common kind of breast cancer; about 80% of all breast cancer patients have this type. Here's some information from breastcancer.org:
"Invasive means that the cancer has “invaded” or spread to the surrounding breast tissues. Ductal means that the cancer began in the milk ducts, which are the “pipes” that carry milk from the milk-producing lobules to the nipple. Carcinoma refers to any cancer that begins in the skin or other tissues that cover internal organs — such as breast tissue. All together, “invasive ductal carcinoma” refers to cancer that has broken through the wall of the milk duct and begun to invade the tissues of the breast. Over time, invasive ductal carcinoma can spread to the lymph nodes and possibly to other areas of the body."
There is a diagram on that page that might be helpful:
http://www.breastcancer.org/symptoms/types/idc/
Did your doctor give your cancer a certain Stage Number? Staging has to do not only with the size of the tumor but also with where it's located and what kind of tissue it has invaded. From the Mayo Clinic's page, it appears that your tumor would be Stage 2, though barely:
http://www.mayoclinic.com/health/breast-cancer-staging/BR00022/NSECTIONG...
Do you know yet if the cancer has spread to any lymph nodes?
Do you have surgery planned?
Is your doctor recommending chemo?
Chemo is a tricky question for the stage you are in. If you were in Stage I, which is Early Stage Breast Cancer and is characterized by a tumor less than 2 cm big, the question would be a little easier. Here is what womenshealth.gov has to say about whether chemotherapy is necessary:
"Chemotherapy is not recommended for most women with early stage breast cancer. If chemotherapy is recommended, it can improve survival and decrease the risk of breast cancer recurrence. There are several different kinds of chemotherapy, and it is sometimes used in combination with tamoxifen. Chemotherapy is usually given after surgery, but there are exceptions. For example, a woman with Stage III breast cancer may undergo chemotherapy before surgery to shrink a tumor so that she can undergo breast-conserving surgery."
There is a ton of great information on that page:
http://www.womenshealth.gov/FAQ/early-stage-breast-cancer.cfm
And here is the Mayo Clinic's page on treatments and therapies. It also discusses when chemo is used, and how you and your doctor make the decision:
http://www.mayoclinic.com/health/breast-cancer/DS00328/DSECTION=treatmen...
Can you tell us what your doctors are recommending? And again, do you feel you are in the hands of the right doctor now?
July 21, 2009 - 10:09amHi Diane,
Thanks so much for this helpful information and for taking the time to research my case. It has been kind of rough but support like yours helps alot.
I am no longer with the gynecologist that failed to diagnose the cancer (he never once looked at the ultrasound results or the mammograms but simply read the reports) The cancer was originally diagnosed as a fibroadenema 8 months ago and when it continued to grow, I returned and asked if I could have a biopsy.
I see a specialist/surgeon tomorrow and should know more. I don't know what stage it's in but it is grade 2. And it has an HER-2 score of 0 (I read up a little on that as well).
Thanks again so much and I'll be keeping posted of results
July 21, 2009 - 11:08amHello SJ! Let me echo what Diane wrote and welcome you to EmpowHer! We are so glad that you found us.
I am so sorry that you were misdiagnosed with a fibroadenema. I'm glad that you have switched doctors and are meeting with a specialist tomorrow. I am so proud of you for being proactive about your own health and advocating for yourself and a biopsy. It also sounds like you are doing a great job about educating yourself about the cancer and treatments and staying on top of things.
I wanted to let you know that we have forwarded the subject line of your ASK to an expert to get his opinion on chemotherapy. Once he gets back to us we'll post his reply here for you.
I hope you don't mind my asking, but did you feel the lump yourself, or did it show up on the first mammogram and then ultrasound, and you can only feel it now that it's bigger?
Thank you for keeping us posted on your results. I can tell you have an amazing attitude and that will help so much during this time. Big hugs to you, Michelle
July 21, 2009 - 11:14pmHi Michelle,
Thank you for your message and for your encouragement. I live in France, a country where this kind of discourse is really not common. Women don't talk about it much and I am very appreciative of this warm feedback from you and Diane.
To answer your question, I felt the lump myself and went to a gynecologist here in France. My own father-in-law is a doctor here and raised concerns about the gynecologist early on, saying he didn't like the gynecologist's dismissal of my concerns as normal breast aging. Even as a general practitioner, he said he didn't think lumps were part of any normal breast aging he knew. I should have done something then but I thought a mammogram and ultrasound would solve the problem.
The new gynecologist who is younger and a woman, is very pro-active and has sent me to a cancer institute here that specializes in breast cancers.
I just want to thank you and Diane both again, for your warmth and support. It means a great deal to me.
I'll post after I see the specialist tonight! take care Jane
July 22, 2009 - 12:02amHi SJ,
I did an audio interview with Dr. Jay Harness about your question and it should be edited and added to the site soon.
Dr. Jay Harness is a member of EmpowHer's Medical Advisory Board, a past-President of The American Society of Breast Surgeons and the President-elect of Breast Surgery International and he's the Director at St. Joseph Hospital Comprehensive Breast Center in Orange, California.
I'm sure his response address your questions.
Thank you for reaching out to us.
Best of health,
Todd
July 23, 2009 - 3:03pmHi Todd,
Thanks alot for this interview. I'll be looking out for it. I just saw a chemotherapist. In fact, my doctor feels the lump should be treated with chemotherapy immediately before surgery (to reduce its size) so I did get an answer at least. I would like to have a second opinion however and the interview can only give me more information for a conditionI am struggling to understand properly (while having it).
thanks agin...best to you as well Jane
July 24, 2009 - 1:03amSJ,
July 23, 2009 - 10:15pmI'm sorry to hear about your diagnosis. Best of luck with whatever treatment you decide to follow.
Thanks anonymous...I appreciate your support Jane
July 24, 2009 - 1:04amDear SJ-
August 24, 2009 - 8:09amA second opinion is always a good idea when deciding such a big issue as chemo therapy. There is a test called the Oncotype DX test which can be performed on breast cancer tumors to see if they will benefit frm chemo therapy. If I understood you correctly your tumor was NOT her2 positive. Her2 positive cancers respond to Herceptin which, even in low staged breast cancers, is most effecftive when given along with chemo therapy. If your lymph nodes are clear (have you have a sentinel node lymph biopsy performed yet?) this would help in the decision as well. I know it is a very scary time for you and I hope you will feel the support of this community in helping you wade through the many choices out there.
Koryn