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Does my wife need chemotherapy after masectomy ?

By Anonymous January 31, 2010 - 3:49pm
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My wife had a 3cm tumor in her left breast and some discoloration in another area. She was originally going to have a lumpectomy but changed her mind and got a full nipple saving masectomy with reconstruction. There was no cancer detected in any other area of her breast and her sentinal nodes and surrounding nodes were cancer free. We are fairly sure that she does not have cancer cells in her system and wonder how much different her prognosis is with or without chemotherapy and with or without radiation.

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Here's one good article by the New York Times that includes some information on chemotherapy in early-stage breast cancer:


There are more side effects to chemotherapy other than the temporary ones of nausea, vomiting, fatigue or hair loss. Chemo also kills good cells, of course. Anemia, liver or kidney damage, increased chance of infection and hormonal changes all are possible. It's certainly good to explore all options available to you, but I imagine that most doctors are hesitant to provide chemo to a patient declared free of cancer because it can harm other, healthy parts of the body.

And here is an article from the National Institutes of Health about adjuvant therapy, which is what they call chemo, radiation, hormonal therapy and so on. This page discusses the role of adjuvant therapy in early-stage breast cancer:


Part of the decision-making process in adjuvant therapy depends on whether the breast cancer is estrogen-positive, for instance.

Here's another page that you may be interested in.


That page takes you through a Q & A that may help in making your decision.

This is a really good discussion by an oncologist on chemo for early-stage breast cancer patients:


That was one of the only pages I found that talked about quantifying the possible benefit of the chemotherapy in patients like this. Here's what it said:

Q: I know that some patients I talk to want to try to figure out how to quantify the benefit that they might get from chemotherapy. Have you found any useful ways to help patients through that exercise?

A: There’s a variety of tools that are out there. There’s some computer based programs that sort of do a risk assessment of what the risk of disease coming back is just based on features of the tumor, their age, other health issues, the impact of chemo in reducing that risk, the impact of hormonal therapy, and the impact of other active medical issues that are competing with the patient’s health issues. And I think a lot of patients find that helpful as a tool. I think, though, for many patients the mere fact that there’s a chance of their disease coming back, if they don’t have any health issues that really stand in the way, want to do everything at this point to reduce the risk so they don’t have to face this issue in the future. Even if the risk of benefit overall survival gain may be on the magnitude of 1 to 2%, many patients will do a short course of chemotherapy for that small gain.

Q: So in our discussion about chemotherapy thus far, we’ve really been talking about adjuvant therapy, which is chemotherapy or any therapy that’s given after surgery. You alluded in our earlier discussion to neo-adjuvant therapy. What patient should consider neo-adjuvant therapy and what is it?

A: Neo-adjuvant therapy is for the patient that presents typically with a little bit larger of a tumor. There may be some early skin involvement. There may be some adherence or stickiness of the tumor to the underlying muscles on the chest wall that may make surgery a little bit more difficult for those patients. And the other group of patients that come in for consideration of neo-adjuvant therapy would be patients that really were motivated for breast conservation and their tumor may just be on the borderline of whether going ahead with surgery first would allow them that option or not.

You didn't mention how old your wife is or exactly what kind of breast cancer she had. This New England Journal of Medicine article discusses adjuvant chemotherapy in women over age 65:


This article from the National Cancer Institute may give you some insight as well:


Does some of this information help?

Is your doctor recommending that your wife go one way or the other?

February 1, 2010 - 10:37am

I'm so sorry to hear about your wife's diagnosis, but it is wonderful news that her surgery was successful!

This is an interesting question, as I assume your wife's doctor said that it was unnecessary to undergo chemotherapy or radiation therapy in the absence of cancer cells...but you and she are wondering...what if? What if there are some cancer cells that have not been identified, and is undergoing these treatments worth the side effects if prognosis is improved?

Let me research this question, and we will get back to you soon.

January 31, 2010 - 9:26pm
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