What Matters Most To You
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have chemotherapy after surgery
Reasons not to have chemotherapy
I want to do everything possible to treat the breast cancer.
I would rather wait and see if the cancer comes back before I have more treatment.
I would have strong feelings of failure if the breast cancer returned.
I know there’s no way to know for sure whether chemo would keep the cancer from coming back.
I want to have the added treatment and be done with it.
I would be comfortable having frequent follow-ups, without the added treatment.
I feel ready to deal with the possible side effects of chemo.
I am very worried about the side effects.
Cancer Researchers Worry Immunotherapy May Hasten Growth Of Tumors In Some Patients
Depending on characteristics such as how many tumor cells, blood vessel cells, and immune cells are touching each other, the tumor microenvironment can nearly triple the chance that a common type of breast cancer that has reached the lymph nodes will also metastasize, Condeelis and colleagues showed in a 2014 study;of 3,760 patients. The discovery of how the tumor microenvironment can fuel metastasis by whisking cancer cells into blood vessels so impressed Dr. Francis Collins, director of the National Institutes of Health, that he featured it in his blog.
The new study took the next logical step: Can the tumor microenvironment be altered so that it promotes or thwarts metastasis?
To find out, Einsteins George Karagiannis spent nearly three years experimenting with lab mice whose genetic mutations make them spontaneously develop breast cancer, as well as mice given human breast tumors. In both cases, paclitaxel changed the tumor microenvironments in three ways, all more conducive to metastasis: The microenvironment had more of the immune cells that carry cancer cells into blood vessels, it developed blood vessels that were more permeable to cancer cells, and the tumor cells became more mobile, practically bounding into those molecular Lyfts.
Pre-op chemo may have unwanted long-term consequences in some breast cancer patients, the Einstein researchers wrote.
Treatment For Stage 1 Breast Cancer
Doctors can offer a variety of treatment options for stage 1 breast cancer, although surgery is the primary treatment.
A lumpectomy or mastectomy are both viable surgical options for people with stage 1 breast cancer. A doctor will decide what surgery is most appropriate depending on the location of the primary tumor, how large it is, the size of the breast, family history, genetics, and the persons preference.
Radiation therapy is a standard treatment for stage 1 breast cancer. However, a doctor may not recommend radiation therapy for people over 70 years old, particularly if hormone therapy is suitable.
If the breast cancer is ER+ or PR+, hormone therapy may be effective. Hormone therapy works by preventing the growth of estrogen, which helps cancer grow. Hormone therapy can reach cancer cells in the breast as well as other areas of the body and reduces the risk of the cancer coming back.
Before recommending chemotherapy, a doctor will test to see whether the cancer is hormone receptive.
If the test results show that the cancer is not receptive to estrogen and progesterone or to another protein called human epidermal growth factor receptor 2 , it is known as triple-negative breast cancer .
Hormone therapy is ineffective against this cancer type, and people who have TNBC will usually need chemotherapy.
Stage 2 breast cancer also has subcategories known as 2A and 2B.
Stage 2A breast cancer is an invasive cancer where:
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Is Chemo Really Necessary
Good morning everyone – I’m on here because my husband was diagnosed with male breast cancer back in April.; He had surgery on 16th May to remove the tumour behind his left nipple, the nipple itself,;and they also took away three lymph nodes under his left arm, as a precaution.; He now has a very large scar!;Last Friday, he went to see the chemotherapy nurse, and has found that he has been scheduled for six sessions of chemo over 18 weeks.; Quite understandably, he is dreading this , and has started wondering if a) he HAS to have it b) are there alternatives and c) what if he has nothing more in the form of treatment?; So far, whilst he has obviously had an operation, he has not been “ill”, and I can’t bear the thought of my good-natured, upbeat, positive Scotsman becoming sick, tired and depressed.; As far as we both know, in follow up scans, there is no sign that his cancer has spread anywhere else, and his surgeon was delighted with the outcome of his operation.; We both know that no two people are the same when it comes to side effects, but sure as eggs are eggs, there will be side effects.; Any advice/reassurance/experience of other therapies would be seriously welcome.; Thank you so much.; Catherine.
Hi HM …… welcome to the forum and I am happy to hear that your husband has recovered well from his operation. That is great news!
What Is Targeted Therapy For Her2
When a cancer is HER2-positive, it means that the cancer cells make too much HER2 protein, which can cause tumors to grow more rapidly than with other forms of breast cancer.
Drugs that target the HER2 proteins are the primary treatment for this type of breast cancer, given along with chemotherapy. Your oncology team may refer to these medications as targeted therapy or HER2-directed therapy.
Trastuzumab and pertuzumab are the most commonly used drugs used to treat HER2-positive breast cancer. Neratinib is another drug that is sometimes given after trastuzumab.
Some other targeted therapy drugs, such as lapatinib or ado-trastuzumab emtansine , are mainly used to treat more advanced HER2-positive breast cancers.
Herceptin and Perjeta are given at the same time as chemotherapy through an IV. HER2-directed therapy is usually given over a longer period of months than chemotherapy.
Herceptin alone is usually continued after chemotherapy has finished, every three weeks for a total of one year.
Side effects for HER2-targeted therapies may include:
- sleep problems
- redness at the IV site
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Increased Risk Of Leukemia
Very rarely, certain chemo drugs can cause diseases of the bone marrow, such as myelodysplastic syndromes;or even acute myeloid leukemia, a cancer of white blood cells. If this happens, it is usually within 10 years after treatment. For most women, the benefits of chemo in helping prevent breast cancer from coming back or in extending life are far likely to exceed the risk of this rare but serious complication.
Many Women With Early Breast Cancer May Not Need Chemo Study Finds
Most women with early-stage breast cancer may be able to avoid chemotherapy, a new study finds.
Researchers determined that patients with smaller tumors that had not spread to the lymph nodes did just as well without chemo as those who got the treatment, according to the study presented Sunday at the American Society of Clinical Oncology meeting and published in the New England Journal of Medicine.
Experts cautioned, however, that the findings may not apply to those who have larger tumors or those with cancer that has started to spread, or metastasize. More studies are needed to look at those groups of women, they said.
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Chemotherapy Before Breast Cancer Surgery Might Fuel Metastasis
When breast cancer patients get chemotherapy before surgery to remove their tumor, it can make remaining malignant cells spread to distant sites, resulting in incurable metastatic cancer, scientists reported;last week.
The main goal of pre-operative chemotherapy for breast cancer is to shrink tumors so women can have a lumpectomy rather than a more invasive mastectomy. It was therefore initially used only on large tumors after being introduced about 25 years ago. But as fewer and fewer women were diagnosed with large breast tumors, pre-op chemo began to be used in patients with smaller cancers, too, in the hope that it would extend survival.
But pre-op chemo can, instead, promote metastasis, scientists concluded from experiments in lab mice and human tissue, published in Science Translational Medicine.
The reason is that standard pre-op chemotherapies for breast cancer paclitaxel, doxorubicin, and cyclophosphamide affect the bodys on-ramps to the highways of metastasis, said biologist John Condeelis of Albert Einstein College of Medicine, senior author of the new study.
Success For Certain Cancer Types
Certain factors are considered in the choice to give neoadjuvant chemotherapy. These include the size of the tumor, evidence of lymph node involvement as well as the type of breast cancer.
Some specific types of breast cancer are more likely to respond to neoadjuvant chemotherapy, Dr. Moore says.
Unless the tumor is very small and shows no lymph node involvement most patients with either triple-negative breast cancer or HER2-positive breast cancer will be candidates for chemotherapy ; either pre-operatively or post-operatively.;;
In the best cases, this therapy can completely eradicate all visible tumor from the breast, producing what is called a pathologic complete response. This means a pathologist finds no trace of the invasive tumor in the breast or lymph nodes after treatment.
Thats good news not only in the short term, but also over a patients lifetime as the presence of a complete response is generally associated with an excellent prognosis.
For patients who do not have a complete response to neoadjuvant chemotherapy, additional treatments can also be administered in the post-operative or adjuvant setting to improve long-term outcomes.;In this way, treatments can be individualized. Often this means applying more intensive treatments to those at higher risk.
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Will The Nhs Fund An Unlicensed Medicine
It’s possible for your doctor to prescribe a medicine outside the uses it’s licensed for if they’re willing to take personal responsibility for this ‘off-licence’ use of treatment.
Your local clinical commissioning group may need to be involved, as it would have to decide whether to support your doctor’s decision and pay for the medicine from NHS budgets.
Page last reviewed: 28 October 2019 Next review due: 28 October 2022
When To Consider Joining A Clinical Trial
If youre newly diagnosed with early or locally advanced breast cancer, consider joining a clinical trial before starting treatment. For most people, treatment doesnt usually start right after diagnosis. So, theres time to look for a clinical trial that youre eligible for and fits your needs.
Once youve begun standard treatment for early or locally advanced breast cancer, it can be hard to join a clinical trial.
Learn more about clinical trials.;
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Radiation Therapy And Mastectomy
Most women who have a mastectomy dont need radiation therapy if theres no cancer in the lymph nodes.
In some cases, radiation therapy is used after mastectomy to treat the chest wall, the axillary lymph nodes and/or the lymph nodes around the collarbone.
For a summary of research studies on mastectomy versus lumpectomy plus radiation therapy and overall survival in early breast cancer, visit the Breast Cancer Research Studies section.
For a summary of research studies on radiation therapy following mastectomy for invasive breast cancer,;visit the Breast Cancer Research Studies section.
Starting With Neoadjuvant Therapy
Most often, these cancers are treated with neoadjuvant chemotherapy . For HER2-positive tumors, the targeted drug trastuzumab is given as well, sometimes along with pertuzumab . This may shrink the tumor enough for a woman to have breast-conserving surgery . If the tumor doesnt shrink enough, a mastectomy is done. Nearby lymph nodes will also need to be checked. A sentinel lymph node biopsy is often not an option for stage III cancers, so an axillary lymph node dissection is usually done.
Often, radiation therapy is needed after surgery. If breast reconstruction is done, it is usually delayed until after radiation is complete. In some cases, additional chemo is given after surgery as well.
After surgery, some women with HER2-positive cancers will be treated with trastuzumab for up to a year. Many women with HER2-positive cancers will be treated first with trastuzumab followed by surgery and then more trastuzumab for up to a year. If after neoadjuvant therapy, any residual cancer is found at the time of surgery, trastuzumab may be changed to a different drug, called ado-trastuzumab emtansine, which is given every 3 weeks for 14 doses. For people with hormone receptor-positive cancer in the lymph nodes who have completed a year of trastuzumab, the doctor might also recommend additional treatment with an oral drug called neratinib for a year.
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What Should A Person With Stage 0 Or Stage 1 Breast Cancer Expect Regarding Treatment
Even though Stage 0 breast cancer is considered non-invasive, it does require treatment, typically;surgery;or;radiation, or a combination of the two. ;Chemotherapy;is usually not part of the treatment regimen for earlier stages of cancer.
Stage 1 is highly treatable, however, it does require treatment, typically surgery and often radiation, or a combination of the two. Additionally, you may consider;hormone therapy, depending on the type of cancer cells found and your additional risk factors. Like stage 0, Chemotherapy is often not necessary for earlier stages of cancer.;
Material on this page courtesy of National Cancer Institute
Healthbrca Mutations Don’t Hurt Breast Cancer Survival
The new study followed 9,717 women with early-stage disease, ages 18 to 75, with estrogen-receptor-positive, HER2-negative cancers that had not spread to the lymph nodes cases where doctors have been unsure whether chemo would be helpful.
Of the 9,717 women, 6,711, or 67 percent, had test scores indicating an intermediate risk of recurrence their score was 11 to 25. After surgery and radiation, those women were randomly assigned to receive chemotherapy with an estrogen-blocking medication or just the estrogen hormone blocker.
Prior to the study, doctors knew women with a low score on the test, less than 11, were told they could skip chemo with no ill effects. Women at high risk, or scores of 26 or higher, were advised to have chemo.
The new study showed that women with intermediate risk, it made no difference in terms of recurrence whether a woman was treated with chemotherapy or not.
We didnt know if chemotherapy benefited women in this range,” said Dr. Sara Hurvitz, an associate professor at the University of California, Los Angeles, and director of breast medical oncology at the UCLA/Jonsson Comprehensive Cancer Center. “The study showed that if you take the group as a whole, there is no difference in the risk of recurrence when you compare chemotherapy to no chemotherapy.
Some cancer specialists have been postponing the decision to treat their newer patients with chemotherapy until the study findings were released.
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Hormone Therapy After Surgery
If the DCIS is hormone receptor-positive , treatment with tamoxifen or an aromatase inhibitor for 5 years after surgery can lower the risk of another DCIS or invasive cancer developing in either breast. If you have hormone receptor-positive DCIS, discuss the reasons for and against hormone therapy with your doctors.
Chemo Not Always Needed Breast
Some women are being treated for breast cancer with chemotherapy, when taking a pill would be just as effective, according to a study to be released today.
The study looks at one form of chemotherapy in postmenopausal women whose cancer was confined to their breasts.
The study found that women with hormone-sensitive tumors fared just as well taking the drug tamoxifen alone as did women who had chemotherapy and tamoxifen.
But both treatments together better helped women whose tumors were not sensitive to hormones.
The research suggests chemotherapy is not appropriate for all breast-cancer patients, who often suffer through hair loss, nausea and other side effects from the treatment.
“We’re hoping this study will question the routine use of chemotherapy in the group,” said Richard D. Gelber, a biostatistician at the Dana-Farber Cancer Institute in Boston, who was involved in the study.
While the findings might help doctors avoid the unnecessary use of chemotherapy for some patients, doctors say the research ultimately calls attention to the need for better chemotherapy drugs.
The researchers used a regimen of chemotherapy referred to as CMF, which includes less-aggressive drugs often used for older patients who cannot tolerate more-toxic regimens.
In the study, 1,669 women were divided into groups depending on whether their cancers were sensitive to estrogen, a hormone that can promote the growth of tumor cells.
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More About Endocrine Therapy In Rxponder
Meeting co-director Osborne said that premenopausal women in RxPONDER were “nearly always” prescribed tamoxifen.
However, he observed that the current standard approach to treatment in this age group would be ovarian suppression plus either an aromatase inhibitor or tamoxifen, “both of which have been shown to be superior to tamoxifen alone in this subgroup.
“Since the adjuvant chemotherapy causes ovarian suppression in many premenopausal patients,” he said, “these patients then in fact received ovarian suppression plus tamoxifen,” rather than tamoxifen alone for the group that did not receive chemotherapy.
Osborne asked a question that came up again and again during the post-presentation discussion: “Is the difference in outcome in this subset due to the endocrine effects of chemotherapy?
“Unfortunately, we may never know the answer to this question,” he added.
Kalinsky replied that whether the difference in benefit of chemotherapy in premenopausal women “was a direct benefit, meaning that there’s something about the biology difference” between tumors in premenopausal vs postmenopausal women, “or whether this was an indirect effect, meaning impacting rates of amenorrhea…is not specifically how this study was designed.”
However, an exploratory landmark analysis at 6 months suggested that the use of ovarian suppression with endocrine therapy did not have an effect on outcomes.
San Antonio Breast Cancer Symposium 2020: Abstract GS3-00. Presented December 10, 2020.