Unnecessary chemo?

Maryflier

My friend had lumpectomy 3 weeks ago. NED in lymph nodes, declared stage 1. Doctor recommended chemo 1 X weekly for 1 year! Any explanation, anyone?

Bengal

Sounds like what I went through. Stage 1, no lymph node involvement. Apparently depends on type of cancer and size of tumor. I was told I wouldn't need chemo. After the lumpectomy it was determined the tumor was larger than originally estimated putting me over an arbitrarily line. First word out of oncologist mouth after my lumpectomy was chemo, once a week for 18 weeks, then once every third week for total of 53 weeks. Ǹ

po18guy

The sticking point is "MRD" or Minimum Residual Disease. Technology can detect cancer only down to one million plus cells (some claim much more than that). At that level, or below, it falls off the radar, yet still lives in your body. You are declared NED or Radiologically cancer free" but that is a rather crude standard with a very high margin of error. Since a single cancer cell missed by treatment and your immune system means that you have cancer, a course of therapy is intended to eliminate any cells that persist.

It is a mathematical regression: One infusion eliminates 75% of the remaining cells, leaving 25%. The next infusion eliminates 75% of that 25%, leaving 6.25% and so on until the level is so low that it has either been eradicated or your immune system is capable of dealing with it.

GregP_WN

Another way of looking at it is one of my experiences. In my first diagnosis, I was given chemo the standard regimen for Hodgkins lymphoma ABVD. Then I was supposed to have 28 radiation treatments. After 25, they stopped the treatments. I wasn't under any stress from them, I was doing OK. They just told me that they thought I had enough and could go about my life. 6 months later I had a recurrence.

So the question I have asked for 33 years now has been, what if? What if I had gotten those other 3 treatments? Would that have kept me from having the recurrence? I wasn't complaining, I would have gladly taken the last three.

So your friend might be just fine without the chemo, but also might not. I'm working on dx #5 right now, so if there is some treatment out there I want some of it. But, there are lots and lots of people that are more afraid of the treatment than they are of the cancer.

Each to their own decision.

po18guy

Bearing in mind here that the numbers in my earlier post are hypothetical and express a treatment principle. Actual regimens would vary depending on the type, stage and grade, as well as location of the cancer.

cak61

I had stage 1, my need for chemo was determined by Oncotype DX test. My score was low enough that I would not benefit from it.
This test is for ER positive cancer.
Was a reason given?
Maybe a second opinion should be sought?

Dltmoll

I would agree- get a second opinion and take someone with to take notes. There may be a good reason for this, but maybe it wasn't explained well enough or she was overwhelmed at hearing it.

2943

There is more to the decision making than stage. As previously stated, an oncotype or Mammaprint test will help decide. Which one depends on her cancer HER2positive, negative. Doctors also consider Er and Pr positive/ negative. Doctor may also want her to take an aromatase inhibitor. Many pieces to this puzzle. Hugs to her.

MarcieB

It is curious? I have to say I have never heard of anyone doing chemotherapy weekly for a year! Maybe it is a very low dose? I agree about a second opinion, or at least more clarification. I did herceptin every three weeks for a year, in addition to other chemotherapies. But, that was no big deal to tolerate. Maybe she just heard *a year* and her mind turned off - that happens to me and then I have to go back and ask, "Did you really say...?"

2943

That is also why I strongly encourage everyone to take someone with them. The patient is taking in so much and dealing with so many emotions, hearing sometimes stops.

TerriL

I would definitely get a second opinion, and have them take someone else with them to make sure they are understanding everything that is said.

ChicagoSandy

Another vote for second opinion—but was it Stage IA or IB? (Under some circumstances, a node-negative tumor, even if as large as 5+cm, can now be classified as IB)! What was the grade? Were the hormone receptors and HER2 status positive or negative? If the tumor was estrogen/progesterone+, what was the OncotypeDX or Mammaprint score? Triple-neg requires chemo. And HER2+ (regardless of hormone receptors) requires “targeted” therapy (usually Herceptin or Perjeta), which in turn requires chemo.

“Stage I” and node-negative is, sadly, not the whole story.

fiddler

Agreed, it's strange.

As a comparison, I had triple-negative breast cancer (TNBC), stage 1a, so it was not in the nodes. TNBC is the one 'they say' they can't do anything for, so they throw the kitchen sink at it.

My tx: a cocktail of A & C then T (I had 3 types of T) every other week for about 13 weeks, then 32 zaps of radiation.

For 1a.

If that's "throwing the kitchen sink at it", then what are they doing to your friend!

Please ask you friend to seek a second opinion.