Asking for a friend

fiddler

A good friend was diagnosed recently with invasive lobular cancer. The treatment they came up with is MRI to see if it spread to lymphs, removal of cancer, chemo, rads. She is stage 1A, the size is 5mm. This seems like overkill; what do you all think?

beachbum5817

I agree with you fiddler, I would encourage your friend to get a second opinion. My treatment was very close to this, and I am 3A and had a 5 cm tumor.

Kp2018

It wouldn't be overkill if it's triple negative. I'm glad your friend's cancer was found in such an early stage.

2943

If they are proposing a lumpectomy, radiation is almost always proposed. Chemo is indicated due to more than just stage. Type, location, genetic makeup all contribute to treatment course. Second opinion and asking for ALL OPTIONS are a good recommendation. Hugs!

Jouska

It really depends on the pathology of the tumor and other factors. So I agree with everyone else suggesting an opinion. It really helps to be all in on one's treatment, so if there are concerns that this is the right treatment a second opinion will help. My oncologist was very good about explaining exactly why certain things were in my treatment plan. I was 2a but HER2+ which always means chemo and targeted therapy (Herceptin). Her oncologist should be willing to go over the plan and why certain treatments are indicated. I chose to have a double mastectomy, my tumor was on the cusp of being too large for a lumpectomy and I just decided to eliminate risk with removing both breasts.

Gin

Age can also have an impact on a treatment plan. As previously mentioned, there are so many different factors that impact a treatment plan that no two are the same. It is very important to trust the oncologist and the treatment plan. Your friend should speak with the oncologist and give an opportunity for each step to be explained. If concern remains, then certainly seek a second opinion. My prayers are with your friend. Thank you for being an advocate for her.

legaljen1969

I hope your friend has a compassionate oncologist. Mine is definitely willing to explain all of the options and the reasons for their choices. Sometimes just having someone who is willing to explain the variables in layman's terms is invaluable.
Just based on "stage" and "size" maybe it seems a bit much, but I am sure there are many other factors in play that led to the treatment. Best wishes to your friend for a successful treatment regimen.
None of us want this horrible beast in our bodies. I have to say that the best advice I got early on was that of course you need a support network, and people who have had cancer can definitely give you some tips on things, but everyone's journey is different so don't get too locked into any one person's experience unless you know the whole story.
There are just too many variables and we all know cancer is definitely not a "one size fits all" disease.
Knowledge is power.

LiveWithCancer

I have a friend who I think had similar treatment after a double mastectomy (her choice to just get rid of the offenders and hopefully the possibility for more cancer). Her cancer, too, was very early stage.

fiddler

Wow ya'll - you blow me away! Thank you for you loving and caring responses. I have forwarded them to her. Perhaps she will join WhatNext for the good support she can find here.

Her sister died a year or two ago and she is deep in grief; they were very, very close, both adopted, from Ireland, from different women. Shall we talk 'corrupted DNA'? LOL

@Kp2018 ... I had TNBC, stage 1A, <5mm, and they threw the kitchen sink at it - lumpectomy, chemo, rads. Hers is much different than mine, thank God!!!

po18guy

If your friend is in the US, I strongly encourage a consult at a National Cancer Institute designated comprehensive cancer center for confirmation of the pathology report and for a second opinion on treatment.

https://www.cancer.gov/research/infrastructure/cancer-centers/find

ChicagoSandy

You also mentioned it was invasive lobular rather than ductal, which also makes a difference. It's a sneakier kind of breast cancer, and can spread further undetected (it tends to "hide out," and sometimes a lumpectomy doesn't get it all, even with clean margins. Pre-op, Stage I"A" is always a "guesstimate" with any invasive b.c. until lymph node status has been definitively determined--that they don't want to wait for a sentinel node biopsy during surgery but want to go ahead with an MRI first to check for lymph spread also is an indicator that it may be more serious than the mere tiny size would suggest.

The histology is important too: triple neg. or HER2+ can make it more aggressive, as can younger age (especially pre-menopausal). One thing you did not mention in the treatment plan is endocrine therapy,--which tells me it's not hormone-positive, and therefore may be potentially more aggressive. No mention of an OncotypeDX score also indicates it's at least ER-neg.

But by all means she should seek a second opinion--or a detailed and compassionate explanation of why they're throwing nearly the entire arsenal at such a tiny tumor. I suspect there may be more than meets the eye. Best wishes and good luck to her--may she get the treatment she needs, may she be able to tolerate it well, and may it be successful.

fiddler

@ChicagoSandy
Thank you for your thorough answer. It's not TNBC. She's hormone positive (HER2 & estrogen, progesterone), but I was surprised the doc didn't mention hormone therapy. She gets the MRI results tomorrow or Friday.

I have copied all the answers to this question and sent them to her, for support. Also, I sent her the link to join. She can use the awesome support from ya'll. Thank you so very much!

Carool

All I’ll add to the information provided by everyone else here is that I wish her all the best.

fiddler

P.S. - she said she'll have endocrine therapy, too.
I'm going to stop following now.
Thanks everyone!

ChicagoSandy

Fiddler, if her ILC is not just hormone but HER2+ ("triple positive") that, too, is an indicator of a more aggressive tumor. Did she say whether her chemo would include "targeted" therapy (e.g., Herceptin or Perjeta, both of which require a year of chemo first)?

cards7up

Lymph nodes always need to be checked with a breast cancer diagnosis. This is definitely not overkill by any means. A brain MRI should also be done. These are staging tests, so she really can't be staged by just the size of the nodule alone. And I definitely would get a second opinion at a top rated NCI cancer center.
https://www.breastcancer.org/symptoms/types/ilc