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Suggest Treatment For 3B Breast Cancer

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Posted on Thu, 3 Apr 2014
Question: My mom who is 84 and in good all around health has stage 3B breast cancer. She has had a mastectomy and 10 lymph nodes removed which 7 were cancer. The dr. wants to do chemo and radiation. What are her chances if she does both or what if she just does radiation.
doctor
Answered by Dr. Krishna Kiran Kannepalli (1 hour later)
Brief Answer: Family has to decide Detailed Answer: Hi. Thanks for the query. It is a tricky situation. As per guidelines, patients in stage IIIB require both chemotherapy and radiation. But at 84 years of age, cure is not the only criterion that we should aim for. Her ability to tolerate the treatment is also equally important. Chemotherapy is associated with significant side effects and they should not be ignored in the decision making process. 2 important things to look at are the ER/PR status, Her 2 status and whether it is a left sided tumor or right sided tumor. If the tumor is ER/PR positive, then at this age according to me, hormonal therapy in the form of Aromatase inhibitors should suffice. Her cardiac status should be evaluated by a cardiologist before taking a decision. If it is right sided breast cancer, dose to the heart will be minimal and radiation can be given safely. If it is left sided then dose to the heart will be significant and one has to weigh the risks and benefits of radiation very carefully. Techniques such as IMRT should be used to minimise dose to the heart. If the tumor is Her2 positive, Herceptin is indicated. It is however cardiotoxic and therefore the heart condition should be good enough to tolerate the medication.If the tumor is ER/PR negative, chemotherapy becomes a necessity, non cardio toxic drugs such as taxanes are preferable at this age. I hope my answer has satisfied you. In case of doubts, please revert back. I will be happy to answer you.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Krishna Kiran Kannepalli (1 hour later)
Her tumor was on her left side. They were going to put the port on her right side. I don't know what you mean by her ER/PR status is.
doctor
Answered by Dr. Krishna Kiran Kannepalli (1 hour later)
Brief Answer: hormonal status Detailed Answer: Hi. Thanks for the query. ER/PR (estrogen and progesterone receptors) status represents the hormonal receptor status of the tumor. It will be mentioned in the biopsy report. You can check it with your oncologist. It is a mandatory test in all breast cancers as the entire treatment strategy revolves round the receptor status. Since the tumor is on the left one had to be very careful while giving radiation in order to avoid cardiotoxicity. Please discuss these issues with your oncologist and if possible request for your case to be discussed in a tumor board meeting.
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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Krishna Kiran Kannepalli

Oncologist, Surgical

Practicing since :2004

Answered : 59 Questions

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Suggest Treatment For 3B Breast Cancer

Brief Answer: Family has to decide Detailed Answer: Hi. Thanks for the query. It is a tricky situation. As per guidelines, patients in stage IIIB require both chemotherapy and radiation. But at 84 years of age, cure is not the only criterion that we should aim for. Her ability to tolerate the treatment is also equally important. Chemotherapy is associated with significant side effects and they should not be ignored in the decision making process. 2 important things to look at are the ER/PR status, Her 2 status and whether it is a left sided tumor or right sided tumor. If the tumor is ER/PR positive, then at this age according to me, hormonal therapy in the form of Aromatase inhibitors should suffice. Her cardiac status should be evaluated by a cardiologist before taking a decision. If it is right sided breast cancer, dose to the heart will be minimal and radiation can be given safely. If it is left sided then dose to the heart will be significant and one has to weigh the risks and benefits of radiation very carefully. Techniques such as IMRT should be used to minimise dose to the heart. If the tumor is Her2 positive, Herceptin is indicated. It is however cardiotoxic and therefore the heart condition should be good enough to tolerate the medication.If the tumor is ER/PR negative, chemotherapy becomes a necessity, non cardio toxic drugs such as taxanes are preferable at this age. I hope my answer has satisfied you. In case of doubts, please revert back. I will be happy to answer you.