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Suggest Treatment For Ductal Carcinoma
Question: My aunt is diagnosed with ductal carcinoma T2N0M0. She got operated 8 days back by a surgical oncologist(lumpectomy with lymp node removal) . Final pathology report is attached for the reference. She is at present 53 years old.
My questions are:
1. How serious the reports are and can this be cured completely?
2. Today I spoke to the oncology surgeon who operated her and he was mentioning that the chemotherapy may not be needed but radiation and hormonal therapy is must. I will be meeting a oncologist tomorrow in his clinic to get further opinion. Kindly let me know your advice after seeing the report.
3. Surgeon mentioned that the radiation will start after 1 month of surgery. Is it ok to wait one month for the radiation?
4. What precautions she should take to avoid the recurrence of the disease.
My questions are:
1. How serious the reports are and can this be cured completely?
2. Today I spoke to the oncology surgeon who operated her and he was mentioning that the chemotherapy may not be needed but radiation and hormonal therapy is must. I will be meeting a oncologist tomorrow in his clinic to get further opinion. Kindly let me know your advice after seeing the report.
3. Surgeon mentioned that the radiation will start after 1 month of surgery. Is it ok to wait one month for the radiation?
4. What precautions she should take to avoid the recurrence of the disease.
Brief Answer:
yes it is curable
Detailed Answer:
Hi
Thanks for your query.
She has a small tumor with nodes negative, so chances of cure are high. As it is hormone receptor positive and her2 receptor negative, role of chemotherapy is low. Mostly it is hormone therapy tablets. Radiation is of course needed as the breast has been preserved.
Considering all factors, extra benefit of chemo in this situation is around 2% hence we usually do not recommend it. However, her treating oncologist may have a different opinion, which is justified as not everything is fixed in these situations.
Radiation usually starts 3-4 weeks after surgery.
She can lead a normal life, should maintain healthy body weight and avoid any estrogen supplements.
Hope this helps.
Regards
yes it is curable
Detailed Answer:
Hi
Thanks for your query.
She has a small tumor with nodes negative, so chances of cure are high. As it is hormone receptor positive and her2 receptor negative, role of chemotherapy is low. Mostly it is hormone therapy tablets. Radiation is of course needed as the breast has been preserved.
Considering all factors, extra benefit of chemo in this situation is around 2% hence we usually do not recommend it. However, her treating oncologist may have a different opinion, which is justified as not everything is fixed in these situations.
Radiation usually starts 3-4 weeks after surgery.
She can lead a normal life, should maintain healthy body weight and avoid any estrogen supplements.
Hope this helps.
Regards
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Thanks for the response.
I have heard that the "Ki 67" test value can be used in deciding the chemotherapy option. Request you to provide your inputs on this test. In the report, the value mentioned is 15%.
I have also heard of "oncotype dx" test but this is not yet done for her. Do you recommend doing this test as well? Is this test available in Bangalore? Please let me know your thoughts.
I have heard that the "Ki 67" test value can be used in deciding the chemotherapy option. Request you to provide your inputs on this test. In the report, the value mentioned is 15%.
I have also heard of "oncotype dx" test but this is not yet done for her. Do you recommend doing this test as well? Is this test available in Bangalore? Please let me know your thoughts.
Brief Answer:
Ki67 is borderline
Detailed Answer:
Usually the cutoff of ki67 is 14-15%. So it is borderline in her. Even if we take it as positive, the benefit comes to around 2%.
Oncotype dx can help in deciding but it is not available in XXXXXXX The biopsy block has to be shipped to USA. It will cost $3000-4000. Hence rarely done.
Ki67 is borderline
Detailed Answer:
Usually the cutoff of ki67 is 14-15%. So it is borderline in her. Even if we take it as positive, the benefit comes to around 2%.
Oncotype dx can help in deciding but it is not available in XXXXXXX The biopsy block has to be shipped to USA. It will cost $3000-4000. Hence rarely done.
Above answer was peer-reviewed by :
Dr. Yogesh D
Today, we have been told to meet the radiation oncologist by our surgeon and the plan is to start her with radiation first from 31st XXXXXXX Doctor mentioned that we need to do below blood test before coming for radiation.
CBC
RBS
BUN
SCRENT
Doctor also told that some scan will be performed before starting the radiation and based on the progress they will decide on how many days it has to be given and also chemotherapy is needed or not.
He also mentioned that her age is the only factor to consider for the chemotherapy, otherwise there is no reason to choose it.
I asked him about the ONCOTYPE DX test but he mentioned it is very expensive and there is an equivalent test available in XXXXXXX which would cost around 40k. He told some name but forgot it. Are you aware of any test like this?
Basically they will take a decision on the chemo during the course of radiation. I am not very sure whether we are in a right path with the treatment. Please advise.
Hormone therapy will follow.
CBC
RBS
BUN
SCRENT
Doctor also told that some scan will be performed before starting the radiation and based on the progress they will decide on how many days it has to be given and also chemotherapy is needed or not.
He also mentioned that her age is the only factor to consider for the chemotherapy, otherwise there is no reason to choose it.
I asked him about the ONCOTYPE DX test but he mentioned it is very expensive and there is an equivalent test available in XXXXXXX which would cost around 40k. He told some name but forgot it. Are you aware of any test like this?
Basically they will take a decision on the chemo during the course of radiation. I am not very sure whether we are in a right path with the treatment. Please advise.
Hormone therapy will follow.
Brief Answer:
Chemo before radiation
Detailed Answer:
If chemo is to be given, it has to be before RT. Nothing new is going to happen during RT which would provide more information to decide about chemo. Age alone is not criteria, size of tumor, grade, lymphovascular invasion, nodes, ER, PR, her2, everything should be taken into account. The estimate which I have given is from predict tool of NHS UK, available online for free.
Many labs in XXXXXXX have started various genomic tests for less cost but these are not standardized in my opinion.
I think you should meet a qualified DM Medical oncologist in your city. That would clear the doubts.
Chemo before radiation
Detailed Answer:
If chemo is to be given, it has to be before RT. Nothing new is going to happen during RT which would provide more information to decide about chemo. Age alone is not criteria, size of tumor, grade, lymphovascular invasion, nodes, ER, PR, her2, everything should be taken into account. The estimate which I have given is from predict tool of NHS UK, available online for free.
Many labs in XXXXXXX have started various genomic tests for less cost but these are not standardized in my opinion.
I think you should meet a qualified DM Medical oncologist in your city. That would clear the doubts.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for your response.
As suggested, I will book an appointment with medical oncologist at the earliest to get the treatment plan and will update you.
Just curious to know, even in this case 6 to 12 rounds of chemo is recommended? Asking this question because in my known circle, most of the cancer cases received these many rounds of chemo. I know it depends on the stage and other factors but just trying to understand the protocol.
As suggested, I will book an appointment with medical oncologist at the earliest to get the treatment plan and will update you.
Just curious to know, even in this case 6 to 12 rounds of chemo is recommended? Asking this question because in my known circle, most of the cancer cases received these many rounds of chemo. I know it depends on the stage and other factors but just trying to understand the protocol.
Brief Answer:
Even less is ok
Detailed Answer:
For her, even if chemo is given, 4-6 cycles should be enough
Even less is ok
Detailed Answer:
For her, even if chemo is given, 4-6 cycles should be enough
Note: For further queries related to kidney problems Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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