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What treatment should be done for breast lump?

DOCTOR OF THE MONTH - Sep 2012
Sep 2012
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General & Family Physician
Practicing since : 2008
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The breast lump got trucut biopsy and report cance the oncologist has suggested few test like ER,PR,CErbb2 and ki67 and bone scan test ,after that he will start cemotherapy to kill cancer cells , then once lump reduced in size(presently size is approx is 6cm by 8cm) will operate .'other dr. suggest immediate surgery and then cemo.
we are confused what to do.
pl guide.
Posted Sat, 5 Jan 2013 in Breast Cancer
 
 
Answered by Dr. Das Arindam 1 hour later
Hello,
Thank you for posting a query.

Firstly, you should provide the total impresseion written at the last part of the biopsy report. This is important.

Some points determine need of neoadjuvant (chemotherapy given before surgery) chemotherapy :
1.     Size more than 5 cm. These tumors have higher chance of recurrence.
2.     Tumor differentiation.
3.     ER / PR expression of the tumor cells. In case of tumor containing cells expressing these receptors, the prognosis is excellent. Early starting of the treatment will help the tumor to reduce in size and help the clinician to detect the proper line of treatment depending upon the response of these hormonal agents. This point is not applicable in tumors expressing low ER / PR.
4.     Her2 Neu expression by the tumor cells. In case of positive tumor, chance of recurrence is greater. So, surgical extension and line of treatment can easily be determined by the clinician depending upon the expression of this marker.

So, in your case, lump is larger than 5cm. But, you have to do the tests for ER, PR, and Her2Neu. these are most important. Erbb2 and ki67 are not important in this stage. But as you have to do immunohistochemistry test on the biopsy slide, it is better to do all these at a time.

Lastly, you really need chemotherapy before surgery depending upon the size only. So, it is better to do the tests, mentioned above and go for chemotherapy before surgery.

Hope this information suffices. Let me know, if you have any more question.

Regards.
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