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Dr. Andrew Rynne
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for invasive ductal carcinoma


My mom has recently been diagnosed with IDC grade 2, invasive tumour in dermis and all first 8 lymph nodes tumour free with TNM: pT1, pN0, pMx. The tumour size is 0.8x0.7cm. The epidermis of skin is tumour free however tumour is identified in lower dermis. Tumour cells express E-Cadherins and are ER/PR positive and HER +2. The doctor has done Mastectomy and now advicing us that she would have radiation therapy for 4 weeks, may or may not with chemothrapy or 5 years medicine. I don't have any idea what to do as i can't understand why radiation is needed after mastectomy. If radiation is necesaary, what type is right for this kind of cancer (external or internal) and what dose is recommended? Further, why chemotherapy is needed in this case? Early suggestions would help.

Thank you.

Fri, 18 Sep 2015
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Oncologist 's  Response
Gretings. If a complete mastectomy has been done and nodes are free of tumor and the tumor size is small( as in your case), then radiation therapy is not required. Now comes the question of chemotherapy. First of all she has HER-2/neu status of 2+. so a FISH test is required to confirm whether she is HER-2 positive or not. If FISH test comes out to be positive ( a bad sign) then i will suggest chemotherapy plus targeted therapy for HER-2(trastuzumab drug). If it does not come positive(good sign) then trastuzumab is not required and requirement of chemo will be decided by another test called oncotype dx. if oncotype dx is high then chemo is required otherwise not.
Now comes the question of anti hormonal therapy. She requires 5 -7 years of anti hormonal therapy as she is ER positive. hope that solves your queries.
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