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If you had stage 1 breast cancer and clear margins with no evidence of lymph nodes involved would that mean?

Discuss Breast Cancer, one of the most common forms of cancer in the world today.

If you had stage 1 breast cancer and clear margins with no evidence of lymph nodes involved would that mean?

Postby cocidius » Fri Apr 01, 2011 9:59 pm

that it is probable that the cancer DID NOT enter the bloodstream?

A friend was just diagnosed with this and the oncologist said it was up to them if they wanted chemotherapy. (Which just does not seem right) but apparently the team said it could go either way. Knowing the costs of what chemotherapy could do, I would say they are steep.

So do you think chemotherapy would be needed if margins were clear. Dealing with Triple Negative Breast Cancer, stage 1. 1.25 cm.
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If you had stage 1 breast cancer and clear margins with no evidence of lymph nodes involved would that mean?

Postby shea51 » Fri Apr 01, 2011 9:59 pm

that it is probable that the cancer DID NOT enter the bloodstream?

A friend was just diagnosed with this and the oncologist said it was up to them if they wanted chemotherapy. (Which just does not seem right) but apparently the team said it could go either way. Knowing the costs of what chemotherapy could do, I would say they are steep.

So do you think chemotherapy would be needed if margins were clear. Dealing with Triple Negative Breast Cancer, stage 1. 1.25 cm.
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If you had stage 1 breast cancer and clear margins with no evidence of lymph nodes involved would that mean?

Postby korey37 » Fri Apr 01, 2011 10:05 pm

Hi Dave
Denisedds is revealing her age a bit if she remembers when chemotherapy was not recommended for node negative breast cancers. That was the 1980's
With a 1.25 cm primary lesion + clear margins and a good axillary lymph node sampling showing no positive nodes, the likelihood ~ 90% that the breast cancer cells have not spread via the bloodstream.
That still leaves a ~10% risk that the cancer cells have spread and will cause recurrent disease in the next 5, 10, 15, or 20 years. So, if this person receives adjuvant chemotherapy, she may reduce that ~10% risk of recurrence to maybe 5%. A 90% chance that she is cured without chemo vs a 94 to 95% chance that she will be cured with chemotherapy.

And here's the rub, Dave. Roughly 9 out of 10 women with this stage disease do not need the chemotherapy with all the expense and the toxicity which you are well aware of. But we do not know which ones are already free of microscopic disease. So we now treat 10 women to possibly help 1. I greatly disliked this part of oncology - the guessing that is a part of the process. It would take an hour to explain this to a patient and her family. Then they would have to decide what risk they were willing to take. They would usually ask me, "What would you do?" I could not answer that. Only a person faced with this risk can really answer this. How much is one willing to go through to optimize the chances of remaining free of future breast cancer recurrence?

Even more difficult is the fact that even people who go through aggressive adjuvant chemotherapy for breast carcinoma cannot be sure they are truly cured until about 20 years go by. I think you know this all too well.

In adjuvant breast cancer therapy, we are treating disease we cannot see - disease which might or might not be there. Only when recurrent breast cancer develops years later do we know which women had microscopic spread before the primary lesion was removed. Once breast cancer recurs with visible metastatic lesions, it is no longer curable with chemotherapy. The time to treat it with systemic chemotherapy is when it is too small to be seen with any scans known to man.

The choice is up to the patient and the family
- but the current recommendation is to treat 10 to possibly help 1.
In the 1980's we felt that a ~90% cure rate without chemotherapy was enough.
Now the recommendation is to treat all to help a few.
What do you think?
Also, what age is this person? That makes a difference too.

Please note that recurrence rates for stage one, node negative disease vary from study to study. As Denise says, triple negative is not good.
The data I have used is for purposes of example to make my points - but these are close figures. If we go into all the variable data from many studies we wind up confusing people even more.

The choice of regimens is another guess. Denise says that the regimen would not be as aggressive as you wife's treatment. That may or may not be true. It depends on the oncologist. I favored a milder chemotherapy approach for people who already had a 90% chance of being cured with local treatment alone. I did not want 9 of 10 women who were already cured to have Taxol toxicity - usually neurologic damage - for the rest of their lives - nor heart damage from the Adriamycin. I may have missed some chances for cures by using milder regimens. The guesswork is a major stress for oncologists who care.

Added note - "Inverse Mushroom Cloud" has an excellent personal response. Only people who have "been there" can tell you what it's like. You and your wife have been there. I suspect you will be a great help to this friend.
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If you had stage 1 breast cancer and clear margins with no evidence of lymph nodes involved would that mean?

Postby wilmod » Fri Apr 01, 2011 10:17 pm

There is no way to know. Breast cancer can recur 10-15 years later. Usually if the woman does not want radiation a modified radical mastectomy is done. If a lumpectomy is done radiation is recommended. Having a triple negative cancer increases her risk for recurrence. At one time we did not routinely give chemo with node negative breast cancers and the 10 year survival rate was about 65%. In this situation the woman’s age plays a factor. It’s one of those situations where the doctor’s recommendations are more of a blend of art and science, as there are no steadfast rules. Like they told her it could go either way. Also, the chemo she would receive would not be the same as Becky’s
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If you had stage 1 breast cancer and clear margins with no evidence of lymph nodes involved would that mean?

Postby uilleam » Fri Apr 01, 2011 10:18 pm

yes its sounds like an excellent prognosis
However my wife died of breast cancer so , sell the house , go into debt , go bankrupt and get the chemo.
If you does metastasize then the average time from diagnosis to death is 6 months and the 5 year survival rate is 15%

You hear about how the american system fails people this is yet another situation, sooner Obama care starts , sooner americans will stop dieing
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If you had stage 1 breast cancer and clear margins with no evidence of lymph nodes involved would that mean?

Postby burhleag » Fri Apr 01, 2011 10:26 pm

First of all how is it confirmed that its cancer? Try to go for PET CT Scan the best way to find out. If its stage 1 then by Chemo & then surgery or radiation it can be controlled. Remember now oral chemo has come out with less side effects.
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If you had stage 1 breast cancer and clear margins with no evidence of lymph nodes involved would that mean?

Postby farnall » Fri Apr 01, 2011 10:35 pm

Hey Darlin Dave! That's a very early cancer and just radiation would suffice...for now. I certainly would not go without any treatment, that's for sure. read up on Cheryl Crow's breast cancer; same situation and she did not have chemo. Take care and I'll be looking for you!
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If you had stage 1 breast cancer and clear margins with no evidence of lymph nodes involved would that mean?

Postby bailintin » Fri Apr 01, 2011 10:36 pm

Hey Darlin Dave! That's a very early cancer and just radiation would suffice...for now. I certainly would not go without any treatment, that's for sure. read up on Cheryl Crow's breast cancer; same situation and she did not have chemo. Take care and I'll be looking for you!
If that was my diagnosis I would still want to be sure the beast was dead. Yes by all means go for the chemo and radiation.
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If you had stage 1 breast cancer and clear margins with no evidence of lymph nodes involved would that mean?

Postby bedford51 » Fri Apr 01, 2011 10:47 pm

This is one of the more difficult scenarios to deal with.

Denise will give you the numeric analysis ... Spree will give you the medical one.

I'll tell you as a survivor: if that had been my diagnosis ... as a 50 year old female with the hope and desire to live another 20-30 years, I would probably go with the chemo. If I had been 70 ... not so much. I would want to hear the actual pathology of the tumor: is it Grade 1 or Grade 3 ... highly differentiated or poorly differentiated? I would want to know exactly what those cells look like. If they are dividing rapidly and don't look much like breast cells any more, I'd certainly go for chemo.

I would always choose the chance of knocking out cancer the FIRST time it comes into my life. My team chose to treat my cancer fully, and I liked that approach. I'd rather knock it out fully now, than to reserve treatments for a possible recurrence.

I think you have a wide range of answers here ... print out the page and give it to your friend. I'm sure one of the excellent answers you have received will resonate with your friend.

ADDED: A lady in my bc support group was early Stage 2 but with no (known) node involvement. She was just diagnosed with bone mets to the pelvis and thigh. She did have chemo, and radiation, as well as surgery. There is never any guarantee.
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