Is chemotherapy needed even after post-lumpectomy treatment?

Question

Hello doctor,

I felt the lump seven months back, but did the test four months ago and had the surgery three months ago. I have been diagnosed with early-stage breast cancer and had an excisional biopsy procedure where the tumor, safety margin, and three lymph nodes were dissected.

My doctor told me that I need to undergo chemotherapy followed by 20 sessions of radiotherapy, and then I will start hormonal therapy. I have started chemotherapy with 130 milliliters of Taxol 6 mg/L weekly, took five doses till now, and there are seven more.

My hair started to fall, and I feel very weak. I cannot lift my arm. Sometimes I feel my heart pounding very fast. And I have started to think, did I really need all of this even after removing the lump completely?

I am attaching the biopsy report that revealed ER, PR positive, and HER2 negative.

Please suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your query and attachments (attachments removed to protect the patient's identity). Being an oncologist involved in the care of breast cancer patients, I can understand your concerns.

Based on the query, I can gather a few things:

You are 29, which is quite an early age to develop breast cancer. You have undergone breast conservative surgery (BCS) along with sentinel LN (lymph node) surgery of the axilla (SLNB). This is a current standard of care (SOC).

Your breast cancer is hormone-positive, meaning it is ER (estrogen) or PR (progesterone) positive and HER2 (human epidermal growth factor receptor) negative.

Treatment for this includes:

Surgery and SLNB, which you have undergone.

Radiation is needed as you have undergone breast-conservative surgery. Radiation reduces the risk of the tumor coming back to the same site. If you have undergone removal, complete breast radiation may have been avoided depending on the final histopathology.

Hormonal treatment is recommended if your tumor is hormone-positive; it will respond to hormonal treatment. This will be started once you complete your chemotherapy and will be continued for a minimum of five hours. It may be extended for ten hours, depending on tolerance. I want to tell you that it is very easy to take. These three things are needed in every case.

The need is decided on the HPE (histopathology) report. For this, I would like to see the entire report. Also will need to know if you have undergone any additional testing to see the risk of tumor recurrence.

Tumors can have different risks of recurrence based on histopathology and genetic features. If the risk is high, chemotherapy is definitely needed to reduce the risk by an absolute 10 %.

Considering all this and your age, most oncologists will be inclined to give you chemotherapy as 29 is too early for CA (carcinoma) breast. I would also like to know if there is any family history of CA breast cancer?

And would consider doing genetic testing, as every breast cancer below 50 has an almost 15 % chance of being genetic.

I would be able to give you a clearer answer regarding chemotherapy if you can provide me with histopathology details after surgery and reports of any additional tests.

If you have any other questions, please revert here.

I hope you find this helpful.

Thank you.