How is invasive ductal carcinoma treated effectively?

Question

Hello doctor,

I am a 45-year-old female recently diagnosed with HER2-negative invasive ductal carcinoma. My tumor is ER-positive (90%) and PR-positive (80 percent), with a size of 0.98 inches, Grade 2, and one out of three lymph nodes positive. My Ki-67 index is 25 percent, indicating moderate cell proliferation, and my Oncotype DX score is 18, which falls in the low-risk category.

I am experiencing mild breast pain and occasional fatigue. I am seeking guidance on treatment options, including hormone therapy, chemotherapy, and potential targeted therapies, along with their side effects and impact on my daily life.

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

Given your specific diagnosis, the treatment plan will likely involve a combination of surgery, hormone therapy, and radiation. Chemotherapy might be considered, but your low Oncotype DX breast recurrence test score suggests a lower likelihood of benefiting from it.

However, a physical examination by an oncologist is essential to determine the best possible treatment. Surgery to remove the tumor will be necessary. A lumpectomy involves removing the tumor and some surrounding tissue, while a mastectomy involves removing one or both breasts, depending on the size and location of the tumor.

Since one out of three lymph nodes tested positive, your surgeon may recommend removing more lymph nodes to assess the extent of cancer spread. Since your cancer is ER-positive (estrogen receptor-positive) and PR-positive (progesterone receptor-positive), hormone therapy will be a key component of your treatment. Hormone therapy is typically recommended for five to ten years, depending on individual factors.

With a Ki-67 proliferation index (which measures the percentage of tumor cells that are actively growing) of 25 percent and a low Oncotype DX score of 18, chemotherapy may be less likely to be recommended. Chemotherapy can cause side effects such as fatigue, nausea, hair loss, and an increased risk of infection.

If you undergo a lumpectomy, radiation therapy is often recommended to reduce the risk of cancer recurrence in the breast. Since your cancer is HER2-negative (human epidermal growth factor receptor 2-negative), targeted therapies that specifically target HER2-positive breast cancer would not be appropriate in your case.

The side effects of hormone therapy are as follows:

Hot flashes.
Joint pain.
Fatigue.
Increased risk of bone thinning.

With chemotherapy, to manage side effects, I suggest you follow the instructions:

Use anti-nausea medications.
Maintain a healthy diet.
Perform regular exercise.
Consume a balanced diet.

Regular checkups and imaging tests will be essential to monitor your progress. I suggest you consult a specialist, talk with them, and take the medications with their consent. Discussions with your oncologist will help you make informed decisions about your treatment.

I hope this has helped you.

Kindly follow up if you have more doubts.

Thank you.