Chemo or Not

I had a wide local incision lumpectomy and 4 lymph nodes removed in early May. My oncologist confirmed last week ‘at this time’ I don’t have cancer as there are no nasties in the surrounding tissue and the lymph nodes are clear. 
However he offered chemo and I have to decide whether I want chemo or not or go with radiotherapy and hormone treatment. 
No one will make this decision and I’ve been told by my breast care nurse she doesn’t envy me trying to decide and I have to be comfortable with my decision.

My feelings are more to go with radiotherapy and hormones with mammograms for 5 years as no one can tell me it will or won’t come back no matter what course of treatment I go for. 

I know in life there are no guarantees but to have the option to have or not have chemo messes with your head and seems a bit of a cop out. 

If your cancer is ER+ have you asked about Oncotype testing? It should be a really helpful tool to help you make your decision. 

Hi Wendy,

That’s a really tough choice. I think it’s great that they have transparency, and consent and informed choice. Of course. Obviously. But at the same time, sometimes I would just like them to tell me what to do! 

Were they able to give you any numbers or take you through the Predict tool? I know statistics don’t apply at the individual level, but at least it’s a guide. Only if you find that sort of thing helpful though, I know many don’t. 

Don’t forget to talk to your BCN or one of the nurses here, so you don’t start to feel like a hamster on a wheel thinking about it. They won’t tell you what to do, but talking it through may give you some clarity.

Kelly xx

Hi Wendy! I second the oncotype suggestion. If you are hormone positive, that score would tell you whether chemo was beneficial for you. For instance I was node negative but had a grade 3 tumor that came back saying that chemo could be beneficial to me. So I did it. If they don’t do oncotype then another thing to consider is your grade. Grade 1’s, no, don’t do chemo, grade 2’s probably not, grade 3’s probably so. To help differentiate grade 2’s better, find out what you mitosis score was. That’s the measurement for how quickly the cells are dividing. If it is a 3, do chemo, if it’s a 2 I’d go back to probably not. Something else to consider is LVI. That’s where the tumor has infiltrated the surrounding lymph or blood vessels in it’s surrounding tissue. It doesn’t mean it has spread to distant sites but it does tell you it wanted to and was making progress to doing just that. If you have LVI, even with a grade 2, it might not be a bad idea to do chemo. If you decide not to, maybe consider an AI and ovarian suppressor if you’re premenopausal instead of tamoxifen.

Not a doctor by the way. Just well read. So make sure you talk over any rational in regards to your decision with your doctor. Good luck!

Hi Wendy,

I have just had a lumpectomy to remove a grade 3 ER+ rumour that had spread into 1 lymph node. So, the also did an ancillary clearance and took out 26 lymph nodes! I’m waiting to start radiotherapy. There was a lot of debate about chemo for me as the HER2 receptor was negative and they sent off for an oncotype DX test. That is to this I am not having chemo as I got a low enough score on this test. I’m not sure if all hospitals do it, as they said it was very expensive and had to go to the USA. So,they check with me before sending it that if it came back and the recommendation was that I should have chemo that I wouldn’t then refuse it.
Worth asking if you can have the test as it gives peace of mind. Good luck

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