Diagnosed at 30 (no kids) with Grade 3 Invasive ER+

Hi I am 30 years old and I was diagnosed on 05 Aug as having Grade 3 Invasive Ductal Carcinoma ER+. (29x22mm). Still awaiting HER2 and BRCA results. However I have no family history and they don’t think it has spread to lump nodes. I have already been to the fertility clinic and they have advised it would take approx 4-6 weeks to harvest eggs or I can have a monthly injection to shut down ovaries whilst having chemo in the hope it protects them. I am in a relationship but if I am honest I had not made a decision on having children as I was busy with my career and I really didn’t think I would suddenly have to make a decision regarding my future fertility let alone throwing cancer into the mix so it’s all been a bit of a whirl wind the last couple of weeks. I have an appointment with the oncologist next week, I think I have two options Neoajuvant chemo 6 rounds in total one every 3 weeks to hopefully shrink the tumour, lumpectomy (breast conservation) and then radiation then tamoxifen OR mastectomy and then chemo then tamoxifen. Hopefully the oncologist will enlighten me a little more next week as currently I just feel lost with all the decisions. If anyone has any advise or has been in a similar situation I would love to hear from you.

Hi Rosalyn,

It is so sad that you find yourself here, especially at such an early age. However you are in a good place here and there are many threads, which can offer much support, help and advice as you move through your treatment. This is a great place to rant and rave, have a cry and a laugh, too.

Thankfully, in nowadays, treatments are so advanced that outcomes have improved immeasurably  as to many years ago. 

The primary consideration, at this time might likely be your fertility, even if you have previously not thought about having children. It tends to be the best option to have all bases covered, as once that specific door is shut - it cannot be opened again. Who knows how one will feel many years down the line. It would always be good to have the option, even if you may never take it up.

I am glad they have discussed your treatment options with you. It will be your choice to make and the best outcome with regard to surgery may also depend on your actual breast size.

I was diagnosed with a lobular invasive (Grade 3, ER+, HER2-, no node involvement) and opted for a skin sparing mastectomy and immediate reconstruction via an implant. This option tends to be good for up to a C cup. Being able to have a skin sparing mastectomy enabled my onco plastic surgeon to fashion a skin bud out of my breast skin, which really does look like a nipple. It may be worth knowing that a reconstruction with an implant is not quite the same, as when having a breast augmentation. The reason is that with breast augmentation the implant tends to be placed under existing breast tissue, whilst with a mastecomy that will no longer be there. 

I was glad I opted for this choice, as the pathology results post surgery did show the cancer to be considerably larger than the initial ultra sound and MRI scans showed, due to the invasive ‘tentacles’ being, in parts, only a couple of cell strands wide. So I know that it is completely gone and that there is enough clear margin.

Should you consider a mastectomy, which would then be followed by chemotherapy - they may likely initially insert an ‘expander pocket’. The reason is that implants can be affected by chemo and radiotherapy treatment and would need to be replaced. So often an expander is put into place and once all active treatment is completed - the implant will go into the space the expander will create.

So this may be something to discuss with your oncologist.

When you have your operation they will also do a sentinel node biopsy, which means removal of the first cluster of your lymphnodes closest to your affected breast. These will also be closely examined in pathology to find our whether they are clear or whether some cells may have escaped into them.

All treatment options should be explained in detail to you and the final decision will be with you, rather than your treatment team. It may be an idea to take notes during your consultations, as so much information will come your way. It might help you to review the information and then make a decision, rather than doing it ad hoc.

You also say that you are working. It is very much up to you whether you tell your employer or not.

As it is, you now fall under the Equalities Act 2010, which has replaced the Disability Discrimination Act, for the rest of your life. This is important, as your employer has to make reasonable adjustments to accomodate your status as you move through your treatment. Whether you are able to work, whilst on chemo, will very much depend on your type of job and on which side effects of chemotherapy make it challenging for you to work. I managed to work 2 out of three weeks during my first 2 cycles, but post cycle three now have to take 10 days off each cycle - to recover adequately to continue working before my next one. The fatigue effect, unfortunately, is cumulative, hence the need for me to take that time off.

I hope you find this link of help with regards to work - macmillan.org.uk/information-and-support/organising/work-and-cancer/information-for-employees

I do hope that above is of some help. Do let us know how you get on - so we can point you into the directions of other relevant threads in due course, which may be of great help and support for you.

Hugs

Sue xx 

 

Spoke to the oncologist today and tests came back as HER2-. The plan is to have neoajuvant chemo and then decide on the best surgical option on completion of the the chemo. I do not have a family history however I would prefer to get my genetic BRCA tests back before making a decision on the type of surgery and what will suit best for my future. The tests may take a few months to return by which time I will nearly be finished with chemo. Whilst having chemo I will have an injection to suppress my ovaries, I decided not do egg harvesting as this will prolong everything by a further 6 weeks and there is no guarantee that sufficient egg will be collected and the longer I prolong chemo the greater that chance of having it spread. I am in the mind set now where I just want to get on with this unfortunate challenge I have been given. I will have lymph node testing in the next couple of weeks, and be given my Prostrap injection 2 weeks prior to chemo so hopefully be starting chemo in the next 2-3 weeks.

Just an update; I was given an injection of Prostap on Wed 31st Aug to suppress my ovaries. I had my SLNB last Friday 2nd Sep went in at 11:00 and was home for 18:00. Pain hasn’t been to bad from the SLNB just a little sore other than been an emotional wreck I think the mix of codeine and been thrown into a pseudo menopause where not a good combination. I have had side effect from the Prostap tiredness, nausea and hot flushes however these only lasted a couple of days. The main think that has bothered me is the dizziness and headache, I still have a dull headache now. I will see what happens at the end of the month when I get my next Prostap injection as I will have started chemo by then. I am due to start chemo on Friday 16th Sep, and I go to hospital tomorrow for my SLNB results so fingers crossed. I will be having 6x Taxotere and Carboplatin, has anyone else had this combination? I don’t need to have Herceptin as my HER2 was negative. I worked out my last treatment should be on 30 Dec, my 31st birthday so I shall not forget the date! Everything seemed to be moving slowly from diagnosis but now things are in place it all seems to be flying by, I hope the next 3.5 months fly whilst having chemo I will look forward to saying goodbye to 2016.