My sister has breast cancer. How can she handle chemotherapy?

Question

Hello doctor,

My 45-year-old sister found a lump in her left breast two weeks ago during self-exam, and we just got back from the oncologist, who confirmed it is breast cancer. The biopsy showed invasive ductal carcinoma grade 2 with ER-positive and HER2-negative results.

Her CA 15-3 tumor marker is elevated at 67, and CEA is 8.2, which has us all really scared. She has two young kids, aged seven and ten, and is a single mom, so this could not have come at a worse time.

The oncologist wants to start neoadjuvant chemotherapy with the AC-T protocol before surgery, but she's terrified about losing her hair and being too sick to take care of her kids.

Her periods have been irregular for the past year, and the doctor thinks the chemo might put her into early menopause, which she wasn't prepared for. She also tested positive for the BRCA1 mutation, which means increased risk for ovarian cancer, too.

Should she consider having her ovaries removed at the same time as a mastectomy?
We are worried about her daughters. When should they start genetic testing?

The treatment plan seems so overwhelming, and we do not know how to tell the kids what is happening.

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I hope you are doing well. I understand and appreciate the amount of fear and pain that you and your sister are experiencing. I also understand, of course, that she is scared about the treatment journey. Let me discuss the matter with you carefully.

The first thing is that we give her chemotherapy before surgery to shrink the tumor and reduce its size. We could perform a tumor removal, lumpectomy, and lymph node (LN) dissection.

But because she is BRCA (breast cancer gene) positive, the safest and most secure approach is to remove the entire tumor, both the right and left sides, and remove both ovaries.

This reduces the risk of recurrence to about 95 per cent. However, if she does not want this option, that is absolutely fine. We have alternative solutions, which involve active surveillance. This means we monitor her regularly, performing an annual breast MRI (magnetic resonance imaging), a pelvic ultrasound, and CA (cancer antigen) 125 tests.

This way, we can track any developments over time, plus taking hormonal therapy ot will protect against breast recurrence. Regarding her daughters, if they are over 25 years old, we perform the BRCA test.

If they are positive, we can also provide preventive options for them. For now, the treatment plan involves chemotherapy, surgery, and hormonal therapy

Since you are her sister, I also recommend that you take the BRCA test so we can determine the appropriate preventive measures for you as well. As for chemotherapy, it does have side effects. This stage can be a bit difficult for her, and she will need your support, nutritional support, and proper hydration.

Be there for her until she can get through this stage. She may experience hair loss, fatigue, and tiredness. She can manage hair loss by using wigs until her hair grows back, which will happen naturally once treatment is completed.

If you have any questions at any time, I am here for you. I hope my answer is sufficient for you, and for more queries, feel free to reach out to me.

Follow up with me after seven days.

Regards.