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Q. I had breast cancer, and the entire lump was dissected. Do I still need to undergo chemotherapy?

Answered by
Dr. Pawar Satyajit Jalinder
and medically reviewed by Dr. Sushrutha Muralidharan
This is a premium question & answer published on Jul 06, 2021 and last reviewed on: Aug 11, 2021

Hi 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 have been dissected. My doctor told me that I need to undergo chemotherapy followed by 20 sessions of radiotherapy, 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 week. I cannot lift my arm. Sometimes I feel my heart pounding very fast. And I am started to thinking did I really needed all of this even after removing the lump completely. I am attaching the biopsy report that reveald ER, PR positive and HER2 negative. Please advise me.

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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 few things:

1) You are 29, which is a quite early age to develop breast cancer.

2) You have undergone breast conservative surgery (BCS) along with sentinel LN (lymph node) surgery of axilla (SLNB). This is a current standard of care (SOC).

3) 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 will need:

1) Surgery and SLNB, which you have undergone.

2) 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 of complete breast radiation may have been avoided depending on final histopathology.

3) Hormonal treatment as 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.

4) Chemotherapy need is decided on 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 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? 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 more clear 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.


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