How do I manage breast cancer with lymph node involvement?

Question

Hello doctor,

My mother had breast cancer at the age of 49, and my aunt had ovarian cancer at 51.

I found a hard, painless lump in my left breast two months ago, and a biopsy confirmed invasive ductal carcinoma.

The pathology report showed a tumor size of 1 inch, estrogen receptor (ER) positive (90 percent), progesterone receptor (PR) positive (80 percent), human epidermal growth factor receptor 2 (HER2) negative, and a Ki-67 index of 35 percent, indicating high proliferation. Three out of four sentinel lymph nodes were positive for cancer, consistent with stage IIIA disease.

My CA 15-3 tumor marker is 52 U/mL. What steps should I take to manage this?

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

I am really sorry to hear about the breast cancer diagnosis, and I understand that it seems to run in the family. Wishing an easy and smooth treatment journey ahead, God willing. In this case, treatment usually begins with chemotherapy before surgery. If chemotherapy has already been completed before surgery, that is ideal. If not, and surgery was done first, chemotherapy will be given after the operation. Since the tumor has spread to the lymph nodes, radiation therapy will also be required after surgery, targeting the breast area and the underarm (axilla).

After completing radiation therapy, any side effects from chemotherapy will gradually subside.

Similarly, radiation may cause mild skin irritation, which typically resolves once treatment sessions are finished.

Following radiation therapy, hormonal therapy will be started. It usually continues for around 10 years, with one tablet taken daily. Common side effects may include hot flashes, vaginal dryness, or mild irritation.

During this stage, vitamin D and calcium supplements are recommended to maintain bone health. Since both the mother and aunt had breast and ovarian cancer, a BRCA test (breast cancer gene 1 and breast cancer gene 2) is strongly advised. This test helps determine whether there are any targeted therapies or special treatment options that could be beneficial if the disease ever becomes advanced.

If there are daughters in the family, they should also undergo the BRCA test, but only after the age of 25 years. This helps assess if they carry the same genetic risk and whether preventive measures are necessary in the future.

Before deciding on the next steps, the following investigations are advisable:

BRCA1 and BRCA2 testing (breast cancer gene 1 and breast cancer gene 2)

I would suggest the following measures:

Neoadjuvant chemotherapy.
Surgery.
Radiotherapy.
Hormonal therapy (for seven days initially, to be continued as per oncologist’s advice).

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.