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Old 03-07-2018, 04:35 PM   #1
alicem
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Join Date: Jan 2009
Location: Colorado Springs, CO
Posts: 430
Treatment for an 87 year old mom

Hi everyone,

The 87 year old mom of a friend of mine was recently diagnosed with breast cancer for the first time. My friend, Barb, is having difficulty registering on this site so I am asking questions for her. Here is the pathology info that I have received:

Breast, right, partial mastectomy - poorly differentiated (grade III/III)
Invasive ductal carcinoma, 3.3 cm in greatest dimension, with all surgical margins free of tumor (T1NXMX, histologic stage IIA)

The surgeon recommended a lumpectomy since Bette has a history of strokes when being under full anesthesia. At first the family thought that Bette would only be receiving Herceptin and Tamoxifen (she has osteoporosis). Now there is confusion as to whether she will need radiation.

1. What are the dangers of radiation for a woman of her age?

2. Is radiation really necessary?

3. Does it make sense for her to receive only Herceptin, without chemo?

4. Does anyone know of someone with a similar age/diagnosis...what have they done?

5. Bette lives in South Dakota and is seeing an oncologist in Rapid City. Does anyone have any experience with doctors in that area?

6. If radiation is recommended, would it be a good idea to get a second opinion?

That is all for now. I know from past experience with my own cancer that the men and women on this forum are brilliant and oh so helpful.

Thank you in advance!!

Alice
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__________________
9/15/08 (age 52) - Mammo: calcifications
9/22/08 - Biopsy: DCIS, grade 3. ER,PR status: Pos. in 75-90% of tumor cells.
10/01/08 - Ob/Gyn appt.: found complex, mostly cystic mass on right ovary - 11cmx12cmx 8cm
10/15/08 - Hysterectomy & Oophorectomy, Lumpectomy: Cyst on uterus, not ovary - all was benign. Breast - 5 of 6 bad margins. 2 Sentinel Lymph nodes removed, both negative. Stage 0, Tis, N0
12/11/08 - Mastectomy & DIEP reconstruction: Surprise! 2 cm Invasive DC, grade 2 found. One benign internal mammary lymph node. Stage 1, T1c, N0, all clean margins. ER+ (Proportion Score = 2/5, Intensity Score = 2/3) and PR+(Proportion Score = 3/5, Intensity Score = 2/3)
HER2 score = 3+
1/09/09 - Oncotype DX: Recurrence S/core of 60 !?!?! ER status is NEG!! PR staus is NEG! HER2 score = 12.2 (still positive, greater than 11.5 is positive).
1/20/09 - Started chemo: TCH
5/26/09 - FINISHED CHEMO!
1/05/10 - FINISHED HERCEPTIN!
1/22/10 - Port-a-catheter removed!
3/07/18 - Still NED
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Old 03-07-2018, 06:52 PM   #2
Lucy
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Join Date: Oct 2014
Posts: 248
Re: Treatment for an 87 year old mom

Alice,

I saw your questions and while I can't answer all of them from personal experience I will throw out there what I can and hopefully others will join the conversation. (Disclaimer: when I say you or you're I mean it in a general sense, I did catch that you were asking for a friend. )

The reason radiation would be important is because she is having a lumpectomy. When I was diagnosed I was told that with a mastectomy I may or may not need radiation but with a lumpectomy the risk of recurrence goes up significantly without radiation so my takeaway from that was that it's a critical part of treatment if you have a lumpectomy.

Herceptin is a targeted drug for HER2 cancers and while everyone is different, my understanding is that herceptin alone is more likely to have a positive result than chemo alone. There may be a reason the doctor is not recommending chemo and it never hurts to ask that question, just so you know what's going on. Doctors handle these situations every day and I think they sometimes forget we don't have the educational background they do so if you're unsure about something they're telling you, you should ask. If they have a problem with that then I would consider getting a different doctor to be in charge of my medical team.

I hope that helps some.
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Old 03-07-2018, 11:10 PM   #3
StephN
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Join Date: Nov 2004
Location: Misty woods of WA State
Posts: 4,084
Re: Treatment for an 87 year old mom

Regarding radiation. There are new machines that are less hard on us. I have a friend in a "minor" metropolitan area who had radiation via this new method. If that is available in Rapid City, there should be no problem.

The whole line of treatments will be tiring as it is for someone that age. (Look what it did to us!) But sounds like they are trying to do the minimum and give a good standard of treatment.
__________________
"When I hear music, I fear no danger. I am invulnerable. I see no foe. I am related to the earliest times, and to the latest." H.D. Thoreau
Live in the moment.

MY STORY SO FAR ~~~~
Found suspicious lump 9/2000
Lumpectomy, then node dissection and port placement
Stage IIB, 8 pos nodes of 18, Grade 3, ER & PR -
Adriamycin 12 weekly, taxotere 4 rounds
36 rads - very little burning
3 mos after rads liver full of tumors, Stage IV Jan 2002, one spot on sternum
Weekly Taxol, Navelbine, Herceptin for 27 rounds to NED!
2003 & 2004 no active disease - 3 weekly Herceptin + Zometa
Jan 2005 two mets to brain - Gamma Knife on Jan 18
All clear until treated cerebellum spot showing activity on Jan 2006 brain MRI & brain PET
Brain surgery on Feb 9, 2006 - no cancer, 100% radiation necrosis - tumor was still dying
Continue as NED while on Herceptin & quarterly Zometa
Fall-2006 - off Zometa - watching one small brain spot (scar?)
2007 - spot/scar in brain stable - finished anticoagulation therapy for clot along my port-a-catheter - 3 angioplasties to unblock vena cava
2008 - Brain and body still NED! Port removed and scans in Dec.
Dec 2008 - stop Herceptin - Vaccine Trial at U of W begun in Oct. of 2011
STILL NED everywhere in Feb 2014 - on wing & prayer
7/14 - Started twice yearly Zometa for my bones
Jan. 2015 checkup still shows NED
2015 Neuropathy in feet - otherwise all OK - still NED.
Same news for 2016 and all of 2017.
Nov of 2017 - had small skin cancer removed from my face. Will have Zometa end of Jan. 2018.
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Old 03-08-2018, 10:51 AM   #4
donocco
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Join Date: Oct 2013
Posts: 348
Re: Treatment for an 87 year old mom

I checked google ( topic- radiation for an 87 year old woman with cancer) and got results.
It seems radiation is beneficial and tolerable. One group of mixed patients (male and female)
total number 177 patients, received radiation, some palliative some for curative purposes.
80% of the patients took the full course of radiation. About 36% had the full course but had to take therapy breaks. The overall impression I got was that radiation was beneficial
in holding back the disease.

Paul
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Old 03-08-2018, 11:31 AM   #5
alicem
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Location: Colorado Springs, CO
Posts: 430
Re: Treatment for an 87 year old mom

Lucy, Steph & Paul,

Thank you so much for your responses. I have passed them along to Barb.

Lucy, I thought the radiation was added because of Bette’s lumpectomy. Thanks for confirming that!

Steph, do you have a specific name for the new radiation treatment? It sounds interesting.

Paul, thank you for doing that research. It is good to know that Bette could take a break from her treatment if necessary.

Alice
__________________
9/15/08 (age 52) - Mammo: calcifications
9/22/08 - Biopsy: DCIS, grade 3. ER,PR status: Pos. in 75-90% of tumor cells.
10/01/08 - Ob/Gyn appt.: found complex, mostly cystic mass on right ovary - 11cmx12cmx 8cm
10/15/08 - Hysterectomy & Oophorectomy, Lumpectomy: Cyst on uterus, not ovary - all was benign. Breast - 5 of 6 bad margins. 2 Sentinel Lymph nodes removed, both negative. Stage 0, Tis, N0
12/11/08 - Mastectomy & DIEP reconstruction: Surprise! 2 cm Invasive DC, grade 2 found. One benign internal mammary lymph node. Stage 1, T1c, N0, all clean margins. ER+ (Proportion Score = 2/5, Intensity Score = 2/3) and PR+(Proportion Score = 3/5, Intensity Score = 2/3)
HER2 score = 3+
1/09/09 - Oncotype DX: Recurrence S/core of 60 !?!?! ER status is NEG!! PR staus is NEG! HER2 score = 12.2 (still positive, greater than 11.5 is positive).
1/20/09 - Started chemo: TCH
5/26/09 - FINISHED CHEMO!
1/05/10 - FINISHED HERCEPTIN!
1/22/10 - Port-a-catheter removed!
3/07/18 - Still NED
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