Just Getting Started
 

Hi, my wife, Jane, was recently diagnosed with Her2+ breast cancer...left side. Her lymph nodes on her left side are also involved. They took 3, and 2 of them were mildly affected and 1 was more than what they like to see. She had her first neoadjuvant chemo treatment yesterday. She is doing TCH-P. The plan is 1 session every 3 weeks for 6 cycles. After that we were told it would be either a lumpectomy or masectomy and removal of the nodes on that side. Then radiation. She is 48 years old and we have no idea what we are in for really. Obviously she is scared. Just got a text that the nausea is starting. Are there any other folks on this protocal?

Re: Just Getting Started
 

Stephen, glad you found us, sorry you had to. Of course she is scared, you too, probably
But we are here to help you We have all been where Jane is now. Getting dumped into cancer land without a road map It will begin to sort itself out and a routine will form, believe it or not! You get into the rhythm of this "new normal"
So far it looks like she is on a standard, proven protocol.
Side effects vary with each person and there are meds to counteract them. She should report these to her team so she can get them under control
I know that others here will be along to offer support
Keep the faith

Re: Just Getting Started
 

Hi Stephen~
I just finished my last of 6 TCHP chemo treatments last week. I have to say that each of the 6 times I felt completely different. Nausea and fatigue has been my primary side-effect, but not so much that it incapacitated me (I've not missed a day of work). Water, gatoraid, and naps were what has helped me the most.

Has she done the genetic testing? I would think that would definitely help with the surgery decision down the road. You've found the place to be for support and answers to questions from women who have "been there and are doing that"! Hang in there...it's one heck of a ride :)

Re: Just Getting Started
 

Thanks for the responses! She has done the genetics test and both were negative.

Re: Just Getting Started
 

Oh...one more thing. If you Google HER2+, be careful - I cried for days on end after doing that. You have to look at dates of research out there. Most of it is outdated, prior to Herceptin, and now Perjetta. A friend of mine who went through this 6 months prior to me, told me "We have the worst cancer with the best treatment"

After my first round of chemo, I could no longer feel the lump, and then at the mid-chemo scan, the lump had almost completely disappeared. For me, the chemo is working to get rid of this bad-boy, so I have always kept that in mind during the icky feeling times of chemo, loosing my hair, etc.

Re: Just Getting Started
 

Hi Stephen, its no picnic but all doable and there's usually a med to help counteract any side effects she may get, tell her to be sure to take the anti nausea if she feels she doesn't need them as its easier to prevent nausea than stop once it starts. Drinking water during and after the infusion helps too and tell her to report any issue's she's having but hopefully any side effects will be minimal.

Re: Just Getting Started
 

Stephen,
We were in your shoes last year. I'm 47 and had an er-/pr- Her2+...2cm tumor and two nodes. I did a similar treatment plan and I did pretty well with it. I'm a teacher and I was able to continue working half days throughout. Took one month off in the beginning just to process everything (and cry...a lot!). We made it through, one day at a time...and you will too! You sound like a great support for your wife, and that's just what she needs!

Good luck to you!
Kim

Re: Just Getting Started
 

Thanks everybody!
Kim, Jane is in education also. She is an asst prinicipal at a primary school. Since it was so close to the end of the year she just took the rest of the year off. Are you still treating?

Re: Just Getting Started
 

Stephen, I'm glad she'll be able to take some time this summer to regroup. For me, the beginning was the hardest. I did much better as I went through treatment and literally felt the tumor getting smaller. By the time chemo was finished my tumor had almost completely disappeared and there was no cancer left. You will get through this! I opted for a lumpectomy and then six weeks of radiation. I finished Herceptin this past December.

There have been great advances in medicines and treatments for us Her2 ladies. In fact Jane's treatment of TCH-P is the newest drug combo for our diagnosis. I had AC/TH just a year ago and wish I had been offered TCH-P instead. Our prognosis is much better than it used to be!

Re: Just Getting Started
 

Hi Stephen, First of all let me welcome you to our wonderful site where you will find a lot of information regarding the latest treatments for us ladies Her2+, an aggressive type of cancer with the best drugs available, in fact, most of us, especially my sisters who like myself are a true warriors and have battle this disease for a long, very long time and continue enjoying normal life just everyone else.

Glad to hear you are a health advocate for your wife, she will do just fine and with your help, her ride through chemo and all will be a much easier than for a lot of women who have no family, or family support during these trying times.

Cancer is a gift-- it changes you for the better, that's what cancer did to me, and for that I'm grateful, I never would have been able to discover and or experience the real love my fiends and family have for me and the complete happiness I have found in the smallest, tiniest things in life. I had never experienced such joy and peace in my life. I won't change/trade it for anything. I'm a walking miracle.

Please keep us posted on your wife's progress.

Adriana

Re: Just Getting Started
 

Hi Stephen,

All the others have said valuable things. There's one thing I'd like to add: if the nausea continues or gets worse, please contact her medical team asap. There are different types of nausea meds, and some work, while some don't for individual patients. They can stop working too, so keep asking. Some of these meds are quite expensive, so most doctors try the cheaper ones first. This leads to unnecessary suffering.

And perhaps it is good to know that I was diagnosed in 2004 and am still cancer free.

Jacqueline

Re: Just Getting Started
 

Adriana has said so well what I have tried to convey to many over the past year....true words.

Re: Just Getting Started
 

Thank you for all the comments and advice!!!! Jane is handling the nausea pretty well. However, the indigestion is getting to her bad. And she can't find anything that suits her thirst. Any suggestions?

Also, her doctor told her that she would probably have either a lumpectomy or masectomy after chemo and that he would more than likely do a total disection of the lymph nodes under her arm and then radiation. Are there any studies about NOT doing the lymph node removal at the time of surgery and just doing radiation? She really doesn't want that done if at all possible.

Re: Just Getting Started
 

I drank cranberry grape juice. for some reason, it was the only thing that appealed to me during treatment.

I had sentinal node biopsy (SNB)done at the time of my mastectomy. They came back negative so no nodes under my arms were removed. I had radiation after I healed from the surgery. With the SNB, I only had 4 nodes removed from my breast.

Re: Just Getting Started
 

She needs to ask for Nexium or something similar to take daily for the heartburn as the toxic meds can damage the oesophagus, I only found out afterwards and have a hiatal hernia and need to take Nexium every day since, sorry I can't help with your other question.

Re: Just Getting Started
 

Definitely get the Nexium. It should do the trick. Probably take daily through treatment.

Green tea seemed good to me. I couldn't drink anything carbonated-the carbonation burned my mouth.

Best to you both.

Re: Just Getting Started
 

Hi Jane's Husband
Doing full axillary node dissection after postive sentinel nodes is becoming controversial because outcomes are similar with or without. The following 2 articles are available on pubmed. There are a few others as well. Hope this is helpful.
Lisa
Orv Hetil. 2013 Dec 8;154(49):1934-42. doi: 10.1556/OH.2013.29765.
[Optimal treatment of the axilla after positive sentinel lymph node biopsy in early invasive breast cancer. Early results of the OTOASOR trial].

[Article in Hungarian]
Sávolt A1, Musonda P, Mátrai Z, Polgár C, Rényi-Vámos F, Rubovszky G, Kovács E, Sinkovics I, Udvarhelyi N, Török K, Kásler M, Péley G.
Author information


Abstract

in English, Hungarian
INTRODUCTION:

Sentinel lymph node biopsy alone has become an acceptable alternative to elective axillary lymph node dissection in patients with clinically node-negative early-stage breast cancer. Approximately 70 percent of the patients undergoing breast surgery develop side effects caused by the axillary lymph node dissection (axillary pain, shoulder stiffness, lymphedema and paresthesias).
AIM:

The current standard treatment is to perform completion axillary lymph node dissection in patients with positive sentinel lymph node biopsy. However, randomized clinical trials of axillary dissection versus axillary irradiation failed to show survival differences between the two types of axillary treatment. The National Institute of Oncology, Budapest conducted a single centre randomized clinical study. The OTOASOR (Optimal Treatment of the Axilla - Surgery or Radiotherapy) trial compares completion axillary lymph node dissection to axillary nodal irradiation in patients with sentinel lymph node-positive primary invasive breast cancer.
METHOD:

Patients with primary invasive breast cancer (clinically lymph node negative and less than or equal to 3 cm in size) were randomized before surgery for completion axillary lymph node dissection (arm A-standard treatment) or axillary nodal irradiation (arm B-investigational treatment). Sentinel lymph node biopsy was performed by the radio-guided method. The use of blue-dye was optional. Sentinel lymph nodes were investigated with serial sectioning at 0.5 mm levels by haematoxylin and eosin staining. In the investigational treatment arm patients received 50Gy axillary nodal irradiation instead of completion axillary lymph node dissection. Adjuvant treatment was recommended and patients were followed up according to the actual institutional guidelines.
RESULTS:

Between August 2002 and June 2009, 2106 patients were randomized for completion axillary lymph node dissection (1054 patients) or axillary nodal irradiation (1052 patients). The two arms were well balanced according to the majority of main prognostic factors. Sentinel lymph node was identified in 2073 patients (98.4%) and was positive in 526 patients (25.4%). Fifty-two sentinel lymph node-positive patients were excluded from the study (protocol violation, patient's preference). Out of the remaining 474 patients, 244 underwent completion axillary lymph node dissection and 230 received axillary nodal irradiation according to randomization. The mean length of follow-up to the first event and the mean total length of follow-up were 41.9 and 43.3 months, respectively, and there were no significant differences between the two arms. There was no significant difference in axillary recurrence between the two arms (0.82% in arm A and 1.3% in arm B). There was also no significant difference in terms of overall survival between the arms at the early stage follow-up.
CONCLUSIONS:

The authors conclude that after a mean follow-up of more than 40 months axillary nodal irradiation may control the disease in the axilla as effectively as completion axillary lymph node dissection and there was also no difference in terms of overall survival.


KEYWORDS:

completion axillary lymph node dissection; early breast cancer; komplettáló axillaris blokkdisszekció; korai emlőrák; loko-regionális besugárzás; positive sentinel lymph node; pozitÃ*v őrszemnyirokcsomó; regional nodal irradiation

PMID:24292111 [PubMed - indexed for MEDLINE]



Am Soc Clin Oncol Educ Book. 2013:61-5. doi: 10.1200/EdBook_AM.2013.33.61.
Which patients with sentinel node-positive breast cancer can avoid axillary dissection?

Ho AY1, Cody HS.
Author information


Abstract

Sentinel lymph node (SLN) biopsy is standard care for patients with cN0 breast cancer. An extensive literature, including seven randomized trials, has established that patients with negative SLN do not require axillary dissection (ALND), that axillary local recurrence after a negative SLN biopsy is rare, that disease-free and overall survival are unaffected by the addition of ALND to SLN biopsy, and that the morbidity of SLN biopsy is substantially less than that of ALND. It is now clear that many patients with positive SLN do not require ALND. In ACOSOG Z0011, 6-year locoregional control and survival were equivalent with versus without the performance of ALND in cT1-2N0 patients with ≤2 positive SLN treated by breast conservation with whole breast radiation therapy. A small but growing body of data now suggests that ALND may not be required for selected patients outside the Z0011 eligibility criteria, specifically those treated by mastectomy (without post-mastectomy radiation therapy), by partial breast irradiation, and by neoadjuvant chemotherapy. Looking ahead, the principal goals of axillary staging, prognostication, and local control will be accomplished by SLN biopsy for a substantial majority of patients, and the role of ALND will continue to diminish.

Re: Just Getting Started
 

for my constant thirst I drank soda water, the kind with natural flavor...no added sugar, color. La Croix is the brand I like (still!!!) can get it at Costco.