Follow-Up after Surgery

[Belleview Teacher]

On November 20 I had a simple mastectomy of the right breast and a sentinel node biopsy.  The pathology findings were 1.1 cm medullary carcinoma, surgical margins negative, lymph node negative for malignancy, ER/PR negative, HER2/neu negative, stage T1c No Mx. My follow-up with the oncologist is on January 14.  What adjuvant treatment can I expect?  What questions should I ask the oncologist?  What further tests should I request (MRI, bone scan, PET scan) to insure that there is no cancer anywhere else? Thanks for your help.

[Belleview Teacher]

Sorry for not giving you the whole picture.  I am 57 years old and had a total hysterectomy 8 years ago because of cysts,fibroids and a family history of ovarian cancer (mother, maternal grandmother).  There is no history of breast cancer on either the paternal or maternal side for at least the two previous generations. My overall health is good; I take no medications, but did smoke cigarettes for about 30 years.

[surgeon]

you didn't state your age or menopausal status. However, you are at the borderline of needing any further treatment, in addition to which, as you may already know, medullary cancer tends to behave better than other forms. So it might well be that no treatment would be recommended. If it is suggested, the main questions to ask are the statistical benefit for your specific situation, versus the statistical risk. Statistics, of course, are guidlines at best, since they can't predict the outcome of an individual. But that, it seems to me, would be the area on which to focus. Benefit would be quite clear, were it much larger, a different cell type, node positive, etc. As to further testing: data have shown pretty well that for stage I breast cancer, such things as PET, MRI, bone scans don't provide useful data and aren't needed for the significant majority of women.

[CCF-RN,MSN-JS]

Dear Belleview Teacher, Adjuvant therapy is treatment given after surgery to try to prevent or minimize the growth of microscopic deposits of tumor cells that might grow into a recurrent tumor.  The current standard is to offer adjuvant chemotherapy if the size of the tumor is greater than 1 cm, regardless of lymph node status.  However, a medullary carcinoma tends to have a better prognosis than typical invasive ductal or lobular cancers, so that may be taken into account with treatment recommendations.  With the negative ER/PR status, adjuvant hormone therapy would not be recommended.  

Your oncologist may or may not do any further staging scans.  If you have no concerning symptoms, (pain, cough, etc), considering the size of tumor and medullary component it may not necessarily add any information.