Timing of chemo after mastectomy with fluid drainage

[concerneddaughter123]

My mother (67.5 yrs) underwent surgery for breast cancer 6 weeks ago, she had invasive ductal carcinoma with a 1.8 cm tumor and 1 axillary node involved out of 13 studied (report says capillary effraction on that node). Her tumor grade is G3.  Her hormonal test results came Er+ (45%), Pr+ (10-15%), Her2/neu -. The tumor is also presumed to have developed very quickly, as less than 1 yr ago ultrasound showed nothing suspicious.

Her medical oncologist recommended she starts ACT chemo asap but be monitored, given that her cardiac health is good but not great.  However, the same oncologist is now delaying the start of chemo, given that my mom gets lymph fluid drained out of her underarm (at the hospital, with a serynge) at a rate of ~25-30 ml every 2 days; he is concerned about infection.

What is the optimal timeframe to begin chemotherapy (I was told 4-6 weeks post surgery) and how should this be assessed relative to the risk of infection from lymph fluid accumulation?  Can she continue to have fluid drainage during chemotheraphy?  Also, could my mom benefit from hormonal therapy like Tamoxifene or aromatese inhibitors giver her Er/Pr status?  Which and when should she begin hormonal therapy, given the ACT chemo?  Finally, do you think she will also need radiation therapy, and if so, when?

Many thanks for all your help!

[Cleveland Clinic]

Dear concerneddaughter123:  If chemotherapy is recommended, it is usually recommended to begin about 4 weeks after surgery (plus or minus a week or 2).  However, if there is a wound or invasive procedures, chemotherapy may be delayed.  Most oncologists will not want to be doing invasive procedures during chemotherapy given the increased risk for infection.  In a case where hormone receptors are positive, it is likely that hormone therapy would begin after chemotherapy and radiation therapy (if she needs it).  Her doctor will be best to advise regarding this.  If you are concerned, you may want to consider a second opinion.

[concerneddaughter123]

Thank you. To clarify, is fluid drainage with a seringe considered an invasive procedure or wound in this case?