the Impact of Delayed Breast Cancer Treatment After Colorectal Surgery

Ductal Carcinoma In Situ (DCIS)

Dear Doctor,
My mother was diagnosed with stage III colon cancer three weeks ago and has undergone a right hemicolectomy.
In early February, she also had surgery to remove a tumor and sentinel lymph nodes due to ductal carcinoma in situ of the breast.
Post-surgery, the pathology report for the colon cancer confirmed lymph node involvement, and she will need to undergo chemotherapy for six months.
Therefore, the radiation therapy and hormonal treatment for the breast cancer will begin only after the chemotherapy is completed.

I would like to ask:
1.
If the radiation therapy and hormonal treatment for the breast cancer start six months later, is there a risk of breast tumor recurrence during this six-month period? I am concerned about potential delays.
2.
Additionally, will chemotherapy have any adverse effects on the already removed axillary lymph nodes or on the breast that has not yet completed the full treatment regimen?
Thank you very much for your time and response.

Chen Ting, 20~29 year old female. Ask Date: 2022/02/13

Dr. Yuan Tianmin reply Breast and Thyroid

The subsequent treatment for breast carcinoma in situ is primarily hormone therapy; however, the priority should be given to chemotherapy for colorectal cancer.
I believe it should be acceptable to start hormone therapy for the breast after the completion of chemotherapy.

Reply Date: 2022/02/13

More Info

When it comes to breast cancer treatment, particularly after a patient has undergone surgery for another cancer, such as colorectal cancer, timing and the sequence of therapies can significantly impact outcomes. Your mother's situation, where she has been diagnosed with stage III colorectal cancer and has also had surgery for breast cancer, raises important questions regarding the timing of her treatments.

1. Impact of Delayed Radiation and Hormonal Therapy: The concern about delaying radiation therapy and hormonal treatment for breast cancer until after the completion of chemotherapy for colorectal cancer is valid. Research indicates that the timing of adjuvant therapies can influence the risk of recurrence. In general, for breast cancer, it is recommended to initiate radiation therapy within a few weeks after surgery, ideally within 4-6 weeks post-operatively. Delaying radiation therapy for six months may increase the risk of local recurrence, especially if the breast cancer was aggressive or if there are other risk factors present.
The risk of recurrence during the waiting period largely depends on the characteristics of the breast cancer itself, such as tumor size, grade, hormone receptor status, and whether there are any lymph node involvements. If the breast cancer was hormone receptor-positive, hormonal therapy is crucial as it can significantly reduce the risk of recurrence. Therefore, delaying this treatment could potentially allow for the cancer to recur or progress.

2. Effects of Chemotherapy on Breast Cancer: Chemotherapy is designed to target rapidly dividing cells, which includes cancer cells. However, it can also affect normal cells, particularly those in the bone marrow, gastrointestinal tract, and hair follicles. In the context of breast cancer, if the axillary lymph nodes were previously involved, chemotherapy can help to eliminate any remaining cancer cells that may have spread. However, if the chemotherapy is not completed or if there are concerns about its effects on the breast cancer, it is essential to discuss these with the oncologist.

The chemotherapy for colorectal cancer should not adversely affect the breast cancer directly, but it can impact the patient's overall health and ability to tolerate subsequent treatments. If the patient experiences significant side effects from chemotherapy, this could delay the initiation of radiation or hormonal therapy, which could further complicate the treatment timeline.

In summary, while it is crucial to prioritize the treatment of the most aggressive cancer (in this case, colorectal cancer), it is equally important to consider the implications of delaying breast cancer treatments. It is advisable to have a multidisciplinary team involved in your mother's care, including oncologists specializing in both colorectal and breast cancers, to ensure that her treatment plan is optimized for both conditions. Regular monitoring and communication with her healthcare team will be essential to address any emerging concerns during her treatment journey.

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