Post-Surgery Breast Cancer Treatment: Options and Concerns

Postoperative treatment for breast cancer?

A month ago, my mother felt a small hard lump under her breast.
She went to a nearby hospital for an examination, and the results indicated it was benign.
However, feeling uneasy, she returned to Chung Shan Medical University for a more detailed examination 2-3 weeks later.
Initially, it was also diagnosed as a benign tumor, but for safety reasons, the doctor recommended surgical removal.
The day before the surgery, she underwent more thorough tests and was informed that it was a malignant tumor.
They explained that a lymph node biopsy would be performed during the surgery to check for any spread to the lymph nodes.

After the surgery, the doctor informed us that the tumor had been removed and that the lymph node biopsy results showed a 90% chance that it had not spread, with the remaining 5-10% results to be known in a week.
My mother’s post-operative condition was better than expected, and she was discharged three days after the surgery, which relieved the family’s worries.
However, during a follow-up appointment a week later, the doctor mentioned that, as a precaution, she would need six sessions of chemotherapy, radiation therapy, and five years of medication, stating that ten years of treatment would yield better results.
Hearing this was overwhelming, and I forgot to ask for more details or if this was absolutely necessary.
Many women who have had breast surgery undergo chemotherapy, but my mother is in the early stages; can’t we consider other treatment options that are less burdensome on her body?
Since I am not familiar with the medical system and do not know anyone in the medical field, I would like to ask the following questions:
1.
Many details were only briefly communicated by the doctor.
Regarding the biopsy data, such as whether my mother’s breast cancer is estrogen receptor positive or negative, we are unclear.
Can patients request copies of their examination data from the hospital? Can we use this report to consult other doctors at different hospitals? After all, even for a cold, different doctors may have different opinions and treatments, let alone for tumors.
Moreover, if another surgery is needed for another lymph node biopsy, it seems unnecessary.
2.
If we want to discuss this with the original doctor, how can we have a detailed conversation? To be honest, the doctor was very optimistic at first, and the sudden news left us unprepared to discuss everything thoroughly.
Can we only communicate through outpatient visits, or can we schedule a specific appointment with the doctor?
3.
I understand that I have not provided any examination data, so you cannot give me a definitive answer about whether chemotherapy is necessary.
However, based on general information, is chemotherapy absolutely required? I have heard about hormone therapy and that chemotherapy can involve medication.
My mother is older, and I do not want her to suffer from the side effects of chemotherapy.
4.
If chemotherapy is indeed necessary, what side effects should we be aware of, and what precautions should we take? Where can we find this information?
I appreciate your time and assistance in answering my questions.
Thank you very much.

Hui, 30~39 year old female. Ask Date: 2009/02/27

Dr. Chen Sirong reply Oncology

Dear Ms.
Hui,
1.
It is the patient's reasonable right to request a copy of the pathology report from the original treating hospital.
Seeking a second opinion from another oncologist with this information is also a reasonable course of action, and the hospital and physician should be willing to cooperate.
2.
Discussions regarding the treatment plan are generally conducted through outpatient visits.
3.
Generally speaking, unless it is very early-stage, most breast cancer patients are required to undergo chemotherapy.
There have been significant advancements in chemotherapy and symptom management, resulting in minimal side effects for patients.
The five-year medication mentioned by the physician refers to hormone therapy.
4.
For concerns regarding the side effects of chemotherapy, it is advisable to discuss them with the physician who prescribed the chemotherapy, as different chemotherapy regimens can result in different side effects.
Wishing you peace and health,
Dr.
Kao Chung-Shu
Attending Physician, Department of Oncology
Taoyuan Hospital, Ministry of Health and Welfare

Reply Date: 2009/02/27

More Info

Post-surgery treatment for breast cancer can be a complex and daunting process, especially when it comes to understanding the options available and the associated risks. Your mother's situation, having undergone surgery for a malignant tumor, raises several important questions regarding her treatment plan, particularly concerning chemotherapy, hormonal therapy, and the overall management of her condition.

1. Understanding Treatment Options: After surgery for breast cancer, the standard treatment often includes chemotherapy, radiation therapy, and hormonal therapy, depending on the specific characteristics of the tumor. In your mother's case, the recommendation for six cycles of chemotherapy, followed by radiation and a five to ten-year course of hormonal therapy, is not uncommon, especially if the cancer is aggressive or has specific markers that indicate a higher risk of recurrence. The decision to proceed with chemotherapy is typically based on factors such as tumor size, lymph node involvement, hormone receptor status (ER/PR), and HER2 status. If your mother’s tumor is hormone receptor-positive, hormonal therapy may be a viable alternative or complement to chemotherapy.

2. Requesting Medical Records: It is entirely reasonable for you to request copies of your mother's pathology reports and any other relevant medical records. Patients have the right to access their medical information, and this can be crucial for seeking second opinions or further consultations. You can ask the healthcare provider for a copy of the pathology report, which will include important details such as hormone receptor status and HER2 status. This information can help you and your family make informed decisions about her treatment options.

3. Communicating with the Physician: Effective communication with your mother's healthcare provider is essential. If you feel that the initial discussions were too brief or not detailed enough, you can certainly request a follow-up appointment specifically to discuss her treatment plan in more depth. Many physicians are open to scheduling dedicated consultations to address patient concerns, especially when it comes to significant decisions like cancer treatment. Prepare a list of questions beforehand to ensure that all your concerns are addressed during the appointment.

4. Is Chemotherapy Necessary?: Whether chemotherapy is necessary depends on various factors, including the aggressiveness of the cancer and the likelihood of recurrence. While some patients with early-stage breast cancer may not require chemotherapy, others may benefit significantly from it. Hormonal therapy, on the other hand, is often recommended for hormone receptor-positive cancers and can be an effective treatment with fewer side effects than chemotherapy. It’s important to discuss the specific characteristics of your mother’s cancer with her oncologist to understand the rationale behind the recommended treatment plan.

5. Potential Side Effects of Chemotherapy: If chemotherapy is deemed necessary, it’s important to be aware of the potential side effects, which can include fatigue, nausea, hair loss, increased risk of infection, and changes in appetite. Each chemotherapy regimen can have different side effects, and your mother's oncologist should provide detailed information on what to expect. Additionally, supportive care options, such as anti-nausea medications and nutritional support, can help manage these side effects.

6. Finding Reliable Information: For more information on breast cancer treatment and management, reputable sources include the American Cancer Society, the National Cancer Institute, and the American Society of Clinical Oncology. These organizations provide comprehensive resources on treatment options, side effects, and coping strategies for patients and families.

In conclusion, navigating post-surgery breast cancer treatment requires careful consideration and open communication with healthcare providers. It’s crucial to gather all relevant information, understand the treatment options available, and make informed decisions that align with your mother’s health goals and preferences. Don’t hesitate to seek second opinions and advocate for her needs throughout this process.

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