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Treatment I might expect for Breast Cancer

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currently diagnosed provisional grade 1 bc in1 lymph node. Having more tests MRI, CT scan and repeat ultrasound to axilla as there appears to be further indiscriminate lymph nodes. Results will be available in 2 weeks  I am currently on letrozole. Breast conserving and lymph node removal have been mentioned. I am wondering if there is cancer in more lymph nodes should I expect further treatment.  ?

JaneL - Macmillan
Posted by

Hi Suzy19

Thanks for getting in touch. It can be a very frustrating and worrying time waiting for results that will help your hospital team decide what is the best treatment for your cancer. Trying to take a sense of control during this waiting period can help.

A group of experts called a multidisciplinary team (MDT) will meet to plan your treatment. After the meeting, your specialist will talk to you about the treatment options. This depends on the type, stage and grade of the cancer. It will also depend on your general health and what you may prefer. The scans that you have had will help to determine the stage of your cancer.

Your team will use national guidelines to help them decide whether you need further treatment or not. They also must look at your risk of the cancer recurring when they make the decision about further treatment. Doctors can use online computer programmes to estimate prognosis.

You may find it useful to have a chat with your breast care nurse or consultant if you are feeling very worried about the time to wait for your results. You can think about ways to relax or activities that provide a distraction. Do also speak to your GP if you feel you are not coping with the worry.

I hope this helps to answer your question. If it would help to talk things over with one of the nurses on the support line, please don’t hesitate to give us a call.

Best Wishes

Jane – Macmillan Information Nurse Specialist

Posted by

Hi. Thankyou for your response. I am still waiting results of second biopsy. However, my surgeon mentioned the Letrozole reducing the tumour. How much does the tumour shrink in a 3 month period?  I have a lot to consider I know nothing about iodine seed targeted axilla Ray dissection which was also mentioned. In between all of this I also have a meningioma which I need a craniotomy. Any help thanks in advance 

Ellen M-Macmillan
Posted by

Hi Suzy,

Thanks for getting back in touch with us. I’m glad you found Jane’s answer to your previous question helpful.

It’s difficult for us to say how much your cancer will shrink in a 3-month period, this is because everyone’s cancer responds differently to treatment. This research reported a median time (50% of people) had a maximum response with letrozole of 4.2 months. However, over a third of responding patients required more than 6 months of treatment.

It’s not unusual for doctors to start someone on Letrozole before surgery(neo-adjuvant) with the aim of shrinking the cancer before surgery. Your doctors will want to do a further scan such as an ultrasound to measure the cancer. They will compare it with the scan before starting treatment to assess the response that your cancer has had.

How to manage the axilla after someone has had treatments before surgery is an ongoing debate amongst surgeons and oncologists. This is because when someone has had neo-adjuvant treatment it can be difficult to assess the response of axillary node metastasis. Because of this doctor would usually recommend an axillary clearance after treatments such as chemotherapy given before surgery.

The MARI (marking axillary lymph nodes with radioactive iodine seeds) is a procedure that doctors are looking at to see if it will prevent axillary clearances being performed for someone who has had treatments before surgery. It’s not routinely offered to patients in the UK. You might find this article about the procedure being pioneered at the Royal Victoria Infirmary helpful to read.

I hope you don’t have to wait too long for the results of your second biopsy so that you have a clearer idea of what your treatment plan will be. It’s important that when you go back and speak to your doctors that you can ask questions so that you can make informed decisions about your treatments.

They will also be considering your meningioma and how soon you will need to have a craniotomy when they are making decisions about your treatment plan.

I can see that you’ve already joined our surgery online group. Our supportive breast cancer group can be helpful to join too. There may be someone there who has had this procedure and would be able to share their experience with you. There is nothing quite like the support that you can get from others who know what it’s like.

You can also give our Support Line a call on 0808-808-0000 and talk to one of our nurses. Our lines are open every day from 8am till 8pm.

Best wishes and take care. 

Ellen-Macmillan Online Digital Nurse Specialist.