Invasive Carcinoma Breast Stage II

Hi all

New to the group. I was diagnosed with invasive ductal carcinoma at the beginning of April strongly estrogen posltive in 80-100% of the tumour cells- right breast right behind nipple they said progesterone negative and her2 negative and biopsy said not showing in lymph nodes but 2 would need to be removed. I went to one hospital who gave me this opinion that it was 3cm and lumpectomy and radiation are the treatment. I was started on the 8th of May on Letrozole in the hope that it would shrink. 

Anyway I thought the tumour was bigger than 3cm myself so I went for a second opinion to a second breast consultant. I didn't want to believe it was so I went along to another breast surgeon with all my questions on lumpectomy and radiation.  He unfortunately gave me the bad news that he didn't believe that the size of the tumour was amenable to a lumpectomy. He advised going back to the first hospital as they never did a physical breast exam when they first diagnosed just ultrasound, mammogram and biopsies. I know missing a basic step :(

Took ages to get an apt back at the first hospital but I went back and they said that they made a mistake in that they didn't assess that I was A/B cup size and he agreed with the second surgeon that the cancer remains 4cm in size and that based on esimated cup size attempts at breast conserving surgery would be removing well over 30% of breast volume and would not be a good aesthetic outcome and that I would be better served by mastectomy. He said the best thing now would be an MRI to give more visual information of the extent and he said they would schedule it Sept or October.  I met him by the way on the 6th of August.  I was upset because I am working 3 days a week and a full time carer for an 88 year old mother who has huge health issues and I have no support yet. Carers are hard to find - only working myself 18.5 hours and finding good ones well that is a minefield. Just have 14 hours a week for my mother who is also late stage dementia which comes with so many challenges and heart failure. The last 9 of my life have been hugely stressful relentless, was caring for my father before he passed away. 

To cut a long story short I had Ultrasound yesterday in the second hospital and they said the tumour was still 3cm what the first hospital had said comparing ultrasounds. I am totally confused. She said then the breast surgeons may have said 4cm based on physical exam. She said there is no change from the first ultrasound. It wasn't a particularly nice experience with her when I asked questions and even explaining why I am with two hospitals. She said 'I don't want to get into that with you'. I said but you asked me how I come to be here and why you have scans from the other hospital. She said 'stick with one hospital because we don't link with scans and it can take ages to get scans to us from another hospital'. I felt like saying I am in this situation because there was a discrepancy with one breast surgeon saying lumpectomy and the other saying mastectomy but I didn't bother.   She wasn't happy yesterday when I said I would do the ultrasound and I didn't want mammogram as I didn't get a letter for that. I really could not be doing with that pain again of squishing the tumour, I don't care and probably spreading it who knows.... I nearly passed out the last time. She said 'It's even sore for me having a mammogram'. I was going to say but you don't have a 3/4 cm tumour but I didn't bother.  Her tone, her frustration and generally non supportive. I had my mum with me too as had no carer for yesterday.

Anyway my questions:

Tumour is the same 3cm (can we trust this?)- does this mean letrozole has not worked from 8 May to 12 Sept (4 months) - is it too soon to expect any shrinkage or does it mean the cancer is more agressive? I am gutted. I am in no position right now for a mastectomy given my mother's health and I really don't want one. I doubt I will stand up to that psychologically given how much stress I have endured for years. I have not met with any oncology but she spoke to me over phone and she said she would expect some shrinkage when I had the ultrasound which was yesterday. Now I don't know if it was 4cm and shrunk to 3cm what the original first hospital said. Or it is 4cm on physical exam but is 3cm on ultrasound. 

The alarming thing she said yesterday it was - this is close to the skin (I had felt that it was a bit smaller but no so according to her but she said it is right behind nipple and very close to the skin and it could be growing outwards.  No one mentioned this aspect before. Is it a new finding or an old one. I was scared to ask her. She said when are you seeing the breast surgeon, I replied on 23rd Sept. - Does this mean it is growing towards the skin? She said 'You don't want this coming out'. At that point my brain shutdown because her approach was just all wrong. I gave up. 

So deflated after yesterday and now going letrozole must not be working or am I expecting results too quickly and what is this new finding it is very close to the skin. Am I in major danger?

If anyone has had any experience of this? My distrust of hospitals goes back a long way because my father got harmed by one and the mistakes I saw being made. This situation is not reassuring me. Do I need a third opinion or wait for MRI. I am also doing watchful waiting on complex cyst ovary 7.8cm - that a separate consultant now wants to remove on my right ovary - remove ovary and cyst as higher risk of it turning because of the links of ovarian cancer and breast cancer. He wants to biopsy it. Have parked that for minute but I am still in touch with him keeping him updated and he would like to see me any wednesday to try to accommodate me getting care for my mother. He does want to take out and biopsy in case... I am 54 and menopause only at 53 prob down to stress and suffered endometriosis all my life. Seems I am growing everything on the right side.

Any advice welcome. I missed 3 oncology apts as hadn't care but she said she was only going to meet me to say stay on letrozole. Now I am worried is this more aggressive after yesterday's encounter. The bit from the radiologist 'you don't want this coming out' was like payback for not doing the mammogram and adhering to her instructions. I really think the radiologist would benefit from the tutelage of someone older and more sensitive in how she words things...which I will say to breast surgeon. Is this going to alter stage...etc. 

Down after yesterday and trying to pull myself back up - sorry if badly typed... too tired to read over it. Can I have some good news...  Not able...