Expert: Claes-Gustaf Nordquist, M.D. - 6/7/2008

Question
My mother was diagnosed with breast cancer in her right breast last July.  There were 2 lumps-- one she discovered originally, and a smaller one they found with an MRI.  The size was listed as 2.1cm.  She had a sentinel node biopsy, and only 1 node was found positive.  Then, she had 4 rounds of chemo, which we were told had eliminated the smaller lump and shrunk the larger lump.  In December, she had a mastectomy.  At that same time, a plastic surgeon moved a muscle from her back to her chest for greater blood supply during her future reconstruction.  The pathology report showed that the lump was more like 2.5cm (but that was after chemo, and after they thought it had shrunk, so it is possible that the initial reading of 2.1cm was smaller than actual).  She was staged as IIB.  After the surgery, she went through 6 more rounds of chemo.  Now, they want to do radiation.  We are concerned about side effects.  We were told that there would definitely be lung scarring, but what is the likelihood that she'll be on the severe side of that with trouble breathing, etc?  She burns and bruises very easily with very fair, thin skin.  We were told that skin color and texture didn't matter, but we are still concerned, especially given that we were told everyone who gets breast radiation receives the same dosage.  We want the best chance of not having a recurrence, but we don't want to impair her quality of life.  She will be 70 years old this summer.

Given the negative margins, only 1 positive lymph node, a tumor of 2.5cm (which may have been a little larger in the beginning-- unknown), her age, the muscle in the chest, and the fact that she has gone through chemo both before and after surgery, would you recommend radiation therapy?  Oh, she did have a small cancer removed from her face several years ago, but it was not melanoma-- not sure if that makes a difference in your recommendation.

Thank you very much for your help.

Answer
Her little skin cancer does not change anything. Dear Laura, I have to remind you that her problem is not her radiation therapy it is her breast cancer - which was rather big too and had spread to a lymph node! So you must keep your priorities straight! Yes there may be som lung scaring, as seen on x-ray, but very rarely any symptoms of it! So the important thing here is to do EVERYTHING possible to increase her chances of a cure - please remember that no guarantees can be given! So I do indeed recommend that radiation therapy is done too! Good luck!

If it has spread to a lymph node it has spread to a lymph node! Then it HAS spread! 2.5 cm. is rather large for a breast cancer and that was AFTER chemo so it is probable that it was bigger to begin with! In my book a clear case for radiation therapy!