Hmmm, hatte jetzt gaaaanz viel geschrieben und es ist weg, das ist doof, aber ich versuche es noch einmal.
Ich wollte dich, Anne, fragen, was der genetische Test beinhaltet. Nimmt man da nur Blut ab oder muss man andere Untersuchungen über sich ergehen lassen? Und was sagt der Test dann aus?
Ich habe auch festgestellt, dass die Ärzte zum Teil ein wenig überfordert sind mit einem medulären Karzinom bzw. wenig darüber informiert sind. Es gibt aber auch recht wenig Informationen darüber. Habe allerdings etwas auf anglo-amerikanischen Internetseiten recherchiert, einfach mal googeln (medullary und dann breast cancer oder ähnliches) und dann wird man schon eher fündig. Ich habe etwas in einem Forum gefunden, ich kopiere es mal rein. Da ist man sich ja auch nicht sicher, ob Chemo ja oder nein, aber aus eben dieser Unwissenheit heraus wird dann doch zur Chemo geraten. Es existieren viele unterschiedliche Meinungen zu „unserem“ Tumor und richtig fundiert sind die alle nicht, daher wird er dann auch einfach so behandelt, wie alle anderen auch.
Hier mal der Text:
My wife (37 years old) was diagnosed with invasive breast cancer recently.
she had a lumpectomy with Sentinel lymph nodes procedure. The pathology report showed: typical medullary carcinoma, 0.9cm w/negative margin, grade 3, ER/PR-, Her-2 negative. All five lymph nodes were negative.
We have our second opinion done in a famous institute in Boston yesterday, they agreed with the pathology report.
The tricky part is Medullary. All the information we got before we saw our Oncologist stated that Medullary Carcinoma had a better prognosis, and our radiation doctor said no chemo was needed (2002 NCCN guidelines). He said just doing radiation without chemo, the 10 year survival rate for such a small size medullary cancer was around 90%, the chemo may boost it to 91% 0r 92%. Our oncologist showed us the 2003 NCCN guidelines, which stated that medullary was not considered as a milder kind of cancer, for two reasons:1)the risk of metastases equal that of other high grade carcinoma, 2)easy to be misclassified.Her data: 10 year survival rate was 80% and 88% without/with chemo,and she recommended the chemo. Our second opinion doctor confirmed that it was medullary carcinoma, but it was not considered as a more favorable type. chemo or not? up to us. My question:
1)what have changed recently that lets the NCCN reconsider medullary carcinoma?
2)In your practice, did you see any difference in prognosis between the typical breast cancer and the medullary breast cancer?
3)what is the 10 year survival rate for stage I medullary carcinoma with and without Chemo?
4)chemo or not chemo?
Answer Posted By: CCF-RN,MSN-RF on Monday, January 12, 2004
Dear ahubby: It's not that anything has changed other than more data being available to be analyzed. The NCCN is a group that strives to reach a consensus on what should be the standard of care. They base their discussions on research that is available and determine what, as a group, they believe will benefit the largest numbers of people. Remember, data is based on large groups - never on individuals. The biggest reason to not consider medullary carcinoma more favorable is its risk of metastasis. The survival rates in the AJCC staging manual site 5 year survival rates (observed 87%, relative 98%) for stage one breast cancer - it does not differentiate types. However, there are other factors that may make one more prone to consider additional therapy [e.g. Bloom Richardson score, ER/PR status (negative tumors tend to be more aggressive), angiolymphatic invasion, and age of the patient]. The key to deciding upon chemotherapy is considering one's risk and the potential benefits. Dr. Susan Love's Breast Book has a good discussion of this. If your wife's tumor were larger than one centimeter - chemo would be recommended. Given that medical oncologists are the most familiar with the current literature regarding chemotheray, I would be partial to their recommendations rather than those of the radiation oncologist (his job is to be most current with principles of radiation therapy). Ultimately, this decision will be hers. We recommend a thorough discussion with the oncologists (less about the medullary aspect) more about her specific risks versus benefits.
Questions in The Breast Cancer Forum are being answered by doctors from
The Cleveland Clinic , consistently ranked one of the best hospitals in America.
(ich finde dies ist übrigens ein sehr gutes Forum, zu finden:
www.medhelp.org)
Ich finde wichtig, dass geschrieben wurde, dass die Prognosedaten immer nur aus Gruppen resultieren und eigentlich nicht auf eine einzelne Person bezogen ist. Jeder Mensch ist ja anders, daran halte ich mich auf jeden Fall fest.
Vielen Dank für die Übersetzung, Dorothee!!!
Liebe Grüße
Melicia
P.S. Es ist natürlich nicht mehr so geworden, wie ich zuerst geschreiben habe, tja so ist das mir der Technick ;-)