Deb Crowe Schlosser Beats Cancer

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Breast Cancer Pathology Summary:

• ER (Estrogen Receptor) Positive: 46.6%
• PR (Progesterone Receptor) Positive: 33.4%
• HER2 (Human Epidermal Growth Factor Receptor 2) Negative
• Left Axillary Lymph Node: Positive for metastatic breast carcinoma

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Clinical Interpretation:

• ER and PR Positive (Hormone Receptor-Positive):
  This suggests that the cancer is likely responsive to hormonal (endocrine) therapy, such as tamoxifen or aromatase inhibitors.
• HER2 Negative:
  The tumor is not overexpressing HER2, so HER2-targeted treatments (like trastuzumab/Herceptin) are not indicated.
• Lymph Node Involvement:
  Positive axillary lymph node indicates that the cancer has spread regionally, which often places it at Stage II or III, depending on tumor size and number of nodes involved.

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Next Steps Typically Considered:

1. Imaging & Staging:
   Full staging workup (CT, bone scan or PET) to rule out distant metastases. SCHEDULED 5/15/25
2. Multimodal Treatment Plan:
   • Surgery (lumpectomy or mastectomy)
   • Hormone therapy (due to ER/PR positivity)
   • Chemotherapy (likely, due to nodal involvement)
   • Radiation therapy (especially if breast-conserving surgery is performed or nodes are positive)
3. Genomic Testing:
   Depending on overall risk factors and preferences, a genomic test like Oncotype DX might be used to guide chemotherapy decisions (usually in early-stage ER-positive, HER2-negative cancers).

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Chemotherapy Regimen: Adriamycin + Cyclophosphamide → Taxol

This is often abbreviated as:

AC → T

• A = Adriamycin (Doxorubicin)
• C = Cyclophosphamide
• T = Taxol (Paclitaxel)

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Typical Schedule:

1. AC phase (Adriamycin + Cyclophosphamide):
   • Usually given every 2–3 weeks for 4 cycles
   • Duration: ~8–12 weeks
2. Followed by T phase (Paclitaxel):
   • Weekly for 12 weeks or
   • Every 2 weeks for 4 cycles (dose-dense)

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Purpose of Each Drug:

• Adriamycin (Doxorubicin): An anthracycline antibiotic that interferes with DNA replication.
• Cyclophosphamide: An alkylating agent that prevents cancer cells from dividing.
• Paclitaxel (Taxol): A taxane that inhibits microtubule breakdown, stopping cell division.

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Why This Regimen?

In ER-positive, HER2-negative, node-positive breast cancer:

• Chemotherapy reduces the risk of recurrence, especially with lymph node involvement.
• Followed by hormone therapy for 5–10 years (e.g., tamoxifen or aromatase inhibitors).
• Radiation therapy is often added post-surgery if nodes are involved.

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Side Effects to Be Aware Of:

• AC:
  • Nausea, fatigue, hair loss
  • Risk of low blood counts
  • Cardiac toxicity (why heart function is monitored)
• Taxol:
  • Peripheral neuropathy (tingling/numbness)
  • Nail changes
  • Allergic reactions (pre-medication is often given)

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Here’s how AC → T chemotherapy fits into the overall treatment plan for ER+/PR+, HER2−, node-positive breast cancer, and how hormone therapy is integrated afterward.

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1. Typical Treatment Timeline:

A. Surgery (if not already done)

• Either lumpectomy or mastectomy. MOST LIKELY DOUBLE MASTECTOMY
• Sentinel lymph node biopsy or axillary dissection if nodes are involved
• Sometimes done before chemo (for smaller tumors), or after chemo (neoadjuvant approach)

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B. Chemotherapy (AC → T regimen)

• AC: Adriamycin + Cyclophosphamide (every 2–3 weeks x 4 cycles)
• → T: Paclitaxel (weekly x 12 weeks or every 2 weeks x 4 cycles)

Total duration: ~4–5 months

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C. Radiation Therapy

• Usually follows chemotherapy if:
  • Breast-conserving surgery was done (lumpectomy)
  • Lymph nodes were positive
  • Tumor was large or close to chest wall

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D. Hormone (Endocrine) Therapy

• Starts after chemo (and often after radiation), continues for 5–10 years
• Based on menopausal status:
  • Pre-menopausal: Tamoxifen ± ovarian suppression
  • Post-menopausal: Aromatase inhibitors (e.g., letrozole, anastrozole)

This reduces the risk of recurrence long term, especially in hormone receptor-positive cancers like yours.

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Optional: Bone-Strengthening Therapy

• If on aromatase inhibitors and postmenopausal, may receive bisphosphonates (like zoledronic acid) to prevent bone loss and reduce recurrence risk.

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Summary Timeline (Typical Sequence):

scssCopyEditSurgery → Chemotherapy (AC→T) → Radiation (if needed) → Hormone Therapy (5–10 years)

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Here’s a visual timeline of a typical treatment course for ER+/PR+, HER2−, node-positive breast cancer, with notes on when neoadjuvant chemotherapy might be used.

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🗓️ Treatment Timeline (Standard Sequence)

scssCopyEdit[1] Surgery → [2] Chemotherapy (AC→T) → [3] Radiation → [4] Hormone Therapy (5–10 yrs)

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✅ Alternative: Neoadjuvant Approach (Chemo Before Surgery)

scssCopyEdit[1] Chemotherapy (AC→T) → [2] Surgery → [3] Radiation → [4] Hormone Therapy

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📌 When Neoadjuvant Chemo Is Considered:

• Tumor is large (typically >2 cm). MINE IS BETWEEN 3CM & 5CM
• Lymph nodes are known to be positive
• Surgery would require a mastectomy, but patient hopes for breast conservation
• Goal is to shrink tumor and assess response to chemo

If there’s a good response (tumor shrinks significantly), this can help guide further treatment decisions and may allow for less extensive surgery.

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🧬 Example Full Treatment Map:

Phase	What It Includes	Duration
Neoadjuvant Chemo	AC (8–12 weeks) → T (12 weeks)	~4–5 months
Surgery	Lumpectomy or mastectomy	1–2 weeks recovery
Radiation	Daily (Mon–Fri) for 3–6 weeks	~3–6 weeks
Hormone Therapy	Tamoxifen or Aromatase Inhibitor	5–10 years

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🎯 Goal of Treatment Plan:

• Chemo: Kill cancer cells systemically
• Surgery: Remove the tumor and affected nodes
• Radiation: Prevent local recurrence
• Hormone Therapy: Prevent distant recurrence over the long term

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Here’s a list of important questions you can ask your oncologist, as well as a printable treatment summary you can bring to your appointment.

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✅ Key Questions to Ask Your Oncologist

🧬 Diagnosis & Staging

1. What stage is my cancer?
2. How many lymph nodes are involved?
3. Do I need additional scans (e.g., CT, PET, bone scan)?

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💉 Chemotherapy (AC → T)

4. Should I get chemotherapy before or after surgery?
5. How long will chemo take, and how often will I come in?
6. What are the main side effects, and how can they be managed?
7. Will I need a port for chemo?
8. Will chemo affect fertility? Should I consider preservation options?

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🏥 Surgery

9. Will I need a lumpectomy or mastectomy?
10. How many lymph nodes will be removed?
11. If I have neoadjuvant chemo, could it allow for breast-conserving surgery?

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🔆 Radiation

12. Will I need radiation after surgery?
13. How long is radiation therapy, and what are the side effects?

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🌿 Hormone Therapy

14. What type of hormone therapy do I need?
15. How long will I take it, and what side effects should I expect?
16. Will I need ovarian suppression (if premenopausal)?

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💪 Overall Treatment Plan

17. What is the order of treatments and expected timeline?
18. What is the goal of treatment — cure or control?
19. Can I work during treatment, or will I need time off?