What do these blood and CT scan reports for breast cancer indicate?
Patient: Hello, My sister has been diagnosed with Breast cancer in the last few weeks. The reports are attached-she has also had normal blood work and a normal CT scan. She has seen an oncologist who is recommending that she completes Chemo before having the breast removed. They refer to this as neoadjuvant therapy. The course of the chemo will last 16 weeks and the surgery will follow about a month after chemo concludes. My questions to you: 1-What are there benefits/concerns with neoadjuvant therapy vs adjuvant therapy (having the surgery now and determining the exact stage of the cancer to establish the appropriate treatment)? 2-If she proceeds with the neoadjuvant therapy, should she have a lymph node biopsy now? If not, when? 3-Her pathology report shows HER-2 Negative. From what I read this is a good thing. How accurate is the process of determining HER2 positive or negative in a pathology report vs the fish test? 4-Can you tell me if an Oncotype DX test is important? From what I read it can tell you the likelihood of reoccurrence, however, since she will have Chemo, is it still important? It s very hard to get any clear answers and some guidance would really help! Doctor: In stage 3 cancer and in some stage 2 cancer it is recommended to give neoadjuvant therapy first followed by surgery.it will not only give the patient the benefit of conserving breast in some cases but also in cases where there is complete pathological complete response of the tumour to neoadjuvant chemo treatment it has been proven that it has led to decreased  chances of recurrence and increase overall survival rates.FISH  for her2 is generally performed in doubtful cases like her2 2 positive.her2negative is definitely better than her2 positive.oncotype DX is generally recommended for small rumours of size less than 1cm with lymph nodes negative cases though there is slight variation in recommendation in case to case basis.liklihoid of recurrence depends on staged and response to chemotherapy in a patient. lymphnode biopsy is generally recommended before neoadjuvant chemo