My friend had a lumpectomy and removal of some lymph nodes on January 19th, and shortly thereafter was advised that her lymph nodes were "clear" of cancer (a big relief -- blood tests and chest xray had also come back clear). I have been reading about the ways breast cancers are classified, however my friend has not yet been advised as to whether her breast tumor is "in situ" or "invasive" (nor does she know whether it is a ductal or lobular tumor -- she'll be getting the answer to those questions on Monday). All she knows is that following her surgery, and as far as the doctors can tell, there is no further cancer in her body. She has also been advised that she will be scheduled for radiation therapy.

Our question is this: is chemotherapy indicated for women whose breast cancer has not metastasized? Is the designation of the tumor as "in situ" or "invasive" relevant to determining whether chemotherapy is indicated? Is chemotherapy used as a "pre-emptive" thing, or is it only used to treat existing tumors?

-Chemotherapy may be recommended for pre-menopausal women with breast cancer even when there is no sign of metastasis. The theory is that breast cancer tends to be more aggressive in pre-menopausal women, and there may be tiny bits of cancer that have spread into the blood stream (micrometastases), even with negative nodes. Chemo is used as a preventative treatment to kill off possible strays. Unfortunately there is no way to know _for sure_ if someone has micrometastases, so chemo is used as a kind of insurance.

I think chemo is less common (if used at all -- not sure about this) with in situ cancers, so this is a very important thing for your friend to find out. When she gets her complete pathology report the oncologist should go over all of this with her. But yes, it is a possibility with negative nodes and no evidence of mets.

-I am 46 years old, pre-menopausal,had a lumpectomy in October last year and lymph nodes removal. Nine were taken and they were clear of cancer.I had invasive ductal carcinoma, and in situ as well. The tumor was 1.6cm.And ER positive. I started on Tamoxifen straight away.Then I was told I had to have Chemotherapy, because my cancer was Grade 3. Very agressive cells.I am getting CMF for 6 months. I have had 2 cycles with pretty much no side-effects at all.After that treatment I am booked for Radiotherapy as well. The Chemo is just in case cancer cells have gone elsewhere in the body, although there is no sign of that. From all I have read about the subject it seems the survival chances are much better ,if Chemo is given as a precaution. So I gladly take it. It is nothing as bad as I had thought.