3rd Oncologist Advice

Went to meet Dr Manivanan from Wijaya International Medical Centre, located at PJ.

He first examine my report and body.

Some simple practical rules from him
- mastectomy, no need radiotherapy
- ER/PR -ve, must do chemotherapy
- ER/PR +ve, do hormone therapy

About radiotherapy, IMRT is only suitable for organ or area that is in inner body, like kidney, stomach etc. 3D  CRT is the most common and suitable used for breast cancer, as it is considers located at outside of the body, with minimized radiowave into other body organs. About 1% of lung will get damage, the wave will kill the lung cell; 1cm depth start from the edge that is close enough to the breast. He suggests to do 4 weeks shooting on whole breast and another 5 days for boost. Side effects are similar to what other doctors said, darker skin (temporary), nausea, cough, vomit etc. Dr Azrif from Prince Court told me there will be 3 tattoo dots on my body, but Dr Manivanan says there will be only removable marks but not tattoo. Somemore is invisible marks. Cost is about RM15k to RM20k, Dr Mani give me an estimated figure only.

There are 2 types of drug being used in hormone therapy, i.e. Tamoxifen and something called Armidex (not sure about the spelling, assuming this is correct now). Tamoxifen is a very old medication, which is being used for almost 30 yrs. It is very effective and less expensive. Armidex is being used for 5-6 yrs (most is 10 yrs only), better than Tamoxifen in a way, it reduces the side effects. But is about 5-7times more expensive than Tamoxifen. Less assume Tamoxifen is about RM100 / month, this Armidex will cost RM500 or RM700 per month then. According to Dr Mani, Armidex can cause osteoporosis. These medication will actually stop cancer cell from attaching to ER, but not to stop ER production. This is something I misunderstand about this medication previously.

If cancer come back again on the same breast, definitely it will at higher stage and chemotherapy is a must by then.
I dont have the option to do only radiotherapy but not hormone. If decided to go for therapies, must do both.
It is useless to only start the therapies at 6 months later. He mentioned something like, the therapy must start as soon as possible after surgery, otherwise is not much helpful for the cure. He used one very technical term when trying to explain to me, but, I couldnt catch.