Has anybody done chemo before surgery ???

melania

Has anybody done chemo before surgery ???

melania

Hi I am 38 year old,I found a lump in my right breast and I had a mammo and ultrasound and biopsy confirming  invasive ductual carcinoma , my tumor is 2.5 inch and ER/PR+. Grade 2 .

I saw 2 surgeons , the first one wants to do chimo first to see if the tumor is responding to that kind of chimo so that they have an idea , then do the surgery,

the other one told the same thing but then after talking to his uncologist recommends doing surgery first .

Did anybody had the chimo first then the surgery and what is your experiences?

please help i am so confused 

Luah

Melania:  You will find quite a few women on these boards who did chemo before surgery. Hopefully some will be along shortly to tell you more about their experience.  Chemo first is often recommended in the following situations:

1. to reduce a large tumour (especially 5 or more cm.), so that lumpectomy with satisfactory margins is a viable surgical option. (Or a mastectomy can be done with good margins.)

2. to test the effects of a chemo regimen, to see how the tumour responds; this is particualrly useful in triple negative tumours where chemo is the only systemic treatment available.

Without an SNB, however, doing chemo first will not allow for accurate staging as node status will be undetermined.  This is not so much of an issue on an indivual basis if you already know your treatment will include chemo.

WDWfan68

Hi Melania, I had chemo before surgery.  I was diagnosed in March 2010.  I had a tumor that was 3.4cm and it also had a lot of strands around it.  It was very close to my chest wall, so the doctor wanted to do chemo 1st in order to shrink the tumor and get it away from the chest wall.  I did AC for 4 rounds, then had a bi-lateral mastecomy in July.  I am now on chemo again, doing taxotere and avastin.  The AC did shrink the tumor.  I hope this helps.

Leesa

Twinmom77

Hi melania, so sorry you have to be here.  All the waiting and confusion and decision making is the hardest part of all this.  And it especially hard when you get conflicting opinions.

I was diagnosed last year at 32 and had chemo before surgery.  At first I just wanted the cancer out of me, but by getting chemo first you can be sure the chemo is working and if you're a candidate for a lumpectomy (and you want one instead of a mx) then the chemo can shrink the tumor to make a lumpectomy possible.

Personally, I'm so glad I did chemo first.  I could feel the lump changing with each treatment, not necessarily shrinking but getting flatter and mushier, sort of breaking up.  I was comfortable with a lumpectomy and so was my BS (breast surgeon) so about two months after my last chemo I had surgery.  There was no IDC left and just a little DCIS. The BS got clear margins, but not clear enough for her so she went back in and took a little more and there was no cancer in that either.  My breast looks totally normal.  It's just a teeny bit smaller and perkier than the other one, but it's not something anyone else would notice.

Did your surgeon recommend a lumpectomy or mx?  How do you feel about each one?  Do you know your Her2 status yet?  These all might be things that might affect your course of treatment and you want to give some thought to.  It's so hard not knowing what's going to happen and wishing you could see into the future to see what course of action is best.  Just get as many opinions you need to feel comfortable and don't stop asking questions until your satisfied and not so confused.  Hope that helps!  Hang in there!

lago

There are pros and cons to both. I did have a large tumor (origonally thought is was 7cm). They did not do chemo first.

Chemo first advantage:
You can find out if the chemo is working
Can shrink the tumor allowing for lumectomy and/or better margins

Surgery first:
Will know exactly what size the tumor is and if there is/isn't any lymph node involvement. All will help in staging. Staging aids in deciding what treatment.

----------------------------------------------------

At first I was upset that I didn't do chemo first. I asked my surgeon why. To expand on what I wrote above he was concerned about missing a micro invasion in my nodes. With such an aggressive fast growing tumor there was like an 80% chance it was in my nodes. Chemo would have shrunk it and we'd never know for sure. I just happened to be lucky and it wasn't in my nodes. I would have never know for sure otherwise. If it was in my nodes my treament would have been more aggressive and I would have been a stage III.

It's a tough decision. Both courses can be correct.

melania

Thank you so much everybody !

Actually i personally want to do mastectomy on both of my breasts. And i mentioned to dr to disregard that part of the benefit, I think dr's are confused themselves because at some point they tell the cure rate is the same if u do chemo first or after. The other benefit is that before the surgery they have the tumor to compare and see if that chemo is serponding. And to know if it is not responding they dont use it after surgery. Now i want to know what if chemo wont respond and I am delaying the srgery? And they tell oh that will respond for sure, then ok,if it will respond then whay do u wanna see IF it will respond or not if u r so sure then why dont u do that after surgery? this is totally confusing. The one dr that called me yesterday told me because your tumor is favorable for surgery the oncologist think i wont get the benefit from shrinking or not shrinking of the chimo, but i want to know will the chimo first do better in regard if there are other indetecteble cancerous cells which u can stop them from growing before surgery? I mean is this maybe worth to get the chimo first and to see if it's not working dont use it after sugery and use something else to kill the rest of the bad cells in the right way in your body ? or go ahead with the surgery and stop it at least in there from spreading and then do the chimo. I am ER PR + , my her i guess is not showing and i think is considered negative.

In my first biopsy there are 2 lymph nodes which are larger but the dr who wants to do the chemo first ordered anothe kind of biopsy specially for lymh nodes.

The Dr's told mine is grade 2 is the staging different than grading? and will they know it when they find out about lymph nodes?

I have also pet scan and bone scans to do and i am totally scared it has gone to the other parts of the body . Is this common that it has already gone to the bones and liver etc...??

Please tell me all you know

thank you sooooooooooo much

love u aaaaaaaaaaallllllllllll

please tell me what u think .

lago

Yes staging is different than grading. Grading of the tumor tells you how like/different it is from regular cells and how fast it grows:

Cell Feature Scoring
Feature Score 1: Slow cell growth rate
Feature Score 2: Intermediate cell growth rate
Feature Score 3: Fast cell growth rate.

-----------------------------------------------------------

They use the grading info to help stage:
http://www.cancer.gov/cancertopics/pdq/treatment/breast/Patient/page2

Luah

Melania:  It is very understandable to be scared about the scans - we have all been there.  Trust me, I was in tears and convinced I was going to die right after my abdominal ultrasound. These tests are very routine, and usually nothing shows up. Try to take things one step at a time.   

Because you are ER/PR positive, you will likely also have the benefit of hormonal therapy, which has been shown to be of even greater benefit than chemo in many eligible women (not saying chemo wouldn't be advised too, just that your therapy doesn't need to revolve only around that working). 

You may want to ask specifically why the oncologist recommended surgery first (usually surgeons are the ones recommending surgery, so there are probably very valid reasons for this) and/or get a third opinion from another oncologist, also ask about the role of hormone therapy.     

KittyDog

I had chemo first.  I had a huge 10cm tumor and they wanted to shrink it first.  I made it through 7 of my 8 chemos before I got so sick and they took the last one away.  I already knew I had lymph node involment because the surgeon felt the lymph node and ordered a biopsy on it before chemo.  My tumor did shrink to 5cm before having a UMX.

Yes the scans are scary even when you have had them once.  I am already nervously waiting for my rescans in Nov. 

riley702

Hi! I also had chemo first - my 4-4.5 cm tumor was triple negative, so I don't have drugs like Tamoxifen or Herceptin to fall back on after chemo and surgery to prevent recurrence. Most triple negatives seems to be Grade 3 aggressive, and mine was, too. They did a fine-needle aspiration on an enlarged lymph node when they did the biopsy and it was negative.

The BS (and the oncologist agreed) told me he wanted to hop on this with chemo first to zap any undetectable micro-mets I might have in my body, even telling me that IF this thing killed me, it would be spread that did it and not the tumor in my breast, and said he'd have a better idea how the chemo was working by watching the tumor. He also hoped to shrink it enough for a lumpectomy, but after doing a little research on triple negative breast cancer, I told him I wanted a mastectomy.

He agreed, and also agreed to a prophylactic mastectomy on the other side, but is making me wait 6 months between surgeries. He said a bilateral without medical indications (cancer on both sides) carried a higher risk of complications, like clots, without any medical benefit, so he won't do it. I have to respect that. He's one of the most highly-regarded breast surgeons in my state, so I'm going to defer to his better judgement, even though I hate waiting. It's been a week since my LMX, and it's been a lot easier than I thought it was going to be.

Good luck with whatever you decide! Grade 2 gives you a little longer to decide than I did, although my first, and continuing, inclination is to throw everything I can at it.

melania

Thank you very much ladies,

now I have so much info about it , at first i thought they wanna try this on me !!!

Riley can I ask you which state are you living in?

My other question is that how can th Dr's tell me that i am stage II?

My tumor is 2.7 and its grade 2 ,my ER/PR is + , HER2 i think is not yet showing for sure but its 2+ ,dunno yet if my lymph node is involved and havent yt done pet scan or bone scan . Aren't these ct scan and pet scans deciding what stage u r??because how do they know i dont have  mets in anybody else and I am not a stage IV or III or etc..???Can these test change my stage from II to IV???

please lemme know

NancyD

I had my first CT and PET scan before I started chemo (which was before the surgery). I had 4 doses of TAC, then they did another CT/PET scan to compare with the first. They already knew my lymph nodes were involved since one was enlarged and was biopsied at the time my breast lump was done. The second CT/PET scan showed a marked decrease in size. Still I went ahead and had a bilateral mx.

The post surgical pathology report put the tumor size at less than 2 cm, but found cancer in 4 of the 10 nodes removed. Combining this with the initial size determined by the first CT/PET scan, my oncologist did the staging.

I then had two additional doses of TAC after the surgery before I started radiation. 

LuvRVing

The doctors will tell you the staging based on scans and initial biopsy pathology report, unless you have surgery first with sentinel node biopsy.  In my case, the mammogram, ultrasound and pre-surgical MRI indicated a tumor larger than 3 cm.  Pathology after surgery indicated the tumor was only 1.7 cm.  So I went from Stage 2 to Stage 1.  I had no nodal involvement.  If you had surgery and they found cancer cells in nodes, that would affect your staging.  The one downfall to neo-adjuvant chemo (chemo before surgery) is you never really know if your lymph nodes are involved, unless the chemo doesn't work to eradicate the cancer cells.   This is why I chose to have surgery first.

I'm glad I made that decision as it turns out.  I went on to decide against chemo because I was stage 1, no node involvement and I have another condition that could have made chemo side effects particularly dangerous.

Every situation is different and you have to decide what you can live with.

Michelle

melania

Oh you ladies r soooooooooo great,

thanks again.

Nancy, they havent done biopsy on my lymph nodes but they r going to do that, I wanna also do mastectomy on both sides anyways.

Dear Luvrving about the dowfall that you mentioned  won't they know if there is if my lymph nodes are involved by doing biopsy on it ??

lago

I was in the same boat at luvrving. I'm so glad they did surgery first. My BS really thought there would be a micro invasion in my lymph nodes (took out 10 on the left). Ends up he was wrong. This means instead of being a stage IIIA I am a stage IIB. Much better prognosis. If they did chemo first I would have never known for sure.

But they can do a sentinel node biopsy before chemo and MX. This is not unusual and one way to find out if it's in your nodes prior to chemo.

riley702

Melania, I'm in Indiana. My breast surgeon is Dr. Thomas Schmidt at St. Vincent Hospital in Indianapolis.

sling99

Hi Melania,

My tumor was 2+ cm and I had chemo after surgery. From what was seen, there was no lymph node involvement. The doctors did not mention anything about possibly having the chemo before surgery. I decided to have BMX in the end.

chrishat

hi melania,

just to add one more aspect to your decision, i had chemo first, and i had no response to the chemo at all. i, also, wanted (and later had) a bilat mast, but my onc still wanted to do the chemo first, to help insure a 'better surgical outcome'. we knew from an mri that i had at least 3 lymph nodes involved. anyway, after 4 rounds of AC, we did another mri and there was no shrinkage of the tumor...in fact there was new, weird vascular activity around the tumor. so i had my surgery and then did 11 rounds of taxol. anyway, staging questions aside, i wish i would have had the surgery first since that delay allowed my cancer another 2 months to maybe spread! usually chemo works, but some people just don't respond, which sucks. my onc couldn't explain it. my tumor was 97% ER and PR positive, and HER2-. good luck with whatever decision you come to.