advice on neoadjuvant therapy

Survivor2Be

i have a 1.4 cm tumor in my right breast.  i have been advised to do the chemo first, then decide on surgery.  due to the prognostic markers, aggressive features and my young age (33), i'm leaning towards mastectomy (possible double if the BRCA is positive).

 Here's my dilemma: i have friends that have been through breast cancer - obviously all BC is a little different!  However, they are very concerned about my decision to do chemo first and then surgery.  Has anyone else made the choice of neoadjuvant chemo with a small tumor?  if this was offered to you, what was your decision making process?

THanks for any feedback into weighing the options!   

LuvRVing

I was given the option of chemo first or surgery first.  My tumor was thought to be 3 cm.  I opted for surgery first - I wanted that sucker out of there.  And it was a good decision as the tumor was just 1.7 cm.   And I ended up passing on chemo after doing all the research, which I had time to do because I had surgery first.  Mine was also aggressive and my ki-67 was 50, so getting it out of there was a good decision for me.

Michelle

Halah

I'm not sure why they'd want you to do chemo first. I'd think if you have an aggressive cancer, they would want to get it out of there and get clean margins, THEN chemo. I thought chemo first was for large tumors that needed to be shrunk down before surgery.

I just noticed your hormone receptor status. Do you know your HER2 status? It might be different for triple negative high grade cancers so that might be the reason for chemo first because it takes time to heal from surgery. But I really don't know.

Mindy xxx

Survivor2Be

i'm still waiting to get the final HER2 status back.  i think the same as Madalyn.  i know i will need chemo regardless, so i think i like the fact that i can see the tumor shrinking.  plus i feel it gives me more time to make a decision regarding surgery (single/double/reconstruction).   i just have loving friends who are concerned and i wanted reassurance that other women have chosen this same course and their reasons why.  Thank you!

lago

My surgeon said they do chemo first for large tumors and if it has metastasized. At the time they thought my tumor was 7cm and he didn't recommend chemo first. He felt if they did chemo first we would never know for sure the size or if it was in my lymph nodes. This could be an issue in getting the correct stage and subsequently making the correct treatment choices.

I think he also said he wasn't totally convinced  that the tumor shrunk in one piece or shrunk in pieces leave a few cell behind.

I'm glad I did surgery first. My surgeon had a strong feeling there would be a micro invasion in my nodes… and there wasn't. Also my tumor was only 5.5cm not 7.

But yes the advantage of chemo first is finding out if it works. In my case, being HER2+ I knew I was getting chemo & Herceptin anyway.

Suze35

I am having neo-adjuvant therapy, and have multi-focal tumors, each about an inch.  There are also four positive nodes - but they are very low in the breast tissue, before the sentinal nodes, so my Onc. is still staging me at IIb after an MRI and clear PET/CT scan.

This was the protocol from both my Onc and the doctors at Massachusetts General.  Based on the triple-negative, very agressive tumor, and the fairly clear staging, they preferred to stop any spread first, then take it out.  I'm okay with this - I can already feel my lymph nodes are down a bit even after one session.

Talk with your doctors about exactly why they are going this route - studies have shown it makes no difference in terms of outcome to do chemo before versus after surgery.  But you should at least know why they are doing this.

Twinmom77

I had chemo first for a 1.8cm tumor.  They wanted to make sure the chemo was working on it and I was also a candidate for a lumpectomy so they wanted it as small as possible for surgery.  At first I just wanted it out of there, but I'm so glad I had chemo first.  I could actually feel the tumor shrinking and changing with each treatment.

I agree that you need to ask your docs as many questions as it takes to make you feel comfortable with what's going on.  You sometimes have to be like a little kid saying "Why, but why, why, why?"  And I know your friends are very concerned and care a lot about you, but what I've learned is that everyone's treatment is different depending on their diagnosis and even with the same dianosis, the treatment can still be very different.  It's hard not to let people's opinions affect your decision, but ultimately you have to go with your gut and what's best for you.  Good luck to you!

libraylil

I'm also 1/2 way through neoadjuvant chemo.  In the beginning all I wanted to do was get this out asap.  Then realized it would be at least 6 weeks before I could have chemo if I opted for surgery first.  I began to obsess about cells that were making their way out of the barn and into my body since one lymphie showed some cells.I wanted the big guns blazing and chasing them down immediately.  The onc says there has been a total response to the chemo and he can only detect scar tissue.  Also I know what you mean, people think it is weird to have the chemo first.  Plus mine is ILC and HER2 which are two nasty little factors.  Keep posted on what you decide and your progress.  Hopefully, I'll be ready for a lumpectomy around Dec or Jan and we'll see exactly what is left. Beth

Laurie09

I had neoadjuvant chemotherapy.  

My surgeon was the one who really recommended doing chemo first because I had positive nodes on my MRI.  In reality, from what I have read, the prognosis tends to be the same whether you are treated before or after.  

In my case, it was good to have my chemo done first as we were able to see that my primary tumor went away completely with chemo though I still had some cells in my nodes.   

Talk with your doctor - my understanding is that the prognosis is the same with neoadjuvant v.s. adjuvant therapy following surgery though there can be other advantages.   

Good luck to you!  

lindaa

to suze35,  I sent you a pm, but will post question here looking for input from others:

Who is your onc at mass gen?  I too am triple neg and looking for a second opinion or follow-up onc for when I near the end of this phase of my treatment (chemo first, carbo, taxol, avastin).   Do you know of other good triple-neg oncs in new england area?