Considering Chemo before Surgery, Anyone?

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Survivor07

Hi Laureen. Welcome to the club nobody wants to join!!  I had chemo before surgery to shrink my mass (it was quite larger than yours though).  I was told I couldn't start chemo right away, after surgery, until I healed up some because chemo, in essence, stops the healing process. Therefore, my doctor didn't want me to wait weeks before chemo in case there were some hidden cells somwhere. He wanted to start killing them right away!! And I said good for him!! I did chemo before the surgery.

Susan

NatureGrrl

My dx isn't the same as yours but I was given the option of chemo first or mastectomy first.  I was told prognosis was the same.  I went with my gut.  I didn't have much hope of being able to avoid the mast. but I couldn't deal with surgery at that point (I was taking care of my dying mother) so I did chemo first.  Not that chemo was easy, but I felt I could deal with it and my mother better than surgery and my mother.

Long story short, when I was done with chemo, the lump shrank, and all traces of cancer were gone.  My surgeon still recommended a mast. but my oncol. thought a lump. might work -- so my surgeon did it, with several caveats that I would be back for a mast. if my margins weren't clear.

Not only were my margins and all lymph nodes clear, but so was the entire mass of tissue that used to be the cancer.  So for me, the biggest "pro" is obvious. 

I don't really have any cons.  Chemo left me exhausted and they only gave me a month between the end of chemo and the surgery, but a lumpectomy is a fairly easy surgery and I had no trouble.  I healed quicky and well.  I've been NED for about 18 months now.

Talk to your drs., gather information, ask questions, and then go with your gut.  You'll make the right decision for you.  Warm hug and best wishes.

Laurie09

Talk with your surgeon and onc.  

I had neoadjuvant chemo (before surgery) primarily because of the large nodes that were apparent on MRI.  My primary tumor went away completely after chemo though I still had some disease in my nodes. 

My surgeon explained to me after the fact that a lumpectomy could be tried, but because the tumor was largely gone, it would be difficult to know for sure whether a lumpectomy had removed the entire site from the original mass, and that there could be microscopic spots left behind even if the margins appeared clean.    Therefore, we decided a mastectomy would be the safest option for me after chemo.   My primary tumor was larger than yours, though (3-3.5 cm) and I had a ductal carcinoma, so the info may be different for lobular carcinomas.  

My understanding is that prognosis is the same for IDC with neoadjuvant chemo or adjuvant chemo.  The good part about having neoadjuvant chemo for me was that we could see what kind of response I had to treatment after the fact.    

libraylil

Laureen  I too did neoadjuvant chemo much for the same reason as Survivor 07.  Both the BS and onco gave me the option, but I did not want to wait for the healing and surgery to start chemo.  I knew one node was positive at least and I wanted to stop the suckers in their tracks.  I was disappointed that everything did not "disappear".  After my lumpy the surgeon explained that the tumor does not always shrink like a balloon deflating, more like a swiss cheese thing for some patients.  My pathology after surgery showed that 65 % of the cancer cells were dead.  The oncologist considers this an excellent response and a predictor that any loose cells were caught.  I'm glad the chemo was done early and behind me. I just wish the different ways the tumor could possibly shrink would have been explained a little better.  The oncologist told me all along I had a great response (it had begun to shrink by by the 1st treatment) I just wanted to know the whys and wherefores.  Also this gives them an indicator that the chemo of choice is actually working on your BC.   libraylil

Anonymous

I did chemo before surgery too. My grandmother was dying and I wanted to be there for her. Chemo shrunk the cancer down to almost nothing. I had a lumpectomy. My surgeon said that she would have taken the whole breast if I didn't have the chemo first. My love for my grandmother saved my breast. I have been clean since.

roseamy

Hi,

 I too had neo adj chemo primarily to shrink a large tumour 5cm ( mixed lob/ ductal), i had an snb done then 7 days later started chemo. I had a response within a month the tumour started to shrink and at the end of 6x tch it had gone down to 2.5cm. I still needed a mx, but my onc was very pleased that he had seen a chemo response,  I have been ned for nearly 2 years.

I agree with a post by nature girl ask for the info and see what choices they give you and go with your gut instinct, you will know what is right for you.