Surgery after Chemo

crs003

I was originally going to have a lumpectomy followed by chemotherapy. However, after a second opinion I was told that there was another smaller tumor located 6 cm away from the first, and that they would have to cut completely around both and I wouldn't be left with much. I have no problem with them taking out a lot of tissue, since I am a bit bigger breasted, but I was given the option to have chemotherapy to have better surgical outcomes. My family and I are concerned about leaving the tumor there during chemo, since it is triple negative. I was told the research shows no difference in recurrence between those having surgery and those having chemo first. Has anyone had chemo before surgery, and did it change your surgery results?

Kicks

Neoadjuvant chemo (chremo before surgery) is the SOP for IBC to get it to form a 'lump'. It is becoming more common to do with other types today.

Neoadjuvant chemo is fighting/attacking the 'monster' to shrink it and get better margins so less invasive surgery.

SpecialK

It is also commonly SOP to do neoadjuvent chemo for TN cancer to make sure the regimen of drugs is working.  Because TN cancer does not have other adjuvant systemic treatment available - like hormonal therapy - it is critically important to know that chemo worked for you.

Astarte

I had chemo followed by surgery. I just got my results last week. Had a partial mastectomy on the left, followed by a lift on both. They ended up taking out 20 lymph nodes. The chemo wasn't as effective for me as they hoped, but they expect the radiation and herceptin to get the last of it. Had myself a good, long cry over how much I suffered during chemo and wondered what would've happened if I just had surgery and radiation. I did what my doctors said was the best course of treatment and my best chances.

I did have clear margins on my surgery last week. The reasoning behind why my tumor was left was I was part of a study, they monitored the tumor size. And I had big boobs too. Now I have tiny ones by choice. Best of luck to you.

april25

For HER2+, Herceptin with Perjeta given neoadjuvently with taxotere and carboplatin is the protocol that was approved in 2013... So that's the course I decided to go with started in Dec. 2014 and ending just yesterday...

I was going to get chemo no matter what. Also will get Rads no matter what, so that made my treatment a bit clearer (as in, not that many choices to worry about!).

Chemo kicked my ass, but I'm hoping it won't leave me with any lasting effects. I'm still recovering from it, however, with my GI tract still messed up, my legs weak from neuropathy, the top of my left foot is numb, I can maybe walk a block or two... slowly...! And can nearly eat like a normal person (but not quite). And of course, I have no hair. Also lost a ton of weight... 20 lbs. down from my starting weight.

And now I just had surgery scheduled for next week! I'm still a bit anemic. I hope that won't mess things up. It'll be a LX (segmented mx, they are calling it). Outpatient... so how bad can it be? Well, I'm hoping it won't be so bad, anyway!

I'll report back if I find out if chemo before surgery has changed things... I know that there was some concern about the size of my tumor and whether it was too big for a LX to be done on my small-ish breast... It sounds as if the surgeon isn't too concerned now, so maybe the shrinkage has been enough?? I guess I'll see if the result is OK -- as in not a huge divot in my breast...! ... And also if it killed all the cancer in the tumor! (I had an MRI, but none of my doctors are saying anything about all of my cancer being killed!)

ElaineTherese

Hi!

I had neoadjuvant chemo before my surgery. My lump was quite large (5 cm.+), and we hoped to shrink it so I could choose lumpectomy if I preferred it to mastectomy. I am also HER2+, so neoadjuvant gave me the opportunity to get both Perjeta and Herceptin (targeted therapies for HER2+ cancer). After chemo, the MRI and PET scan showed no active cancer. So, in a lumpectomy, my surgeon took out a golf ball sized amount of tissue around the surgical marker, as well as the Levels I and II lymph nodes (a bit of overkill, in my opinion). The pathology report showed that chemo had indeed wiped out all of the active cancer at my lump site and in my lymph nodes.

As a triple positive (a condition which produces aggressive, fast-growing cancer), I was happy with the outcome of neoadjuvant chemo. I could feel the lump getting smaller and smaller. I'm glad I was able to have a lumpectomy because reconstruction can take multiple operations and procedures, and I would rather not do more surgeries right now. Best wishes!

knittingPT

My tumor was originally about 7 cm long. My surgeon and oncologist both recommended doing chemo first. My tumor decreased to about half the size. Feeling it shrink over 5 months was quite a psychological boost and gave me something positive to cling to during the treatment. I KNEW the chemo was working. The decrease in size also allowed me to have a lumpectomy instead of a mastectomy. I had to have the axillary node dissection due to 5/10 lymph nodes being positive. I will still be having radiation. (and would have had to even if I'd chosen a mastectomy). I think the important thing to consider is that you are having treatment even if the tumor is still inside of you. The treatment should stop the growth and possibly shrink your tumor. Good luck and let us know how things are g

april25

I got my post-chemo MRI results--

The MRI findings are compatible with partial or incomplete
response to neoadjuvant chemotherapy. The hypervascular mass at the 12
o'clock position appears smaller but is still evident, measuring
approximately 1.2 x 0.7 cm currently,
versus 1.9 x 1.1 cm
previously. Both the morphology and the type of enhancement are similar
to the prior exam, the latter characterized by plateau-type delayed
kinetics, although the peak enhancement is actually slightly higher on
the current exam.remarkable.

Ah, well. Hoped it would have shrunk more, but at least it shrunk some! (I really have small breasts--smaller now that I lost a ton of weight through chemo. So that was a worry... surgeon still thought it would be OK, but he wasn't sounding totally confident.) Also hoped I'd get the "complete response" result, but then, don't we all? But I was the one who found my lump (even with mammogram screenings), and I could still feel it, even when other people couldn't, so I shouldn't be surprised that it hadn't shrunk way down to nothing...

mary82965

I had bilateral mastectomies hoping this awful disease would never come back. I had six rounds of chemo from August - Nov 2015 and in January I had my surgery. I finished radiation on St. Patty's day and went back last week for my zolodex shot and to meet with my oncologist. She said she felt a minor change on the scar line and slightly above (on the breast cancer side) and was almost certain it was fat necrosis. I am not sure I am feeling what she is feeling and she said when I came for my next shot (i get them every 28 days until have my ovaries removed) she would measure me again. She told me not to worry !! YEAH RIGHT! PANIC CITY over here!

Hopeful82014

April, sorry to hear that. I know the pCR was your goal (and mine). I hope your surgery is going well today and that your surgeon was able to make it work out even with your small breasts. Crossing my fingers for you all day.

Mary, that must be torture to have to wait and wait again. Deep breaths, hang in there.

april25

Mary82965 -- Hopefully it's just scar tissue since it's so close to your incision. They keep telling me that getting hard spots in that area is very common. Best wishes to you for getting good news about this!!!

Hopeful82014 -- I'm out of surgery! Very achy unless taking a pain pill, but otherwise OK (considering!!!). I won't hear about the path until next week, though. I'll try not to worry about it, since worry won't change anything. Thanks for the good wishes!

Hopeful82014

Good to hear from you, April! Don't forget to ice it from time to time;it does help. Did you have full node dissection or skate by with a SNB?

april25

Hopeful82014 -- I'm icing when I can... Put on one of the ice-packs I had in the fridge (forgot to grab the disposable one they gave me after surgery) when I got back yesterday. They took a nap and it got all warm. Then grabbed another one when I went to sleep and it was lying on top of me all night. Now I've got one shoved into my surgical bra! I'm not sure how effective they are with all that gauze between, but oh, well! I'm taking the pain pills and feeling just fine, so who cares?

I got a SNB, and I'm really hoping that will be all! All of the tests never showed any node involvement, so I'm not expecting a dissection of more... I think the surgeon said it didn't look like there was any node involvement that he could tell from the dye... Crossing fingers!

Blue dye is really, really blue when I pee! I can't imagine how much of that they were putting into me! No wonder they were saying that some people got blue boobs and even blue skin up to their faces! Geesh! At least it's slightly, very slightly, less blue today...! I'm glad I don't look like an escapee from that Avatar movie!

mary82965

Glad to hear your surgery went well !!! The pain improves pretty quickly!

Hopeful82014

April, I like the avatar imagery. The icing helps with the swelling, inside as well as out. The trick is not to forget it's there and go to sleep with a warm icepack in your bra . Hope you are starting to feel human again. Do take it easy, thigh; remember, you're still healing from chemo as well as surgery.

april25

Thanks for the good thoughts!

Hopeful82014 -- I'm taking it easy and icing... My sister was a bit annoyed that I wouldn't go out for a walk (she is a bit more of a health nut than I am!!!), but I'm a bit too achy to want to get dressed and go out walking! I think she's nuts to be asking me, but then she hasn't just had surgery, and maybe she's a bit more of an over-achiever! I was happy to be a couch-potato all day, and will try and do that tomorrow, too! (She also told me to try not to take the pain meds, which was also annoying! I have a pretty high pain-threshold and usually don't bother with pain pills, but I am definitely taking some since I don't see why I should have to ache when I don't need to! Ah, well. Maybe getting up so early for my surgery yesterday has put her in a bit of a cranky mood? I'm sure it'll blow over...) I'm about to take a pill, grab an ice-pack and head off to bed!

I hope you all have a good weekend (what's left of it!).

Metta

Hi Crs,

I had chemo before surgery, too, and it did change my surgery results, but in an unexpected way. Usually it gives you the option of getting a lumpectomy (breast conservation). But for me, a mid-chemo MRI showed not one but two sites that were shrinking during chemo: the known tumor and another spot that they had biopsied earlier but deemed benign. So I was told I'd have to either re-biopsy a now tiny spot or have a mastectomy. If you have two tumors, the recurrence rate is unacceptably high because in multifocal/multicentric disease, the tissue between the two tumors is also in the process of becoming cancerous. Anyway, my surgeon insisted on a mastectomy because of that second tumor (and I guess I had small breasts, though I never considered a C cup small ... I'm realizing it totally is).

Good luck. I know it's overwhelming. Once you settle in to treatment, it will get a little more predictable and easier. The unknown really scares me.

Mary, I hope that scar scare is nothing! I would freak out, too.

And hello to Astarte and KnittingPT! Next stop, radiation.

april25

Took a shower this morning to prepare for my post-op appointment. I was surprised that my incisions looked pretty nice! better than my Port incision had looked, actually. Of course, I had a better surgeon for this! No bruising or obvious swelling or redness or bleeding. Whew!

AND I feel a lot better after my appointment because my BS said my margins were clear and nothing was found in my SNB! I'm not going to get up and dance (they told me not to jiggle anything!), but I feel like I COULD!

I'm still trying to read through the Path... It's not easy, but someone gave me a link to how to figure out a path report, so I'll have to go check that out!!!

I'm definitely glad I had chemo done and over first. That was a pain and I'm still sort of recovering from it.

I've got a Radiology appt. tomorrow... so it's on to the next stage!