Questions. Surgery then treatment vs treatment then surgery ?

Jinx27

Hello Ladies and Gents

I was recently diagnosed on 09/08/2015 and this week will be narrowing down where I would like to be treated and have surgery.

1st opinion by breast surgeon (Community hospital associated with UPenn) double mastectomy and then treatment

2nd opinion ( Fox Chase Cancer Center) still waiting will find out this week.

3rd opinion ( University of Penn) Chemo 4 months every two weeks then surgery

Left Breast

was staged a 3b by oncologist from 3rd opinion

ER/PR+

area of concern with chest wall

low nuclear grade 1

Right Breast

stage is unknown there is mostly DCIS and also IDC. Was give a stage 1 could be higher though

ER/PR+

HER2 equivocal and 2+ ( maybe this is why the Onc #3 wants to do chemo first)

Nuclear Grade High

BRCA results wont be in until two or three weeks. My question is, should my BRCA 1 and 2 results along with testing done help all of the opinions decide ? Isnt this an option after surgery only?

I would think that surgery ( double mx) would give the pathologist way more info as to what is going on in both breasts. Im 27 and I dont know if the oncotype test would be accurate but my gut feeling is to reject the chemo first and just go with surgery. That way the entire picture is much clearer....

Please help,

Jinx27

THANK YOU!

ElaineTherese

Hi!

I would wait to see what the results are for HER2 in the right breast. If you are HER2+, you may want to go chemo first because it's easier to get Perjeta for neoadjuvant therapy versus adjuvant therapy. You wouldn't want to miss out on getting Perjeta; it's a very powerful drug. If the IDC in your right breast turns out to be HER2-, I'm not sure it makes a difference about whether you do chemo before or after surgery.

Jinx27

Thanks Elaine

The right breast was determined to be HER2 (2+ equivocal) guess that means positive ? The left breast mass is 6cm and the right breast mass is small but of a higher grade. Both breast have satellite lesions.....

rainnyc

Jinx, sorry you're in this position. Everyone's case is different, and I'd be questioning the docs closely with exactly these questions--especially about the HER2 equivalent status.

My case is not the same as yours in that I'm HER2+ but hormone receptor negative. But I wanted to say that neoadjuvant chemo seems to have done a very good job and made it much easier for the BS to get clean margins. I will also add that for me, it has been helpful to be at a cancer center where the MO and BS work together and where I don't have to question insurance with each new caregiver.

Good luck with your decision--very tough one, I know.

Skittlegirl

I am doing chemo first for a couple reasons. A) I am Her2+, so doing Perjeta neoadjunct. My surgeon was concerned that if I had a complication stemming from surgery it would delay chemo more.

My BS and MO work together with a lot of women, so it's nice having a team that works well with each other. I would also recommend going with a surgeon you are comfortable with. Mine actually took out my gallbladder about 5 years ago. And he did a great job putting my port in. So I have complete faith that surgery will go well.

ruthbru

I would do chemo first for the reasons that you can tell as to whether a particular drug is actually working AND if you can get the tumors shrunk down, it will be easier for the surgeon to get clean margins without having to be as invasive during surgery. And as Skittle says, you don't want unforseen surgical complications to delay chemo.

windingshores

I was also going to say that neoadjuvant treatment helps you see whether those particular drugs work with your cancer, and surgery will be easier presumably. There are arguments on both sides. But since you have HER2+ result you know you will be doing chemo and a HER2 med, so the additional pathology info from surgery first won't really make a difference going forward. I would think that seeing that the treatment works will help you emotionally later on.

Good luck!

Hopeful82014

I can't add much to the comments except that I, myself, did neoadjuvant treatment and find it very helpful to know precisely how the tumor responded to that medication. Good luck with your decision and your treatment.

Kicks

Neoadjuvant (pre-surgery) and adjuvant (post surgery) is NOT the only option. Neoadjuvant and adjuvant chemos are an option. Worked great for me.

Jinx27

This is why I love this site, I know I can count on survivors and current patients to give input. I love you ladies!

It's soo tough making these decisions, im 27 and live with my parents and they have a certain perception about chemo and have friends that went through bad experiences with it. Basically everyone is telling me and them to not do it. But it's my decision in the end, its my health and MY breasts.

Hence the reason for all of my questions.

I will definitely ask those questions this week to the MO and BS. I'm not sure if my HER2 status is positive but I don't think it is.

My anxiety is if chemo doesn't work, it seems like a waste of time to me. I wasn't aware that trying different chemo drugs during the duration of my time in treatment will be a possibility. That means different side effects and longer treatment time right ? This give me anxiety and a headache.....

Did any of you have chemo drugs switched during treatment ?

ElaineTherese

We could tell my chemo was working right away. It began to dissolve my 5 cm+ lump after the first infusion. But the proof was in the MRIs, PET scans, and pathology report. We did an MRI and PET scan before chemo and after chemo. The lump was gone. My one lymph node (which had been compromised) was clear. After my lumpectomy, my pathology report confirmed that chemo had destroyed all of the active cancer in my breast.

Yes, chemo has a bad rap. I had a relatively easy experience with chemo, and was able to work through it. Same thing with radiation. But, everyone is different. I can't tell you it will be easy.

ruthbru

For lower stages, chemo can be debatable, but at Stage III, you really do need it. Chemo could very well save your life. As others have said, there are no guarantees as to how you will react; but many of the stories you hear are from 'the old days' when they didn't have the good anti-nausea drugs they do now and really didn't understand dosing all that well either. I,myself, was able to work throughout chemo, do everything I needed to do and most of the things I wanted to do too. I didn't feel good, but I didn't feel as bad as I thought I would either.

Hang in there. I think that making treatment decisions are the hardest part of the whole thing.

msphil

hello sweetie, i had chemo treatment for 3 months, then Lmast, then 3 months chemo after, got married, then rads, and Praise GOD, then got married was planning our wedding when diagnosed, now by Grace of God i am a 21yr Survivor, HOPE and saying Positive things each nite like" cancer u will leave my body", msphil(idc,stage2, 0/3 nodes, Lmast, chemo and rads and 5yrs on tamoxifen) U and Us All are daily in my prayers.