chemo after or before surgery for TN??

Kcan

Hi all! Hoping you can shed light on some of my mom's experience with TN bc. Sorry for the lengthy post!

A little background info to start. Mom discovered a lump mid may and had a mammo 4-5 days later (her sister had it twice, once in each breast, she is currently healthy). After that she had an US then a week after that a biopsy. Roughly 2 weeks later we received the news that she did infact have bc. At that point all we knew was that she had bc, no specifics. We were told that she would have to have surgery. Mom opted for the lumpectomy and the sentinal lymph node removal. July 15 we found out the bc was TN and there is node involvement. The mass removed from her breast was 2.8 cm and the node tested positive. Mom just had her bone and ct scan today, waiting on results. So my concern is that chemo was not an option until after the sugery, why not before? Having chemo prior to surgery for TN bc seems to be common practice. Has anyone else experienced this? Her margins were clear but the order of treatment confuses me. Any insight would be much appreciated. Thank you!

ElaineTherese

Hi Kcan!

I'm not TN, but I have noticed that neoadjuvant (before surgery) chemo is less common in Canada. I'm HER2+, and in the US, that increasingly involves neoadjuvant chemo. But, in Canada, the norm still seems to be surgery first, then chemo. Neoadjuvant chemo does not necessarily produce outcomes than adjuvant chemo, but with triple negative, it is helpful to see what chemo protocol works for you and what doesn't. Neoadjuvant chemo allows you to see whether or not a particular chemo regimen is working for you.

Best wishes for your Mom!

schrapy

Hi I am in same boat. ElaineThere is right, it does seem that surgery first is more typical in Canada, at least in Ontario (where I am). I discovered a lump this past spring, and after mammograms, ultrasounds, and a biopsy, I finally had surgery (lumpectomy) 3 months later. meanwhile lump grew to 5.5 cm. Only after pathology was it revealed that it was TN with node involvement. So I started Chemo mid Aug. So the surgeon is now recommending another surgery for a full mastectomy, but the medical oncologists seem to disagree, implying it is "highly unusual" to have surgery again. Meanwhile while they arm wrestle this out, the lump grew back to almost its original size in the time between surgery and chemo starting (and another lump in the node area), despite the supposedly clear margins after surgery! That said, it is shrinking now. I would sure like to know if these second lumps are cancer (ultrasound just implies "suspicious"), but the doctors seem to want to take a "wait and see" approach . However I seem to think this would be important information to know to decide if further surgery is warranted?

Moderators

Hi Schrapy-

Wow, that sounds incredibly frustrating! It would seem like they'd want to at least biopsy the masses to be sure. Have you discussed the possibility of a biopsy with the medical oncologists? We hope it turns out to be nothing to worry about, but that you get some answers either way! Keep us posted on what you learn!

The Mods

blamoms

I am triple negative and had a lumpectomy in December and started chemo in February and rads in August