imagings after diagnosis and before surgery

kae_md99

just got diagnosed. right breast, IDC9 ( 2 cm) and DCIS. left breast, DCIS. estrogen and progesterone positive. HER2 will be known later this week. i have selected my surgeon but i cant go to him until feb because of insurance issues.anyways, my surgeon's office did tell me to go ahead and do an MRI so i can have it ready when i see him. what other tests have you done prior to surgery? Pet Scan? bone Scan? Ct scan? i can do all these and just bring the disc to my surgeon later.pls advice. thanks!

kae

ElaineTherese

Hi!

At my breast cancer center, the only major scan I had before meeting with the surgeon was a breast MRI. Once the MRI showed that I had at least one compromised node and that my tumor was 5 cm+ (and with a possible satellite), the center's team recommended neoadjuvant chemo to shrink the tumor before surgery. I was then handed over to my medical oncologist, who ordered a PET scan to rule out mets (cancer was Grade 3 and HER2+, very aggressive). A week later, I got my port, and then a heart scan (I did AC +THP; both Adriamycin and Herceptin can cause heart damage). Then, it was on to chemo.

MRI's are supposed to be (somewhat) more accurate than ultrasounds for measuring the size of the tumor and for discovering compromised nodes. My ultrasound showed a 3.9 cm tumor; my MRI showed it bigger. Also, it was clearer from the MRI that the cancer had spread to at least one node. But, even MRIs can overestimate or underestimate the size of the tumor. Indeed, the only way to really know the size of the tumor is to operate and take it out. Since I had chemo before surgery, and chemo wiped out the active cancer in my breast and node, I will never know for sure the size of my cancer or how many other nodes (if any) were affected.

It is unlikely that your surgeon would order a PET scan or a bone scan unless mets were a possibility.

Best wishes!

dtad

kae....I agree that the breast MRI is the most important screening tool before seeing the surgeon. Good luck and keep us posted.

BG46TN

HI! I had a breast MRI and a Petscan before seeing my surgeon, as well as all the the biopsies. I did also meet with a genetic counselor and had genetic testing done, but I have a strong family history.

MinusTwo

I met with an oncologist before surgery. He/she will be an important member of your team and good to get on board ASAP.

kae_md99

yes, i am gonna be referred to both my surgeon and oncologist at the same time on feb.1. thanks ladies!!

Kicks

We are each unique as are our Drs - so there is no way to know for sure what your Drs will order for you individually, based on what was ordered/required for someone else.

For me, in the 17 days between DX and starting neoadjuvant chemo I saw my Surgeon, my Chemo Dr, my Rads Dr (my Team) and my case presented to the Tumor Board for evaluation. I don't know for sure which (or if all) ordered my Scans and tests but I had (in this order) a Bone Scan, a CT & MRI with Contrast, a PET Scan and an EKG. There was also biopsy of an area along my lower jaw that had 'lit up' on the PET, was biopsied later that day and had the path. report the next day - nothing there.

Have you met with all of your team yet? It is becoming more common 'today' for neoadjuvant chemo to be the first line of 'attack' for other than just IBC, often with a complete response.

Remember that the expertise of a Surgeon lies in his/her 'cutting out' ability, a Chemo Dr/MO (Medical Oncologist) lies in Chemo TX and a Rads Dr/RO (Radiological Oncologist) lies in radiation TX. They work as a Team - not individuals all on their own - for the best outcome/prognosis.

kae_md99

do they usually order breast MRI with or without contrast?

Hopfull2

hi kae, u will be given a MRI with contrast. Sorry about your diagnosis. Good luck

MinusTwo

kae - I always had the MRIs and the CTs both with and without contrast.

Forgot to mention, an integral part of my team was the plastic surgeon also. BS removed the cancer then PS took over and inserted the expanders.

nye1980

I felt a lump, had clear mammogram and ultrasound, was told I could have a biopsy or wait six months. I chose the biopsy, which came back IDC/DCIS. My BS didn't see the point of an MRI. He looked at my mammogram and ultrasound and suggested a unilateral mastectomy. (Good thing, too, since there was a second spot of DCIS). After my mastectomy, because I had one sentinel node positive, I had CT scans of my lungs and liver and a bone scan. I'm coming up to my six-month scans this weekend, chest and abdomen, along with blood work. (My CT was with contrast.)

kae_md99

i am, ER+,85% and PR+,85%, HER2 pending. should i hope to be HER2+ or Her2-?..

ElaineTherese

Hmmm, you should hope to be HER2-. While outcomes have improved for BC patients with HER2+ cancer, treatment is more complicated and typically involves chemo. For example, I had five months of chemo and a year of targeted therapy (Herceptin). With HER2-, your doctors should use the Oncotype test to determine whether the benefits of chemo outweigh the costs, given your particular kind of cancer.

Best wishes!

kae_md99

btw, i am also grade 2. does that make a difference or not really?

nye1980

The grade tells you how fast your cancer grows. Lower grade is "better," whatever that means, but chemotherapy likes fast-growing cells.