Chemo first vs surgery query

Anonymous

Chemo first vs surgery query

Aussieprime

morning all,😘

my surgeon decided to change my treatment last week following clear further testing (CT and bone scans)

originally I was due for mastectomy then chemo then radiation
BUT my surgeon on the Wednesday decided to go with chemo first to try and shrink tumour .
my husband and I saw the fertility specialist Monday as we are going to try and get some eggs for freezing ( we have no kids and was due to start late this year )

But we we now have a very tight window due to changing the treatment plan to chemo first - I'm seeing the medical oncologist today to discuss chemo and if we will have enough time to do the ivf cycle.....BUT I feel like going back to the original plan for couple of reasons

1. Because I just want it gone from my body now
2. It will give us more time for the ivf cycle and I don't want to miss the chance
2. I'm not sure if chemo first is the best way as I may still have to have mastectomy anyway if the tumour doesn't shrink

any thoughts in relation to chemo first bs surgery?

Thanks

FarAwayToo

I'm sorry you are dealing with this and at a young age.

Looking at your receptor status, I'm thinking they drive the decision more than the size of the tumor. Usually, ER-/PR-/HER2+ gets chemo (and herceptin) first. Also, triple negative is likely to get chemo first. However, I'm ER+/HER2- and had chemo first as part of a clinical trial. I understand logistically and mentally you may want to have surgery first, but neoadjuvant chemo is often done with specific BC types or if cancer is locally advanced.

star2017

for Me surgery happened first but they were torn. I was pregnant, and if I had been earlier in the pregnancy chemo would have come first. I think you should explain and see if it can work for you to have surgery first

NotVeryBrave

I had chemo first for HER2 positive - 2 chemo agents and 2 targeted therapies. HER2 cancers can be aggressive. I'm sure that is driving their recommendation.

One good thing about having chemo first is that they can actually measure how effective it is. It completely wiped out my tumor. I couldn't feel the lump after the first round.

I would discuss your concerns with both the MO and the BS as well as the fertility specialists. Hopefully together you can all find a plan that works well and fits with your wishes.

LilyCh

Why would you still choose Mastectomy when the chemo completely wiped out the tumor?

NotVeryBrave

It's a personal decision, but for me:

-- lumpectomy was going to still take a lot of tissue

-- radiation would make what remained smaller still

-- risks associated with radiation

-- probable need for surgery on remaining breast to match affected one

-- concerns about things that were seen in other breast that warranted follow up every 6 months

-- fear of recurrence and ongoing monitoring

While no evidence of cancer was seen on MRI after chemo, it was not guaranteed until confirmed on final pathology. I was able to avoid radiation because of the original location of the tumor and clear lymph nodes. That's not always the case. I really felt that I didn't want to use up my lifetime amount of radiation now. I'd rather be able to use that if needed down the road. I was also able to go directly to implant reconstruction through the one surgery with my skin and nipples saved.

LilyCh

Thanks so much, NotVeryBrave. My wife expects to start the TCHP neo next week and a lumpectomy after. Her case looks similar to yours (06/04/18, IDC, right, 7mm (by mammo), ~ 2cm (by MRI), ER+/PR+/HER2+, node clean (by mammo and MRI)).

NotVeryBrave

Best of luck to her - and you!

LilyCh

Thanks so so much, NotVeryBrave, after nearly one month of torture emotionally (since the biopsy result was out), we are ready to fight!!! .

For the coming TCHP, what would you suggest us to get ready? should we ask the MO to prescribe some medications in advance for the possible side effects?

Thanks again

Tess111

Hi LilyCh,

As you can see by my signature that I went through TCHP, so I have some suggestions.

• 1.It's summer – consider buying a beach bag (zippered ones are really nice) and use it as a Chemo day bag.
• 2.At the center where I went a CNP (Certified Nurse Practioner) went over possible side effects, gave me a list of OTC medications to have on hand, and gave me a prescription for nausea medicine and at my request, one for Emla Cream which I would use when they accessed my port.
• 3.Hopefully, your wife, has had an Echocardiogram before Chemo and will continue to have them every three months while she is on Herceptin. This is to make sure that the medication is not causing heart failure. Sometimes women have to discontinue their Herceptin for a while to give their heart time to "bounce back." Sometimes, however, Herceptin has to be discontinued because of heart issues. Over the years, some of the individuals on the Triple Positive Thread have had this happen, and they are doing fine. (A new study in Europe is saying 6 months may be enough.)
• 4.Some people experience diarrhea and some constipation, so having Senokot and Imodium in your family medicine cabinet could prove helpful. (Believe it or not – I ended up using both.)
• 5.The nausea medicine they gave me was fine but it made me sleepy, and sometime nausea would hit me out of the blue when I just couldn't take the medicine. The nurses tried a nausea patch behind my ear which didn't work for me. My home remedy was peppermint drops – if I sucked on one of them, I got immediate relief. Some people swear by ginger drops – others by lemon drops. Eventually, my MO prescribed a nausea medicine that I put on my tongue and would dissolve. Worked like a charm. I still carry peppermint drops to this day – just in case!
• 6.Some centers offer snacks or food while you are having your infusions. Mine did not, so I took snacks – crackers, little containers of applesauce etc to get me through the day.
• 7.A friend, who like me did TCHP, had a diarrhea accident when she was out and about. It never happened to me but it made me paranoid, so that I kept a spare pair of underwear and shorts in my chemo bag just in case! (Chemo and perjeta both can cause diarrhea – however, once I was off chemo, I got a little tummy ache and mild diarrhea for one day and that was it. Definitely, no big deal!)
• 8.Get some plastic utensils. The chemo that she will be on tends to leave a metallic taste. She won't notice at first but it gets stronger as the chemo goes on. Eating off of plastic instead of metal helps. Also, sweet foods tend to cover up some of the metal taste.
• 9.My friend who battled breast cancer 12 years before me gave me this tip – her nurses and mine swear that it makes no difference, but she told me she would stop and get an Icee at 7-11 before chemo and sip on it. She swears she never had mouth ulcers once she started doing that. I made my own with lemonade the night before. It may be a coincidence, but I didn't get mouth ulcers either.
• 10.If they have ordered your wife to have neulasta shots, have her take Claritin (just plain Claritin not ClaritinD) a few days before and after. Neulasta can cause some wicked bone pain! - Also, Swedish researchers have shown a positive effect for breast cancer patients and Claritin (Loratadine). You can read the abstract at http://abstracts.asco.org/214/AbstView_214_229239.html.
• 11.Join a Chemo thread here at Breastcancer.org – they will have more tips and it does help to know that you are not alone.

I hope this helps. Best of luck to you guys. Remember – you are not alone!

NotVeryBrave

I agree with pretty much everything that Tess covered! You should have a nurse go over all of the SE's ahead of time and figure out a plan for you for management. I took steroids day before, day of, and day after. Also took Compazine to prevent nausea on a schedule after the steroids for a few days. I took Claritin daily to help with bone pain associated with WBC stimulators - it was easier than figuring out when to take it and caused me no problems.

Really low WBC's contribute to mouth sores as does too high dosing of chemo. I agree that sucking on ice during the TC portion of infusion helped.

Emla cream applied (big glop covered with plastic wrap) an hour before helps with port stick as does the "freezy spray" they have there.

No answers on taste and eating. Just try different things. It's really hard to know day to day. Everything pretty much tasted like yuck, even water.

Probably one of the most helpful things was keeping a journal during those months. It allowed me to remember what to tell my MO I was experiencing at first. Later it helped to figure out how long each SE usually lasted. That was encouraging - knowing that whatever it was would usually be gone in X number of days.

LilyCh

Dear Tess111 and NotVeryBrave,

Thanks so much for all the details, both my wife and I greatly appreciate that.

Yes, when we saw MO the first time on uesday, she said an Echocardiogram would be a must before the TCHP. However they searched around and could not get an appointment until July 11 (all are on vacation?). Fortunately I called around yesterday by myself and got an appointment for Friday, tomorrow. Hopefully my wife's treatment can start some time next week.

The BS told us the tumor is not going to change much in a short period of time, but we really want to get it treated and controlled as early as possible!!!

It is really nice of you, thanks very much again.