MO delays surgery for shrinking tumor.

Catob1969

Hello everyone! I hope your journey is smooth today and there is some peace in your soul.

I have been around these forums quite a bit looking for others that have had a similar process to mine.

I was diagnosed with IDC 3.9CM right breast. After MRI, Oncotype, genetic testing, I met with the surgeon who referred me to the MO.

When I met with the MO, he recommended hormone therapy for 6 months, to shrink the tumor then a lumpectomy.

There will be no node biopsy(sentinel or other) until the lumpectomy in 6 months. ( October-ish)

I feel like it is a very conservative option, but at night I panic that I am not even trully sure what I am dealing with until the node biopsy.

Has anyone else waited like this? Is this a newer protocol? Would you be worried?

kber

I think it's a newish, but increasingly common approach.  My BS and MO recommended something similar in my case, but chemo rather than hormone therapy.  It seemed counter intuitive to me at the time and I pushed back.  My emotional reaction was "cut it out of me NOW".  My MO provided a lot of information (plus I got a second opinion from Sloan that matched) that the approach to shrink the tumor first is becoming more common, even with operable tumors.

I think the rational is that pre-surgery therapy is going to catch microscopic "stray" cells, no matter where they are in the body, better than surgery which is locally targeted.  This could decrease the incidents of reoccurrence or spread.  Plus, if it works and the tumor shrinks, surgery is less invasive and it's easier to get clean margins, which is really important for long term outcomes.  

Kkmay

Hi there!

My mom had a similar approach. She is doing chemo prior to surgery later to shrink the tumor. I don’t know about hormonal therapy prior to surgery, but you can always get a second opinion. I recommend getting one and see whether it matches with the first one.

msphil

hello sweetie mine was also similar I had 3 mo chemo before and after Lmast . then got married the 7wks rads and 5 yrs on Tamoxifen. idc stage2 0/3 nodes.This yr I'm a 25 yr Survivor Praise God have Hope and Positive thinking you can get thru this. Believe. msphil

DATNY

I don't think a 6 six month watch is standard of care. Three or four month is common.

Catob1969

Thank you all for your replies.

kber: Thank you! It is comforting to see familiar processes. I hope your treatments are not too harsh

Kkmay: 2nd opinion is scheduled

Thank you for the positivity and story of Survivial, msphil. That helps so much!

DATNY- I am getting a 2nd opinion. I have also scheduled a visit with the MO to go through my fears, questions etc.

Anonymous

hello catob! I’m so sorry you have to be here but I thought I’d write to give you some encouragement and maybe some helpful advise. I’m chiming in also since my tumor is similar size and on the right side as well.

Do you happen to know what your Oncotype score is? If you go to the chemotherapy section and click on one of the pinned sections called tailorx 70% of women with early stage bc may skip chemo. The link there might help guide u and give you info u can bring up with your MO as you ask questions and pin down a plan.

I had to wait for surgery, I did chemo while I waited based on size and my age. Oncotype wasn’t run for me during biopsy. I kinda wish I had had that information so u have an advantage in this regard. I would definitely get a second opinion, the first option seems really conservative to me. I had mri and ct scan along with the biopsy see if anything showed up in lymph nodes etc, so I felt like I had at least semi baseline of what I was dealing with and it helped alittle too with the having to wait for surgery.

If I can be any help to you feel free to private message me :

Catob1969

HI! My oncotype is 8 so that wweighed greatly with the MO decisions,.

I think it is my anxiety that keeps me wheeling around the circle of what if ..

KBeee

I assume they did imaging of the nodes and that they appear clear? Do they plan to rescan after 3 months to make sure your tumor is still responding to this? I would want some reassurance midway through. This is very standard with chemo, but not as standard with hormonal therapy, though I know I've read a couple of things on it over the years, so it is being done some places...though perhaps as part of clinical trials. I would definitely get a second opinion to make sure it matches, so I am glad you've got one scheduled. I would ask the following questions:

1. What studies are there to show that this is an effective approach, or are those studies ongoing? If so, where? Preliminary data? Long-term data?

2. What are the pros and cons of this approach?

3. How will I be monitored during the 6 months to assure that the tumor continues to respond?

4. Can we do testing to make sure that I metabolize Tamoxifen appropriately since some people don't?

5. How was 6 months chosen as the time frame?

Best wishes. I hope you get answers and a plan that you are confident with!

Shamrock0310

Hello Catob1969. I was diagnosed with 8cm of ILC in my right breast in october. Mine is highly estrogen positive and my onco score is 12. My tumor is close to the skin and under my nipple so my SO is trying to shrink mine with hormonal therapy. I started on tamoxifen at the end of october. I just had another MRI on March 19th. My tumor has shank half a cm in that time. It hasn't pulled away from the skin yet so my surgeon wants to wait and see if it will shrink more by July. They have told me they will only try this approach 9 months total before they will just go ahead and do surgery. I hope this helps some to hear my story. I am being treated at a large university hospital.

Catob1969

Shamrock, Thank you so much, It does help to hear that you are doing the same type of plan. Thank you so much for sharing!

I hope you are doing ok with the Tamoxifen.

Catherine

Shamrock0310

You are so welcome. The tamoxifen is going ok. I have hot flashes and joint pain but not too unbearable. My MO is actually in the process of switching me over to an aromatese inhibitor to see if we can get a better response than the tamoxifen. I am 41 and premenopausal so I just started Lupron shots to put me into menopause and shut down more estrogen.

OCDAmy

When I was diagnosed Iwas put on anastrozole for 4 months to try and shrink the tumor before surgery. I am high ER/PR positive. After 4 months I had another ultrasound but the tumor had not changed much so we moved forward with surgery then chemo. My MO said 4 months may have not been long enough but at least did not grow. Looking back I wish I'd just had the chemo first but at the time was relieved to only have to take a pill. I believe this may be the way ER positive is treated in future, it just wasn't successful for me.