Chemo Before Surgery?

1207262

Hello all,

My mom has chosen a doctor and hospital. The doctor has said that they want to do chemo before surgery. My mom is said to have a 1.2 cm tumor based on imaging, which I know is inconclusive, but still. It is ER/PR+ but it is grade three. The imaging, which I know also is inconclusive, shows no node involvement. Two doctors clinically staged her at two different hospitals as IB. This doctor she’s chosen has said IIA. I’m confused by that. My mom takes the doctors’ words and just does what they say. I’m an anxious info-hoarder so I dwell on the nitty gritty.

But, regardless of IB or IIA with a 1.2 cm and no predicted node involvement, even for an aggressive subtype why would they do Chemo before? Isn’t it usually done afterwards to try to kill off any possible micrometases?

She mentioned something about her small breasts and how the tumor seemed bigger because her breasts are small. Do you think that is playing a role? I would still think that tumor growth is tumor growth despite relative size of your bosom. Do you think maybe because of her small breasts they’re doing it to possibly be able to do luptecomy instead of MX? The other hospitals said because her tumor is near her nipple she would need MX.

So confused and anxious.

Thank you

Beesie

Is her cancer HER2+? In your previous posts you mentioned that it was +2 on IHC testing and therefore was sent for a FISH test. What was the result?

Whereas in the past neoadjuvant chemo was mostly done on larger tumors, to my understanding it is now common with HER2+ cancers, even Stage I or Stage II.

1207262

Hi Beesie,

Thank you for replying again, I truly do appreciate it. I’m not sure of the results. I am at work, but when I’m home in several hours I can check the results.

Assuming it is positive, which sounds it is the case based on the treatment plan underway, what does this mean for my mom?

Also, do you know what the benefit is of chemo before surgery in the case of HER2 positivity? My mom did mention something about seeing if the chemo is “working” by tracing the tumor’s size? I feel there must be more to it than that.

Thank you!

Beesie

I don't know much about this topic, but from reading here, I know that assessing the reduction in the size of the tumor is a very significant measurement when neoadjuvant chemo is given and is predictive of the overall success of treatment.

Neoadjuvant Therapy for HER2-positive Breast Cancer. https://www.ncbi.nlm.nih.gov/pubmed/28164759

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Association Between pCR and Neoadjuvant Chemo Shows Improved Breast Cancer Outcomes. https://www.onclive.com/conference-coverage/sabcs-...

First things first however, the question is whether your mother's tumor is in fact HER2+.

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I had neoadjuvant chemo and I really don't think it's a bad approach, especially a grade 3. The tumor response can be controlled "in vivo", the tumor can be reduced and conservative surgery can be performed ... Also, for those without a port, it is good to be able to use both arms for IV and blood tests.

Good luck to your mother!👍