Why mastectomy before finding out if cancer has spread?

Too-Ticky

Since a mastectomy is such a big procedure (especially for someone like me who has multiple breast cancers in one side, and large breasts so doesn't necessarily have enough skin to adequately cover the wound) - why does it happen before finding out whether the cancer has already spread to elsewhere in the body?

Would it not be better for a doctor to find out if the cancer is everywhere so the patient can choose how much, if any surgery they want to go through in the context of the wider prognosis and quality of life? Rather than spend months managing pain, disfigurement and potential impairment from (at least one) big surgery before finding out whether or not it has saved or prolonged life expectancy?

What are your thoughts?

Beesie

The answer to your question depends on your preliminary diagnosis.

For early stage patients who show no symptoms of metastasis, full body scans are not usually done. In your case, while you have multiple tumors, what is the estimated size of the largest one? And what is the grade and hormone status? That's what determines your stage and the treatment plan.

Have you seen a Medical Oncologist? It's usually the MO who decides on what scans are necessary and the order of treatment. But for early stage patients where it's clear based on tumor size and hormone status that surgery will be done first (there are very specific circumstances that dictate when chemo should be done first), sometimes the patient doesn't see an MO until after surgery, once the final pathology is available.

exbrnxgrl

Too-ticky,

Beesie said it better than I could. Please remember that routine scans are not usually done for those with early stage bc.Breast cancer rarely presents initially as “spread everywhere “. As a matter of fact only about 6% of initial diagnoses are stage IV. This is part of the reason why scans are not routine. The chances of them finding any metastasis at all are very low. Additionally there is the unneeded radiation exposure, stress, and enormous expense (PET scans run about $5,000.)

Too-Ticky

Thanks for your replies. I've only seen the Consultant Breast Surgeon. He made the diagnosis and will perform the surgery. He told me there's a 30% chance my cancer has spread to my lymph nodes (invasive lobular) - normally there's only a 15% chance of spread, he said. I know he was concerned about how a node in my armpit felt to the touch.

Salamandra

Spread to the lymph nodes is not considered distant metastases, and 30% chance of spread to lymph nodes still means 70% chance of not. If the sentinel node biopsy finds significant invasion, then they may well do more scans. But I believe that recent research seems to indicate that even in advanced cancer, there can be a health benefit - for both quantity and quality of life - from the surgical removal of the tumor.

If you are concerned, my understanding is that foregoing/delaying reconstruction can help minimize the recovery from mastectomy.

However, these are good and valid questions, and you should get them answered by your doctors. If your surgeon doesn't explain it to your satisfaction, you can absolutely ask to see your medical oncologist before surgery. You can also get a second opinion if you are not satisfied with their explanation. Many of us do better when we feel intellectually satisfied/at peace with our treatment course (and plenty of us do better when they follow the advice of doctors they trust without doing their own research project). I think it is very important to know yourself and follow the path that will help you feel good about your treatment.

Good luck!!