Surgery Concern

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Frenchie
Frenchie Member Posts: 37

Hi guys.  I've posted this on another forum, so sorry for the duplication. 

Can I ask a simple generic question here re Masectomy v Tumour removal (leaving the breast intact).  

Let's say the surgeon is able to remove the cancer and leave the bulk of the breast. 

WOULD THE ONLY REASON FOR CARRYING OUT A MASECTOMY HERE BE PREVENTATIVE IN CASE IT RECURRS?  

Or is there an added benefit in removing the whole breast to the diagnosed cancer being treated?

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  • Frenchie
    Frenchie Member Posts: 37
    edited December 2008

    Just to add to this.  IN SOME CASES, doesn't it make sense to have the Lumpectomy first so chemo can be started earlier.

    Then after chemo, have the Masectomy? 

  • FloridaLady
    FloridaLady Member Posts: 2,155
    edited December 2008

    Frenchie,

    The choice is usually doing chemo "before" surgery to see if you will respond to a specific chemo.  Or your doctor may feel your disease is aggressive and wishes to treat before surgery.  I've not heard of anyone doing a lumpectomy first so they can start chemo earlier?  There are women who do go back for a mastectomy because they have a more in-depth pathology report that leads to further concerns of recurrence at a later date.

    Flalady

  • sheila5859
    sheila5859 Member Posts: 35
    edited December 2008

    I had a lumpectomy first and now  they are considering whether or not to give me chemo. I'm having a oncotype test done first.

  • njoylife
    njoylife Member Posts: 6
    edited December 2008

    I had a lumpectomy first and then chemo.  That was before I knew anything about triple negative.  I didn't even see an oncologist until after my lumpectomy!  Now I am having symptoms of IBC as well.  I just finished treatment (rad) in May.  Had I known what I know now, I would have opted for the mastectomy.

  • TammyLou
    TammyLou Member Posts: 740
    edited December 2008

    The party line:  For early stage cancers (I & II), the SURVIVAL rates for lumpectomy and rads are COMPARABLE to mastectomy.

    Part of what you need to understand (IMO) is that people don't die from breast cancer in their breasts (not unless the tumor is so big that you suffocate on it).

    Breast cancer OUTSIDE the breast can invade organs and bone.  The cancer cells invade, replace and destroy normal tissue.  The dead, dying tissue liquifies and causes fluid to build up around essential organs like the liver, lungs, heart.  The organs start to die, and this leads to total body death.

    So, when you talk about surgical options and radiation, you are principly talking about LOCAL treatment.

    Rates of recurrence with radiation and lumpectomy range from 7-14% (depending on who you're quoting).  Rates of recurrence with mastectomy range from 1-4%.

    The inherent problem with these numbers is that MOST breast cancers are ER+...so, it is possible that a study of strictly ER negs would produce a different answer.

    Approximately 7% of women diagnosed with breast cancer have a concurrent cancer within the other breast (simultaneously or within one year of initial diagnosis.)

    IMO, the survival rates are the same because 80% of breast cancers are "early stage"...and smaller cancers at diagnosis are associated with better prognosis.  It has been demonstrated that hormone blockers such as tamoxifen have reduced recurrence rates in ER+ cancers.

    Also, IMO, when you start talking ER- cancers, you are talking about a horse of a different color.

    For myself, I had all of the chemotherapy and radiation I ever want to have...and I could have done without what I tolerated.

     To be real...surgical choices are often about the psychology of the patient.

    Maybe the bi-laterals didn't make a difference...but, my gut was screaming a tune that could have been heard in Zimbabwe.

    You're going to have to pick your "least worst."

    Select your degree of mutilation.

    It's difficult.

    I would much rather choose between cake and ice cream.

     Follow your heart.

    Tammy Lou

  • FloridaLady
    FloridaLady Member Posts: 2,155
    edited December 2008

    Tammy Lou,

    We do not die from cancer that has been only a local recurrence.  But this is extremely hard to treat.  Chest wall is the most difficult part of the body to treat per top breast surgeon's, I've have seen at different research hospitals.  It spreads to IBC that has even more poor prognoses.  I have been in chemo for three years with only aggressive local disease.  I will not die from this disease.  I will die from the on going chemo treatments that I will have to live on for the rest of my life. Untreatable local recurrences still means stage IV disease.

    Bottom line there is no full proof way to stop this disease if it wishes to move on.  We all 2nd guess the road we have taken.  We all most of peace we did what we thought was right (and our doctors) and address whatever we have to in the future. But the number one biggest regret I have found with others is not doing bi-lat mast.  Do it and than you have one less regret....hopefully.

    flalady

  • TammyLou
    TammyLou Member Posts: 740
    edited December 2008

    Good point.

    Your regret is the reason I amputated my own breasts.  Regionally advanced at diagnosis.  I never wanted to find myself in a position where I (possibly) blamed myself.  I had max everything.  Took years to recover from the @ss-whoopin'.  I'm not saying I've fully recovered (or that I ever will completely), but it's a lot better.

    Cancer sucks.

    Tammy Lou

  • tos
    tos Member Posts: 376
    edited December 2008

    Another factor can be if one has a BRCA mutation or not.  It's a good idea to be tested if you have family history.  http://www.facingourrisk.org is a great place to learn about hereditary cancer.

     I have read a study where their conclusion was that with triple negative sometimes the smaller tumors can be the most agressive so it might not always be size that matters.

    Floriday Lady I am so sorry to see you have had a recurrence and will be on chemo indefinitely

    The first time I was diagnosed and had a lumpectomy.  The second time on the other side I decided to go with a mastectomy.  This tumor was considered a New Primary.  Then I learned I was BRCA 1+.

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