How do you know if chemo worked

If you had scans before your chemo began, you probably will not be offered them again unless you have symptoms.  My onc chose not to scan before chemo. She said it was important (since I am also HER2+) to just get started with the chemo and herceptin rather than waiting another 2 weeks to get all the scans done.  In my case, she will do my scans after my chemo treatments are finished.  I think it is more for a baseline than anything else.

Hi,

I'm finding that one has to advocate for the necessary monitoring to ensure that the chemo is working and also to monitor for metastasis to other organs.  I am in the US (Oregon) and monitoring tests may be dictated by the level your oncologist is willing to advocate for you with the insurance agents to cover the costs.  I haven't found any definitive protocols for monitoring cancer treatment response but here's what I've been getting:

I am Her2+/EP-, node +, about stage 3 (they haven't staged yet because I'm getting chemo > then surgery > then radiation).  My chemo treatment was 4 AC bi-monthly treatments followed by 12 weekly TH, then will be H every 3 weeks for a year.

Mostly, my oncologist (and I) tested my response to chemo by physical touch.  My tumor completely flattened out during AC but retained its diameter (4.5cm).  After only 2 treatments of TH, it reduced in palpable size to 2 cm.  Then after 10 TH treatments, I had another ultrasound which confirmed 1.5 cm but I had to insist on getting the ultrasound to measure response to chemo against a baseline measurement.  

I got CMP bi-monthly during AC, monthly during TH to measure my blood chemistry which also can indicate metastasis to other organs under normal conditions.  Your liver and kidneys are under attack during chemo so your numbers will be really screwed up (drink plenty of water). Perhaps someone else can explain other chemistry panel test relationships that can show metastasis.  Also get a Vitamin D test to ensure you are absorbing enough of this.  Any others?

I got CA15-3 tumor marker tests every month and it went up during AC and first half of TH, then went down.  Without chemo, a rise in CA 15-3 indicates progression so I was worried.  But it was explained to me that this will rise during chemo while it is killing cancer cells and then fall as there are less cancer cells to kill.  Anyone understand this test?  I'm a bit fuzzy on the explanation, still.   

I got CA 125 (usually used for uterine cancers but also for breast cancer) before chemo, then around the 3rd week of TH. 

I got a muga scan before starting TH and again midway and then will get an echocardiogram when I'm finished with TH.

I had a baseline breast MRI and Bone Scan before beginning AC and will get those repeated after completing TH.  

I didn't get a baseline bone density scan (not the same as the Bone scan, which shows metastasis in the bones) and when I insisted midway in treatment it showed I had developed osteopenia, a precursor to osteoporosis, which AC can cause.  So I don't know if my chemo caused this or if it was natural progression with age.  If you haven't gotten one, I would insist on getting it because AC can cause osteoporosis (it can be reversed with a good source of vitamin D, calcium, plenty of water and weight-bearing exercises but get a good book on osteoporosis reversal).

There's so much more to monitor during chemo than just the cancer because of the toxic side effects of these drugs.  In general, do your research ASAP and present your recommendations to your doctor.  You have to advocate for your own monitoring and health.  You're going to be too tired to do your research probably so ask a friend.  

Good luck to you.