Surgeon contradict's oncologist's statement--who to believe?

JudyM · December 2009

JudyM · December 2009

I'm having lumpectomy of a 2.5cm tumor next Tuesday. Three weeks ago I met the oncologist, a 34-yr-.old personable woman 3 years out of training. She stated that If a surgeon wanted to shrink the tumor before surgery "there is a pill--not chemo--to do this." The next day I had an appointment with the surgeon, who is 59 and has been practicing for 29 years. I repeated what she said (and I did not misunderstand her because my daughter had been with me to take notes and she agreed) and the surgeon said "If she means Tamoxifen, that is not when it's used, it's used later after surgery..." and had no idea of what she was referring to.

This has given me some uneasy weeks, thinking the experienced surgeon is the expert and the oncologist is kind of new and maybe not experienced enough. I've had a call in to her every day for three days, missed the one call she made while I was at the nuclear medicine appointment yesterday, called this morning and afternoon, still no call at 6 PM. I want to ask her the name of the pill she mentioned.

Then I began to remember my husband, an oncologist and hematologist; we married in his last year of medical school and I saw him evolve from the enthusiasm of beginning practice to the more--I hate to say callous--but definitely NOT excited any more by the time he died of cancer 25 years later. And then realized that my oncologist's youth probably made her MORE up on cutting edge information than the surgeon.

I want to know if anyone here knows what pill she is talking about, just to help me put these two people so important in my treatment in the right perspective?

Thanks, all. I'm still in a whirl since diagnosis 6 weeks ago!

rgiuff · December 2009

If you are postmenopausal, she is probably taklking about an aromatase inhibitor, such as Arimidex. I've heard of it being used to shrink tumors. It stops the body from using the aromatase enzyme to convert androgens into estrogen, thereby depriving the tumor of the estrogen it needs to grow. Is your tumor estrogen receptor positive?.

Regawhatever · December 2009

I'm no expert, but Tamoxifen was the first thing that came to my mind, too. Not that it shrinks tumors (as far as I know) but is sometimes more effective than chemo at preventing recurrence and zapping any stray cancer cells. All things being equal, I would imagine your oncologist would be more expert on your cancer than the sugeon. And -- again, I'm not a doctor -- 2.5 cm isn't that big a tumor. I would think they'd surgically remove it, then give you radiation and Tamox. Ask for the Oncotype test if you're a candidate. Good luck. I know it's frustrating.

-Tricia

Fidelia · December 2009

If you have an hormonally responsive tumour ER+/PR+ and you are postmenopausal - then the oncologist is probably referring to Arimidex or Femara or Aromasin - all AIs which - as rgiuff says are aimed at shrinking the tumour and possibly mop up any stray cells - though this is more of a theoretical hope than a clinically proven one - but whatever helps. I relied solely on surgery - this was a mistake in my case - had I seen an oncologist earlier - it may have helped. These days, no matter what the surgeon 'finds' you will be offered some form of follow up for hormonally postive tumours - there is no sense in waiting

best of luck

apple · December 2009

my surgeon made sure my oncologist stayed on top of things

"those oncologists are so optimistically hopeful" he said.. "I've been around for almost 30 years".

he was consistently right... He's retiring soon.

pj12 · December 2009

I am sorry you are having to start this journey but glad you have found this resource. Someone here will be more knowledgeable than I am.

It is hard to second guess your oncologist. Perhaps she has called you by now. I do know Arimidex is used for two reasons; to deprive ER+ cancer cells of needed estrogen and reduce the risk of mets, and to shrink existing tumors where BC has already metastasized. Arimidex is only used by women who are post menopausal, either due to age or surgery or suppression. It is one of three drugs in the aromatase inhibitor family. I don't know if the other two are used to shrink tumors also. I know chemo can be used to shrink tumors before surgery, I'm not sure if Arimidex is used in that way. If you look on one of the threads for Arimidex you might find a discussion related to your question.

There is so much thrown at you in the early days of diagnosis. You are fortunate to have your daughter for support. You will find many women here who are very well informed and tremendously helpful. Wishing you the best in the weeks to come.

pam

TenderIsOurMight · December 2009

I'd bet like the others it's an Aromastase Inhibitor (AI's) the surgeon is referring to-provided your needle biopsy showed ER+. I peeked at your other posts and see you're postmenopausal, so more likely than not your tumor is ER+.

Femara shuts down remaining estrogen (adrenals, belly fat) fast, but packs a wallop. Seems too to have more studies on it given prior to surgery (neoadjuvent Letroxole). Arimidex, Aromasin, all are AI's.

Sorry to hear about your husband: it must have been a difficult time for you both, as insight gleened from experience (i.e. practicing oncology) on one's cancer may be very frustrating and scary.

Newly trained doctors often do know more of the cutting edge knowledge, simply because there is so much and they are in the pit when training. My own oncologist, now in his 60's, takes hem/onc journals with him on vacation, and reads long after all who accompany him are snoring in their food, exercised, other- induced dreams. That's dedication. So I never generalize.

Hope your surgeon calls soon.

Tender

JudyM · December 2009

Thank you for all the replies. I googled the three AI's suggested above and they are all for post-surgical use. I still haven't gotten a call from the oncologist and still have no idea what pill she meant!

Judy

ktym · December 2009

Judy,

http://www.cancer.gov/clinicaltrials/ft-ACOSOG-Z1031/print

a link to a trial using AI in post menopausal women to shrink tumors pior to surgery. I don't know if you are pre or post menopausal. Don't know if your Onc was thinking of this on or off trial, or thinking of something else, but, there is some use of these preop. Hope this helps. Good luck and keep us posted, the early days and decision making are very rough.

konakat · December 2009

Maybe Xeloda -- isn't that given in pill form?

Surgeon contradict's oncologist's statement--who to believe?

Comments

Categories