Has anybody done chemo before surgery ???

Melania:  You will find quite a few women on these boards who did chemo before surgery. Hopefully some will be along shortly to tell you more about their experience.  Chemo first is often recommended in the following situations:

1. to reduce a large tumour (especially 5 or more cm.), so that lumpectomy with satisfactory margins is a viable surgical option. (Or a mastectomy can be done with good margins.)

2. to test the effects of a chemo regimen, to see how the tumour responds; this is particualrly useful in triple negative tumours where chemo is the only systemic treatment available.

Without an SNB, however, doing chemo first will not allow for accurate staging as node status will be undetermined.  This is not so much of an issue on an indivual basis if you already know your treatment will include chemo.

Hi melania, so sorry you have to be here.  All the waiting and confusion and decision making is the hardest part of all this.  And it especially hard when you get conflicting opinions.

I was diagnosed last year at 32 and had chemo before surgery.  At first I just wanted the cancer out of me, but by getting chemo first you can be sure the chemo is working and if you're a candidate for a lumpectomy (and you want one instead of a mx) then the chemo can shrink the tumor to make a lumpectomy possible.

Personally, I'm so glad I did chemo first.  I could feel the lump changing with each treatment, not necessarily shrinking but getting flatter and mushier, sort of breaking up.  I was comfortable with a lumpectomy and so was my BS (breast surgeon) so about two months after my last chemo I had surgery.  There was no IDC left and just a little DCIS. The BS got clear margins, but not clear enough for her so she went back in and took a little more and there was no cancer in that either.  My breast looks totally normal.  It's just a teeny bit smaller and perkier than the other one, but it's not something anyone else would notice.

Did your surgeon recommend a lumpectomy or mx?  How do you feel about each one?  Do you know your Her2 status yet?  These all might be things that might affect your course of treatment and you want to give some thought to.  It's so hard not knowing what's going to happen and wishing you could see into the future to see what course of action is best.  Just get as many opinions you need to feel comfortable and don't stop asking questions until your satisfied and not so confused.  Hope that helps!  Hang in there!

Melania:  It is very understandable to be scared about the scans - we have all been there.  Trust me, I was in tears and convinced I was going to die right after my abdominal ultrasound. These tests are very routine, and usually nothing shows up. Try to take things one step at a time.   

Because you are ER/PR positive, you will likely also have the benefit of hormonal therapy, which has been shown to be of even greater benefit than chemo in many eligible women (not saying chemo wouldn't be advised too, just that your therapy doesn't need to revolve only around that working). 

You may want to ask specifically why the oncologist recommended surgery first (usually surgeons are the ones recommending surgery, so there are probably very valid reasons for this) and/or get a third opinion from another oncologist, also ask about the role of hormone therapy.     

Hi! I also had chemo first - my 4-4.5 cm tumor was triple negative, so I don't have drugs like Tamoxifen or Herceptin to fall back on after chemo and surgery to prevent recurrence. Most triple negatives seems to be Grade 3 aggressive, and mine was, too. They did a fine-needle aspiration on an enlarged lymph node when they did the biopsy and it was negative.

The BS (and the oncologist agreed) told me he wanted to hop on this with chemo first to zap any undetectable micro-mets I might have in my body, even telling me that IF this thing killed me, it would be spread that did it and not the tumor in my breast, and said he'd have a better idea how the chemo was working by watching the tumor. He also hoped to shrink it enough for a lumpectomy, but after doing a little research on triple negative breast cancer, I told him I wanted a mastectomy.

He agreed, and also agreed to a prophylactic mastectomy on the other side, but is making me wait 6 months between surgeries. He said a bilateral without medical indications (cancer on both sides) carried a higher risk of complications, like clots, without any medical benefit, so he won't do it. I have to respect that. He's one of the most highly-regarded breast surgeons in my state, so I'm going to defer to his better judgement, even though I hate waiting. It's been a week since my LMX, and it's been a lot easier than I thought it was going to be.

Good luck with whatever you decide! Grade 2 gives you a little longer to decide than I did, although my first, and continuing, inclination is to throw everything I can at it.

I had my first CT and PET scan before I started chemo (which was before the surgery). I had 4 doses of TAC, then they did another CT/PET scan to compare with the first. They already knew my lymph nodes were involved since one was enlarged and was biopsied at the time my breast lump was done. The second CT/PET scan showed a marked decrease in size. Still I went ahead and had a bilateral mx.

The post surgical pathology report put the tumor size at less than 2 cm, but found cancer in 4 of the 10 nodes removed. Combining this with the initial size determined by the first CT/PET scan, my oncologist did the staging.

I then had two additional doses of TAC after the surgery before I started radiation. 

Melania, I'm in Indiana. My breast surgeon is Dr. Thomas Schmidt at St. Vincent Hospital in Indianapolis.

hi melania,

just to add one more aspect to your decision, i had chemo first, and i had no response to the chemo at all. i, also, wanted (and later had) a bilat mast, but my onc still wanted to do the chemo first, to help insure a 'better surgical outcome'. we knew from an mri that i had at least 3 lymph nodes involved. anyway, after 4 rounds of AC, we did another mri and there was no shrinkage of the tumor...in fact there was new, weird vascular activity around the tumor. so i had my surgery and then did 11 rounds of taxol. anyway, staging questions aside, i wish i would have had the surgery first since that delay allowed my cancer another 2 months to maybe spread! usually chemo works, but some people just don't respond, which sucks. my onc couldn't explain it. my tumor was 97% ER and PR positive, and HER2-. good luck with whatever decision you come to.