Chemo before mastectomy?

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merovingian
merovingian Member Posts: 17
edited September 2014 in Stage I Breast Cancer

My wife's diagnosis is in my signature. Small lump, almost in the middle of her chest. Just barely on the right breast. Mammogram said one 6mm tumour. BS recommended lumpectomy. He seemed confident, and said she might avoid chemo, but have RT.

Pathology after lumpectomy was disappointing though. Lymph nodes were still clear, but margins were not. 2-3mm mostly, with DCIS at the edge. Plus, they found 5 tumours, 0.5mm to 9.5mm, instead of one. 

My wife is 38. Like a lot of the younger patients on here, she is petite with young children. 160cm (5'3"), 45kg (100 pounds), A/B cup, and our boys are 6 and 4 (both breastfed).

BS says, because of general lack of flesh, a second lumpectomy will not produce good results. The multiple tumours, and HER2+, also further encourage a recommendation of mastectomy plus chemo.

He recommended chemo first, then mastectomy. I think we have that luxury because all known malignancy is already out. Plus it gives more time for acceptance and more time to consult in regards to reconstruction options.

The thing is the breast nurse was surprised by chemo before mastectomy. And from reading many stories on here, it seems to me it's not the norm. Thus far I have complete confidence in the BS, and we see the Onc on Friday. Does anyone think there's anything concerning in all this? I am worried about her doing chemo, and then having the mastectomy pathology still light up.

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  • calevorse
    calevorse Member Posts: 57
    edited June 2011

    I'm doing the chemo/surgery/chemo route.  Doing Chemo before surgery allowed for the tumor to shrink and made for cleaner margins which made for an easier surgery with less scaring.  I don't think one route is better than the other, but if the tumor seems to be growing rapidly it can be good to do chemo first as well.  Mine was growing rapidly and the oncologist thought it would repsond well to chemo, because it was unstable.  So far he has been right.

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  • gutsy
    gutsy Member Posts: 391
    edited June 2011

    I had a lumpectomy first, but margins were not clean, than I had chemo and than a mastectomy. Pathology report from the mastectomy showed that there was no remaining IDC, just DCIS. As my oncologist stated, we are more worried about possible spread beyond the breast, than possible cancer in the breast itself.

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  • merovingian
    merovingian Member Posts: 17
    edited June 2011

    Thanks a lot for your responses.

    calevorse, it sounds like your situation is a little different. I understand the rationale though. Are the two courses of chemo both full courses? (e.g. Like 6 infusions each?) What is currently planned for my wife is just one course. I don't want her to end up with a bonus second course after the mastectomy (if doing the mastectomy earlier could keep it to one course).

    gutsy, your situation sounds very similar. So the presence of DCIS in the removed breast tissues didn't trigger extra chemo or any RT? I mean they were satisfied with the status at that point? No concerns about any trace amounts of DCIS left behind?

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  • MargieC
    MargieC Member Posts: 394
    edited June 2011

    Merovingian --  I am having chemo first too.  I have two IDC tumors and an area of DCIS.  I have to have a mastogomy due to the fact that I have cancer in three ares (currently my limp nodes look clear based on all the test).  By doing chemo first we are reducing the size of the two tumors  which will make surgery easier (chemo will not effect the DCIS) and making sure we kill all the cancer cells that are floating in my body.  My surgeon did tell me we could go either way chemo prior to surgery or after, but based on my case and her advise we choice chemo first.

    That being said you will get a ton of questions from people why you are doing chemo first.  I have gotten tired of that.

    Good luck....

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  • calevorse
    calevorse Member Posts: 57
    edited June 2011

    Yes, I will have two full courses, but only because my oncolgist said that my tumor was very aggressive.  The first chemo is to kill to the tumor (think of it as the cancer factory) while making surgery easier, the surgery to remove the factory and surrounding area and the last chemo is more like "life insurance."  It makes sure that any free cancer cells floating around will get killed too...same with radiation...it's life insurance.  My genetic testing came back positive though, and I believe that has a lot to do with how aggressively they treat cancer.  The likelihood for recurrance is fairly high.  Chemo is by far the worst part in my opinion, but I will always encourage people to take the most aggresive route possible if they are unsure.  Having two rounds of chemo is better than having a second cancer.  That's really just me though, and a lot of people would choose differently.  Either way, wishing you and your wife the best of luck on the road to wellness.  I remember how hard that decision was for my husband and me.  We ended up not deciding and leaving it up to the oncologist.  No matter what you do, it will be right for you and your wife.  No one has the answers, it's just what feels right to you two.  :)

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  • lago
    lago Member Posts: 17,186
    edited June 2011

    I have seen lots of people do chemo before surgery although I wasn't one of them. I'm actually surprised I didn't have chemo first. I did ask.

    But in your case they seem to know the stage so doing chemo first shouldn't effect that. If I did chemo first I don't think the would know for sure if I had micromets in my nodes. I was node negative. I might have been required to do rads if they weren't sure in my case due to tumor size.

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  • tedwilliams
    tedwilliams Member Posts: 178
    edited June 2011

    I had neoadjuvant chemotherapy due to the size of my lymph node....my cancer was found due to the swollen lymph node. Only after an MRI was the primary tumor found. I completed 8 rounds of dose dense chemotherapy. For the area I was living in at the time this was becoming standard protocol. My doctors were able to determine the effectiveness of the chemotherapy by monitoring the size of the lymph node. I was a human petrie dish.



    Jana

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  • merovingian
    merovingian Member Posts: 17
    edited June 2011

    Thanks a lot everybody. I really appreciate all of your responses.

    So it seems my wife's treatment plan is conventional, even if the road less travelled. I will still drive the oncologist mad with a list of questions, but I feel more relaxed about this particular issue at least. Thanks again.

    MargieC, we're only 3 weeks into this BC caper, and I'm already tired of a lot things. Good to know that questions about the treatment plan will be another. Smile

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  • mrsnjband
    mrsnjband Member Posts: 1,409
    edited June 2011

    I had neoadjunt chemo too, this was done because I had inflammatory Breast Cancer. They wanted to shrink the tumor & get the skin healthier so the skin would heal better.  Inflammatory affects the blood vessels to the skin. Maybe they are doing this because she is Triple Positive?  Just wondering. NJ 

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  • alichom6413
    alichom6413 Member Posts: 2
    edited March 2013

    I have a large tumor in my left breast that they estimate is approx. 9cm. There is also lymph node involvemnet.  I am undergoing chemo since the diagnosis in an attempt to decrease the size.  I have 3 more chemo treatments for a total of 8 which should take me through the end of April.  Approx. 2 weeks later, I expect, they will schedule either a lumpectomy depending on the amt. of shrinkage or a mastectomy.  I wish your wife the best.  I am 56 and my youngest daughter is 22 so it is a little easier than being as young as she is with young children.  The best thing you can do for her, I believe, is to love and care for her and the children as she is undergoing chemo and surgery.  I often think, how much easier I have it that when I come home from work, I can lay down if I choose to and not have to worry about dependent children.  Thanks for posting and God's blessings to you all.

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  • msphil
    msphil Member Posts: 1,536
    edited April 2013

    hello there, I was fairly young when diagnosed at 42 and making wedding plans to my 2nd husband, I found the lump in the shower,I was told to have 3 months of chemo to shrink the tumor so they can be sure to ge it all, in my left breast, then the mastectomy, then 3more months of chemo(cytoxin, and adriamycin, and 5 fu) and then I had rads and 5 yrs on Tamoxifen)Praise GOD I am this yr a 19 yr SURVIVOR, so it was a very good plan. msphil 

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  • heather214
    heather214 Member Posts: 142
    edited April 2013

    I am also getting preadjuvant chemo. The reasons are multiple, my tumors are multiple and large, so they prefer to shrink although we know it will be mastectomy not lumpectomy. Because there is question if my nodes are invaded, my surgeon wants to kill any cancer cells that may have escaped before they have a chance to metastasize. I was also given the reason of being triple positive, as your wife is, because this is a more aggressive and faster growing cancer. I was explained that it is more likely that some of the cancer could have become systemic due to the multiple and invasive tumors. I would talk to your Dr. about his reasoning. I was told that in several Drs. opinion, this regimine, with preadjuvant chemo, gave me the BEST chance of survival and eradication of the cancer. Best of luck to you guys, ultimately you have to be comfortable with the treatment and the reasoning for it.

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  • goutlaw
    goutlaw Member Posts: 283
    edited February 2014

    Not sure but I had Chemo first also all 8 treatments& @ time of surgery tumor was still 7.5 cm What a bummer!! But he said he got clear margins so that was a good thing& 3 were cancereous@ the time of surgery in the nodes! Before that I have no clue because imaging is not that good! I was hoping for the 4 then sugery then another 4 chemo to kill just in case but I had talked to many who said its very unlikely for it to spread @ time of surgery but not sure how true because anything open to air can spread! 

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  • kcarcarey
    kcarcarey Member Posts: 7
    edited September 2014

    Thank you everyone I have just been diagnosed and have chosen chemo first.  I have been so worried thinking  I'm making the wrong decision. My surgeon new that I came into this game with wanting to do a double mastectomy first but after I listened to him I agreed with him on chemo first. I have not gotten my pet scan yet and hope it comes back clear. I meet my medical oncologist Monday to go over my chemo plan

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