5 Steps Forward, 3 Steps Back
Newly diagnosed here. Met with my surgical oncologist yesterday and found out that I am triple negative. This morning I was so relieved to find out that my CT scan showed no mets. I felt very encouraged. But now, after researching what triple negative really means, I'm very discouraged. My oncologist said chemo first and then surgery. Anyone else done it this way?
Comments
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I did it the other way around, but then we didn't know I had much of a problem until the surgery.
Good luck, my friend. If you trust the doctor, believe that they have hunted up the best plan for you.
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I am doing chemo first. This way you can see if the chemo is working. My tumor in my breast has virtually disapeared after 3 treatments. I think many are doing chemo first these days.
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I did chemo before surgery. Many doctors will want to do chemo first because they can see how well your cancer reacts to the chemo. Don't go read too much stuff about TN on the web. Somethings that are said are just outdated or plain too scary. I ask both my onc (who specialises in breast cancer and gives conferences on that matter) and my RO if TN was such a bad thing and both told me no. Yes it's aggressive but chemo works very well on TNBC. They are both very positive so I don't see why I shouldn't believe them. But I understand that it is scary. It will get better with time. Hang in there. Good luck.
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I was just diagnosed back in April, everything was rush rush rush. I didn't find out until after my lumpectomy that I was TN and if I had been given the choice I think I would have opted for the chemo first to shrink the tumor then lumpectomy or maybe even masectomy. Now my "girls" aren't even and I hate it, will have to spend more money to have the other one evened out after this is over.
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I also did chemo first and the tumor responded very quickly to it. Within two treatments it was half the original size and we couldnt even feel it at all after 3-4. My breast surgeon said from the beginning that being TN is good news/bad news. The bad news is that is very aggressive but the good news is it usually responds excellent to chemo. There were no cancer cells found in either breast after my BMX! That news was the best call I have ever received! I'm sorry you're having to begin this journey, but I pray you will have a great response like I did. I'm on the other end. I had the chemo, BMX, radiation and just had my exchange surgery almost 6 weeks ago. Feel free to ask any questions you want. Sending positive thoughts your way ...
Kathy -
Kathy what does BMX mean? Next week I will be having my port put in, a bone scan and an echo on my heart. I'll be starting chemo on Friday. The one thing I'm most worried about is the bone scan, praying to God that my bone scan in clear.
I met a lady the other day that has been in remission for 13 years but she didn't find out she was triple negative until a year ago. Also, my case manager who makes all my appointments is also a triple negative survivor, she's been in remission for over 5 years.
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vshowe: bmx means bilateral mastectomy. I chose that route because I wanted to make sure I did everything possible to prevent reoccurrence. Since I was diagnosed at 44, I just chose to throw everything plus the kitchen sink at the cancer. I have no regrets. I think the scariest part for me was all of the testing at the beginning. It's so hard to not have all of the answers. For me, once I started chemo I felt better because I was doing something about it! The port is a great way to go. It makes the chemo process so much easier. I hope the rest of your tests go well. You're about ready to begin your battle. Be good to yourself! This is doable. Just take one day at a time.
And thanks for sharing about the survivors you have met. It's so great to hear that!
Kathy -
I will just share an observation my very capable BS made at the time I was deciding on surgical options. She said that many people assume Mx or BMx is the most aggressive treatment, but Lx combined with rads (as it always is) is highly aggressive too. I would never have agreed to a Lx if I thought I was holding back in any way on treatment. I think that's an important point to make for all of us who quite rationally choose Lx, just as others opt for Mx. The surgical options are different to be sure, but have been shown to be equally effective, and unfortunately neither comes with any guarantees.
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Luah: you are absolutely correct that there are different options and there are definitely no guarantees. It is truly a personal choice and one that we each have to make. I was mainly sharing my chemo before surgery results with vsshowe. Because of the surgery I had I was able to know that there were no cancer cells left in my breast tissue which was a direct result of the chemo first approach. Sorry if I offended you in any way. I certainly didn't intend to.
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I think that chemo is done before surgery with women that have larger lumps also...in the hopes that it will shrink enough that a lumpectomy is an option...if they so choose..
There are so many factors in chemo before or after..bmx or lumpectomy...all based on the individual and their choice and what they are most comfortable with in their treatment options.
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KSteve: Thanks for your post. Perhaps I was being a little too sensitive today... it's just that I see so many posts on these boards referring to Mx as a way to "throw everything at this..." as if those who choose Lx somehow don't.
I think the chemo before surgery is a really good option for many, and for TNs in particular who only have one shot at a systemic treatment (chemo) and can assess whether or not it's working. It's great that you had a complete response.
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Just to chime in - not all TN cancers are the same and not all TN cancers respond well to chemo. Mine did not respond to neoadjuvant chemo and the treatment was withdrawn after 4 rounds of different chemos (I was scheduled to have 8 rounds). After the second round and no response, they changed to Taxol / Taxotere and assured me that the tumour would melt away. They even put a clip where the tumour was so they could find it when it was time to operate. But I had the new chemo and MRI showed no response. I then had a lumpectomy and rads. I think neoadjuvant is the way to go for triple negs - especially since there is no treatment afterwards. It does give them chance to get the chemo right. But also be prepared that it might not work. I suppose psychologically knowing I did not respond to chemo has left me vulnerable. I constantly wory about recurrence and I report every ache and pain (which usually turns out to be nothing). To give them credit - they act straight awaay and scan etc. But that stresses me too!! The upside to this is that the Oncologists withdrew the treatment because it was not working for me and I did not have to have pointless rounds of chemo. Would I do the same again with the knowledge I have today? Yes!
Karen x
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Good point, Karen. And those of us who did chemo after surgery have no idea if it worked or not. I am sure that in many cases, the surgery removes the cancer, end of story. But the worry remains.
Nice to hear you're doing well... I remember your posts, as we were diagnosed around the same time.
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Karen - I was/am in the same boat as you. Initially I responded well to chemo, but became resistant at the end and had a lot of disease at surgery. The psychological impact is big, and I also get scans at the drop of a hat.
I think neoadjuvant will show to improve outcomes for TN because doctors can monitor chemo effectiveness. But doctors need to be willing to do regular scans while in treatment - some prefer to go by feel and just assume they will know when the tumor is changing. I had an MRI after my AC that showed 50% reduction. When my tumor melted away during Taxol/Carbo, we ALL assumed it was continuing to work. If I had gotten another MRI, we likely would have seen otherwise. No one person's fault...but if I did it over again, I would push my doctor to do more than one scan, regardless.
Good luck vshowe! -
Hi Luah - good to hear from you too. I think that the day I was diagnosed with BC will be etched on my mind forever. Scary days and sleepless nights! I am doing fine and in fact just preparing to go to Turkey for a couple of weeks with my son. He is 18 years old now and will be going to university in September. So I figured that a good long holiday would do us both good
. I will be coming back to another scan though - I postponed it until after my holidays and the Oncologist was fine about it. I just have a bit of pain in my ribs and shoulder so he ordered a bone scan. I also had some bloating and feeling sick etc but that turned out to be wind!!
. I am optimistic for the bone scan too. Sometimes I feel like a complete hypocondriac but then I remind myself of what I have been through and that serves to ease my conscience.
Suze35 thanks for your post. For us triple negs who do not respond too well to chemo the world is an uncertain place. You leave the breast surgeon and oncs office and think what now? No pills to take after treatment AND you know the chemo did not work. But Luah you are right - there are women out there who had chemo after surgery and have no idea whether it worked or not. So I personally would not have done things differently.
Dear vshowe - I hope this helps in your decision making. I think for us triple neg gals - whether the chemo works or not - neoadjuvant is the way to go!! I am hoping that the chemo melts your tumour away.
Karen X
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Karen, what a wonderful thing - to spend 2 weeks with your son on a trip! Enjoy. My younger son is the same age and will be heading to uni in the fall too - about 3000 km away.
vshowe - sorry for the highjack. Hope you get some good answers from your docs, feel at peace with your treatment going forward... and keep us posted.
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Hi, this is my first post. I've been reading quite a bit and did not want to be discouraging. I was first diagnosed 6/09, having a golf-ball sized tumor, triple negative. Yes, I had chemo first and the tumor shrunk 80%!! (Chem: TAC) Then had a lumpectomy, all lump nodes under my arm also taken even though they were negative, and then finished my chemo and then had 6 weeks of radiation. I finished up last summer about this time. December 2010, a clear mammo! Yay! February 2001 - "Hmmm... what's that hard area I am feeling?" Yes, triple negative came back.
( It is infamous for that, though not always. NOT ALWAYS, OK??? Don't be afraid. I opted for double mast, done June 29th. Petscan was clear everywhere else. We are blessed to live in the highest technology age ladies, they really do all they can for us and remember EVERY PERSON IS DIFFERENT, is that not tatooed on our foreheads by now? Ha.... Praying for peace and wisdom for us ~ HE holds us in His hand.
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Just so as you all know, TNBC doesn't go into remission for thirteen years.
If we live and are well after five years, we are well. Not in remission, but cured. Anything that comes up later is a new thing entirely.
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vshowe,
No triple negative woman can be in remission for 13 years, so that must be a new thing altogether.
For us triple-negs, if we are clear for five years, we will live happily ever after unless we grow ourself a new problem.
Our e+ and p+ and her2+ sisters have to wait 15 years to see if they will be okay.
The worst thing anyone ever said to me was from an extended family member. She said, "Don't worry. Breast cancer will not kill you for a very long time. It didn't kill my mother for 15 years."
She didn't get that what I had was different, and never would understand that, even though I told her I would not have 15 years to die if I was going to die, but 5 years. Some people know it all and can't hear anyone speaking except themselves. In her mind, I was wrong. She was right. We don't speak anymore, and that is best. There is nothing worse than an ignorant person thinking you are a drama queen when you tell them the truth.
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yellowdoglady,
I'm so sorry someone actually said that to you. What a terrible thing to say. I certainly hope she understands why you don't speak to her anymore!
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Hi yellowdoglady - i'm sorry you had that response too. I have a similar thing at work - everyone thinks I am 'cured'. I spend quite a bit of time 'educating' my colleagues who show any interest that breast cancer is actually a whole 'family' of diseases etc. There seems to be a perception out there that breast cancer is a 'good' cancer to have and that once treated you are 'cured'. Mad!! Anyway, I could get really annoyed with their ignorance too but then I realise that prior to my diagnosis I was ignorant of all the complexities of a breast cancer diagnosis myself.
TruthNLove - thanks for your post. I think it's important for all us triple neg gals to realise that there is an increased chance of early recurrence so we need to be ultra vigilant - even when we are having regular mammograms. My oncologist told me that the greatest chance is between years 1 and 3. So, your experience would confirm that. We have annual mammograms in the UK and I wish it was every six months!
Karen X
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Thanks ladies for all your replies. I had my port put in today and tomorrow I will have a bone scan. Please pray that I will have good results, I'm so scared it will be bad. I start chemo on Friday and I will be part of a trial. I'm ready to get this going.
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vshowe - wishing you good results for that bone scan. I remember my first bone scan - I had awful aches and pains when I was first diagnosed. I was convinced the cancer had spread - but it turned out to be 'muscular sceletal' thank goodness. We all understand how scared you must feel. Just go with the flow - no doubt you will have lots of scans and tests during treatment - especially if you are having neoadjuvant chemo. You will feel much better when your treatment is underway. You mentioned that you will be part of a trial and I will be interested to know what chemo regime you will be having when you have the details.
Karen X
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You know, every once in a while I just want to vent and howl. Sorry for that.
But the fact is that some people just don't understand, even if they are important to you and you try, try, try to make them understand. I think more do understand BC in general every day because this is something they see more. I don't know if it is because there are more of us out there or if we just get out more and don't hide at home waiting to die anymore like our grandmothers did. But the assumption that you must not be very sick if you are dragging your ass to work so as not to lose your job and health insurance is bunk. The idea that it shouldn't bother you to have something deadly because it won't kill you right away is just over the top.
But I like to think that for every rude ignorant hurtful person there is another out there who sees us and cares. I have a story for that too. At one point during my headscarf days, I went to the market and a fellow who worked there pulled me aside in the produce section and whispered, "We know what you've been up to." Well, instantly, I imagined that they had seen the way I was checking out the produce, palming the avocados and thumping the melons. So I acted innocent. "What?" "My mother was there last year, and I told her about you and she thinks you are a brave lady. She's not alone. Everyone in the store thinks you are brave too." Wow. So I asked about this guy's Mom. She'd had breast cancer and was doing well. Her hair was growing back. The grandkids said she is almost like before already. We talk about family some. The wife and young daughter who helped with grandma. Then I hit the hard subject. "So, everyone here knows I had cancer?" "Yes. How was it and how are you?" I pretty much said it was fairly shitty and I'm fine so far, thanks to your excellent produce. Now, a couple of years later, I still go in every week and am treated like family by everyone in the store. And when that produce guy is on the floor, we always have a little chat about how his mom is, how his daughter is doing, vacation plans and such. FYI, I told him I was getting married before anyone else knew. Why? Because he would not leak it to the tabloids or tell family and friends.
And I sent those pretty headscarves and the cozy nightcaps my Dad's cousin made for me to Australia, where they were needed immediately. A friend from high school who was a foreign exchange student back in the day had just learned that her daughter in law had breast cancer at a very young age and needed information, and looked me up. So I sent those things on hoping they would be as much good luck to the new recipient as they were to me. So far, so good there. The children of the house insist on wearing knit caps too whilst their Mum is wearing one during chemo.
So don't be thinking that I'm feeling like a victim here. I can be plenty cranky when someone is just plain stupid, but that should embarrass them, not me. I can embarrass myself quite well, and try not to do that too much. I'd rather see the good, and the better in people. Even myself.
Still, some things just stick in your craw and only fresh air will dislodge them. Thanks all for being such a fine sounding wall. If you think that is not valuable, well, you undervalue yourselves. Stop that!
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yellowdoglady: Wow, what a lovely story about your produce guy! Thanks for sharing.
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Hi yellowdoglady - that's a great story
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jenn-UK just wondered how you are doing? By now you will have had the clip put in (as they did with me). Hope all went well. Do you know what chemo you will be having yet?
Karen.
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Karen - Thank you for your kind words. Yes, I am NOT happy about reoccurance and I am still mentally adjusting to having a flat chest these past 2 weeks...sigh. I am also concerned why my Dec. 2010 mammogram was clear and two months later I could FEEL the tumor! Fast growing that TN is, sheesh!!! Can we trust mammograms? Really? Scary, but getting an MRI is sure not fun and perhaps overkill every year. Hard to really say.
YellowDogGladly - I love how you write, like you are right here talking to us! Vent away! We all do that and empathy here is very calming. Working at a bookstore, I talked to volumes of women about my situation, and also theirs. People not understanding that cancer is not just magically cured after a treatment, a surgery etc., just do not get it. Perhaps they are a scant few not yet touched by the "C" word. My mom passed away in 1976 of pancreatic cancer at age 49 and back then we were not at all encouraged to say the word, talk about it, even tell her she had it - there was no hospice, limited technology and it was rough! I educate everyone I can about what I know, especially those who think, "Oh, a mastectomy, you're cured!" But I still have to have chemo, again, different than in 2009 evidently - and like you guys all have said, it just hangs over our heads. I try to think of it all as an adventure rather than a disease, there are hills and valleys and yes, produce guys, mail people, strangers all over who give us extra care, and I am touched my their kindess and care, they make me smile!
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There should probably be a different thread where we can say how we are changed by the experience. I don't think it is all bad. It made me reorganize my life plans for sure. It made me treasure the good people in my life, and forget about those who take and never give. And I see every day differently than I did before, so I think that also rubs off on those around me. If we spend time together, it is such a good thing. If someone takes me for granted and uses me, I let them know that is not right.
Like, someone comes to visit, says they will stay overnight. Okay, I make up a guest room and plan dinner for the guest. Then we hear, well, I might need to bring more people. How many? We can only accommodate a few. Not sure yet, but probably two more and we'll be coming for dinner, and I have invited two more who are coming for dinner too. So I make up the little space that can fit an extra guest, and plan a meal for seven people.
They showed up late and said that they stopped and ate on the way and phoned the others who were to eat here and told them dinner was off. But they never told us until they arrived and said they were not hungry. I was furious. I had cooked for hours for seven and two of us ate. And it was not just your usual meal. We had made shrimp and lobster and vegetable tempura for a crowd, but nobody wanted it. I'll never do that again, and I told them so.
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Yellowdoglady,
You should start that thread, I'll certainly chime on, I've got a few people I'm in the process of letting go.
How inconsiderate of your friends, sometimes its hard to believe some people can be so self involved. We rarely have guests and like you I would have gone crazy cooking, cleaning, just excited to have have friends over for a nice time. I have to admit your dinner sounds amazing! I think even if I had eaten I would have tried a little.
I have a friend I'm in the process of dropping. She called the other day to see how I was feeling, after a few short sentences from me she started to complain about her boyfriend, his ex, his kids and his child support payments then ended with "at least I have my health"! I was pretty much rendered speechless. Oh, and I just told her that my grandmother was put on hospice. I'm really trying to find a way to gently tell her she's a crazy, self absorbed, socially inept human.
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