Chemo first or surgery first

Here is my take - Because the Military Treatment Facility (MTF) can offer the services, they have "first right of refusal" and can compel her to receive treatment from them. Nature of the beast with military medicine. When the point of contact (POC) determined that they military can offer treatment, they would rescind any civilian referral because of costs.  This is standard for MTF's.  Whatever they cannot do, they refer out.  My treatment has been divided between civilian providers for the things the MTF can't do - and things they can do I have done on base.  I would hazard a guess that they want to do surgery first so that they can accurately stage her, then make treatment recommendations based on what they find.  They may be wanting to put off recon until they know if she will need radiation.  Radiation on top of recon can be tricky.  My guess on the referral for the port has to do with the vascular component - the long tubing on the inside.  My port placement and BMX was simultaneous and I had a subclavian placement.  Whether or not they can do port, surgery, then chemo would be dependent on where they place the port.  Having surgery first will definitely answer questions about size, location and nodes - this would have been problematic with chemo first.  Also knowing all known cancer had been surgically removed prior to chemo was comforting to me personally.  Many times chemo first is done for breast conservation (lumpectomy) and to determine if the particular chemo cocktail is effective. 

Glad I chimed in then!  28 years as a military spouse have given me an education in how this stuff works.  I have had a litany of surgical procedures prior to being diagnosed with BC, and lived in so many different places with different resources available, so baptism by fire.  This is by far the most complex medical situation I have faced - with so many components to the treatment - it has been an education unto itself.  I think the order of affairs you described above will serve your daughter well - I hope for nothing less.  You are a wonderful mother, I am so glad she has you.  I am so happy she is calmer and someone took the time and cared enough to explain things.  Keep asking questions everywhere you go and all along the way, and keep coming back here.  We will always be here for both of you.

My onc today said it makes no difference in survival rate by doing chemo or surgery first.  They are both as effective in stopping the cancer in its tracks.  Made me feel much better as I have read in more than 1 place that they have switched to the chemo first thing as of the last few years.  I have triple negative and for me surgery first got it out of me sooner and I sleep better at night knowing that!

Maggie

Kim, do you know if the civilian or military team your daughter has seen has much real experience with TNBC?  As I'm sure you know, it's somewhat of a subset speciality unto its own, and if Christine were my daughter, I would want an opinion from doctors who have seen a lot of it, which means a major NCI-designated cancer center, like the University of Colorado's center in Aurora before making a decision.  TN can be tricky to treat, and while I know she has constraints due to her military coverage, I'm wondering if you could ask whichever doctors she uses to please consult with CU or UCLA or MDAnderson or The Mayo (there's one in Phoenix) or one of the larger institutions that will surely have valuable experience to contribute to a treatment decision.  While I absolutely believe in intuition, this is something you don't want to get wrong, and since you have a difference of opinion between trained doctors, I'm not sure intution is enough.  I'd really like to know what one of the larger institutions would recommend for her, because I really do think it's that important.    (((Hugs))) to you both ~   Deanna