Surgery or Chemo first?

Hi There -

I had two tumors, one IDC and one DCIS and one lymph node that tested positive from my biopsy. I was given the choice of surgery or chemo first. My OC was leaning to the chemo first - one of her explanations: The chemo can shrink the tumor and the patient can see the results, with surgery first, you, the patient, really don't know if the chemo is working. Anyway, I did chemo first. Four A/C treatments every other week then twelve weekly taxol. After the first A/C treatment the tumor had shrunk. After the second, it was gone. My treatment didn't change. I had surgery on Oct.2 and the pre-surgery MRI I had showed nothing out of the ordinary - no tumors, no suspicious lymph nodes. My path report from surgery came back clean, no cancer. Even in the lymph node that tested positive in March.

Saw my OC for follow-up two weeks ago. She said there was a 15 - 20% chance of the chemo completely obliterating the cancer. So, more likely it would shrink but in my case it disappeared. I am now into my second week of rads. I am excited by the outcome because it was unexpected and of course I'll probably be nervous about reoccurrence for the rest of my life.

It's a hard decision but I based it on my age (49) and the fact I was in good health and the cancer was found early.

I had chemo first and got to feel and see the cancer shrinking. I got a complete response so I was very happy.

I also did chemo first. I had a 3 cm grade 3 tumor near the chest wall if not invading the chest wall. I was told chemo likes fast growing tumors and we tried for shrinkage and try to pull it away from the chest wall. I got the desired shrinkage results.

Final path after surgery. Only a small 5mm residual IDC was identified with an area of 1.3 cm DCIS in the original tumor bed with narrow margin near chest wall so radiation was needed. Also one sentinel node showed fibrous scarring possibly related to prior lymph node metastasis with pathological complete response. Further immunostaining resulted in negative findings of micrometastes in the lymph node.

I feel fortunate my results were a near pathological complete response. 2 more days of radiation and done with conventional treatments.

Final path staging is ypT1a pN0. This means final tumor size 1a and no node involvement after chemo.

Now to wait for a few months and begin the reconstruction process.

Good luck in choosing the correct path for you.

Remember each person's treatment has to be tailored for your tumor and health. By no means what worked for me might be your best option, just gave my details for food for thought. I wanted surgery first for the fear of leaving the tumor there to spread but was convinced otherwise. It worked for me.

(((HUGS)))

I had chemo first also, A/C x 4, three weeks apart. I started with two solid lumps totalling 5cm and a few nodes with cancer. My MO could feel the two lumps shrinking by the 2nd infusion, and the two swollen nodes and the lumps were no longer palpable by the last. A couple months later, I had a SNB and a lumpectomy to check; one of the lumps was totally gone but I did have a 3mm residual bit of the other lump still there. The margins were wide and clean and the nodes were now clear of cancer. I went on to rads, which were completed in July.

Just had a PET scan a few weeks ago, and I am clear of cancer for now. I just hope it stays that way.

Sending prayers and healing thoughts to all here.

Carol

This may sound silly but in addition to all the reasons listed here, I found another little silver lining to neoadjuvant chemo: I got the hair loss over with early on. Then, after my BMX and throughout radiation, I didn't have hair to try to blow dry or style! That worked for me because I didn't have the time or energy to devote to it, and it would've driven me crazy. By the time I finished radiation, my hair was coming back in.

I had no choice - my surgeon needed the tumor reduced before attempting to remove it. I didn't have a complete response but wasn't expecting to with a large ILC tumor, so I was happy with the order of treatment (SNB, then chemo, then BMX, then rads). I also liked having more time to consider my reconstruction options, and by the time I had to decide, I was 100% comfortable with my decision not to reconstruct at all.

Good luck to you, tangandchris. ((hugs))

Good for you, tang! Sending you good wishes for your surgery and recovery.