Timeline from biopsy to surgery

Hi there tmulholl...

My diagnosis is similar, just with the ER/PR reversed. Two and a half weeks after my dx, I started neoadjuvant chemo for 6 rounds every three weeks, so will be looking at surgery after May. My BS and MO wanted to start with the chemo because I could be given the targeted therapy, Perjeta, if it was given prior to surgery. Perhaps that will be an option for you as well. Goodness, I was thinking you have a long wait to see your doctor--but Feb 27 is next week! Where is the time going??

--Lorie

As kayb said one of the reasons to consult an oncologist prior to surgery if one is Her2+ is that there is a newer drug Perjeta  approved (Sept. 2013) for neoadjuvent use only for early stage breast cancer.  This drug is approved for tumors 2cm and larger and has shown to be very effective when added to chemo and Herceptin.

windingshores - it wouldn't hurt to talk to a MO prior to surgery, but technically speaking your mass is too small for Perjeta.  Some oncologists have had success in getting insurance to pay for Perjeta for smaller masses, and also for use of the drug with adjuvant chemo/Herceptin.

tmulholl - I had mammo/US on Sept. 9, biopsy on Sept. 22, diagnosis Sept. 27, first surgical consult on Oct. 5, surgery Nov. 1.

Hey Tmuholl, I can definitely empathize, I had a tough time waiting between Dr's appts. First was the ultrasound, then a week later the biopsy, then another week later I'd see a surgeon, then the oncologist appt was a week after that, and then a radiation oncologist would be a week after that (I was briefly considering intra-operative radiation).

This led me to get a second opinion at a University hospital. They were set up differently - they have a dedicated "Breast Center", and when you first come in you can see the surgeon and oncologist(s) all in one afternoon. They all talk to each other about your case, and can get your questions quickly to the appropriate specialist. They were able to set up my surgery a couple of weeks sooner than the first group. I have no idea if that made any medical difference, but it was good for my peace of mind. On top of that, I really liked all the Dr's there. A year later I'm really glad about making that choice.

I have no idea if there's anything comparable near where you live, but more important is that you do have some choice - I believe a fair number of (most?) insurance companies will cover you getting a second opinion. You might be able to find someone who can see you a little bit sooner. And then if you're not happy with the first surgeon or oncologist, at least you'll have other options without feeling the clock is ticking too fast.

Btw, I'm one of those folks who is early stage, a 1 cm tumor, but I still got Perjeta after surgery w/chemo, no issues w/insurance. That said, some Dr's would think Perjeta was overkill for my case. Pre-surgery (neo-adjuvant) chemo wasn't an option for me because the biopsy never showed the HER2+. They actually thought I was HER2 negative.

One other thing I should mention, just because a lymph node "lights up" in a mammo or MRI that doesn't necessarily mean you have cancer there. For one, MRI's do tend to show false positives - not all Dr's are willing to use them. My mammo report mentioned possible lymph involvement, but the biopsy showed it was negative (and that was what the radiology Dr thought from the ultrasound). Unfortunately, it seems you can't really know until they do the surgery. Yeah, waiting is hard. Windingshores, I think you're onto something!

Best of luck to you!!

tmulholl, my wife and I have 3 little ones (2,4,6) we were able to just slowly talk about what is going to happening to mommy and how she is going to see the doctors and people will be coming over to help out. There are also some great books to read to them, they are age appropriate as the 3yo will not understand what the 6 yo does. My kids have not let up and are the same pre-diagnosis as post. The 2yo is very nurturing and when my wife feels bad she cuddles up with her (so sweet). You can do it, I know it sucks but one step at a time, get second opinions, ask questions. We are only 3 months from diagnosis and my wife was almost identical to you. We ended up going neoadjuvant with the TCHP protocol. We will do BMX after and we don't know about radiation yet but more than likely. Treatment #5 in one week.

I copied your questions in italics and posted our answers in bold..I am not a doctor so please just use this for what it is worth

As far as surgery, it looks like your wife has only had lymph node removal. Is that correct? - yes..its called sentinel node biopsy (SNB), typically for her2 with neo-adjuvant the medical oncologist (MO) or breast surgeon (BS) might recommend it to see if there was/is lymph node involvement, if they look suspicious on the radiology or not. Because post chemo and targeted therapy the cancer hopefully should be gone so it is hard to tell if the nodes were involved. This also allows the MO or radiation oncologist (RO) to determine if radiation is required. Are there plans for a lumpectomy or mastectomy in the future, and at what point? - BMX (bilateral mastectomy, MX is short for mastectomy, LX = lump...) is in our future about 4 - 6 weeks after the last tax/carbo treatment...she will continue with herceptin during surgery and post surgery to make it through a year.

I'm not familiar with the 0/2 nodes notation. Does that mean cancer had spread to the lymph nodes, or not? If not, do you know why the cancer is graded Stage IIIa? - she had 2- nodes biopsied and 0 nodes were postive (0/2) meaning no node involvement, ok...the MO staged it at IIIa right after PET scan which had some suspicious axillary nodes, the MO did not re-stage after SNB. The tumor was two smaller tumors and a vast region in the right quadrant which felt hard and lumpy (she literally finished breastfeeding our 2 yo at the end of july 2014) but no identifiable lump so this area was hard to classify (maybe DCIS??..no one would say)so based on that info 6+cm and suspicious node in the PET scan = stage IIIa.

I found the TCHP protocol definition, but none for BMX. What does that stand for? - BMX (bilateral mastectomy) ...

How many months of chemo are planned? 6 rounds for us, with one full year of herceptin..my wife got a port as she will be getting herceptin infusions for one full year, also she gets nupogen shots (10 of them in her belly that I have to give) after each chemo treatment, our insurance does not cover neulasta which is one shot you might get the day after chemo. The nupogen and neulasta are white blood cell promoters. We got a second opinion from an MO that was very reassuring as it was identical to the first opinion. Also my wife is not hormone positive so that is a difference.

My timeline went fast...Biopsy on 6/9/11, results the following Monday, 6/13/11, meeting with the oncologist on 6/14/11 where we discussed the possible treatment options pending the results of the tests on receptors and her 2 neu, results and another meeting with MO on 6/21/11, with chemo starting on 6/22/11. Yeah, for me it went fast. Of course I didn't have surgery until 11/23/11-after I had completed the Taxotere and the Carboplatin; I continued the Herceptin until May of 2012.

Everyone's timeline is going to be different for many different reasons. It was nine days before they had all the information they needed to start my treatment. Those nine days seemed like a lifetime to me when I was waiting. In retrospect they really didn't mess around with me-they started everything pretty much the minute they had the information they needed to start the correct treatment for me.

I had a complete pathological response and all scans since have been negative. Good to hear there are other options since everyone doesn't respond to herceptin.