Must biopsies be done?

Dear Nammo:

Biopsies cannot spread cancer.  That is absolutely false information.  Do not worry about that.

You must have the biopsies so that the doctor will know what kind of cancer that you have.  Tx decisions cannot be made without this information.  No doctor will do a mastectomy without a biopsy first.  After the biopsy, they will usually order an MRI.

Make an appointment with a medical oncologist as soon as possible after the biopsies so that the MO can explain everything to you and set up a plan for tx for you.

Good luck.  I am hoping that the waiting and wondering does not cause you too much stress and anxiety.  I hope that they caught your cancer at an early stage.  I am sending you positive thoughts, prayers, and hugs.  It is very scary.

614, did I give incorrect info? I thought the biopsy was to first determine malignancy or benign? Yep, my brain does not always function properly. Thanks!

PS. I know it is scary, but waiting a week for the biopsy is not a long time. If the biopsy comes back positive for cancer, they won't make you wait a long time to move forward with a treatment plan.

There are at least two scenarios where it is important to not only establish that you do indeed have breast cancer, but also to have the biopsy in advance of surgery to determine what kind of breast cancer you have, because of the potential need for chemotherapy prior to surgery.  In the case of triple negative breast cancer - where the estrogen receptors, progesterone receptors and Her2 are all negative - neoadjuvent chemo is often given to make sure the chosen regimen is having the desired effect.  The only way to see this is to leave the mass(es) intact and measure them throughout the course of chemo to see them becoming smaller.  If the chosen drug regimen is not working you then have the option of switching to another regimen.  If the cancer had been removed prior to chemo, you would never know if the regimen you are receiving actually works.  Because there is no adjuvant (post-surgical) systemic therapy for this type of breast cancer it is very important to determine that chemo is working.  The other scenario is for a cancer that is Her2+.  A cancer of 2cm or greater, or node positive, is eligible for the targeted therapy drug Perjeta.  This drug is approved in early stage cancer for neoadjuvent (before surgery) use, and is combined with Herceptin, Taxotere and Carboplatin, usually.  If you do have breast cancer of this size, and/or are node positive, it may be very beneficial to receive this newer drug to treat this aggressive form of breast cancer.

I did have a lymph node dissection at my mastectomy, both (mastectomy and lymph node dissection) immediately followed an excisional biopsy that confirmed the presence of cancer. So i had all my surgeries done in one event, but only after the biopsy confirmed cancer. All my lymph nodes looked normal on ultrasound and i think the original plan was to do a sentinel lymph node biopsy but the surgeon saw an enlarged lymph node up the chain and ended up removing 13 lymph nodes, none of which were cancerous.

My understanding is that neoadjuvant and adjuvant chemo therapy are equally effective. The oncologist who treated my triple negative was reluctant to use neoadjuvant because he said this approach does not work for about 20%/of women, many of whom experience disease progression. I know it is a minority of people but still something to consider. I thought one of the benefits of removing the cancer first was the reduction of the tumor burden, which in turn made dd regimens more effective.

Even in the 6 .5 years since I was diagnosed with my first primary, there is so much more information, even about triple negative!

In any case, it is important to have a biopsy so you know what you are dealing with and can move forward with a treatment plan should your biopsy show cancer.

Best of luck.

Neoadjuvant. Hemo iz done before surgery and adjuvant is done after surgery. It is standard with IBC to do neoadjuvant chemo to get it to shrink and form in a 'lump' with margins as it forms as a 'nest' or in 'bands'. It is becoming more common to do neoadjuvant Chemo with other types also. Sometimes 2 different Chemo will be done neoadjuvant but for some of us we do both neoadjuvant and adjuvant. I did 4 DD A/C neoadjuvant and 12 weekly Taxol adjuvant followed by radiation.

Triple negative means your cancer was negative for ER, PR and HER2. So estrogen blockers and/or herceptrin are not needed.

Yes - with IBC neoadjuvant is the first line of TX. Most will do 2 batches of different Chemo neoadjuvant but a few of us don't. A few of us will do 1 batch neoadjuvant (for me 4 DD A/C), surgery, then a batch adjuvant (for me 12 weekly Taxol) and then radiation (started rads a week after last Taxol and Femara a week after starting rads. This is different than most do but it worked for me apparently - 6 yrs and still NED so it worked for me.