Wife Recently Diagnosed - Thoughts on Treatment

Has she met with her Chemo Dr (MO) and Rads Dr (RO) yet? TX is a Team effort - not all 3 'working' totally 'alone'. Has she asked about a port for infusions? What Scans/tests (MRI/CT, PET, Bone, MUGA/EKG, etc.) are scheduled before Chemo?

Neoadjuvant chemo has been SOP for IBC (Inflammatory Breast Cancer) but is becoming more common for other types. The idea is that it will 'atttack' the cancer to get it to shrink and form 'good' margins for better surgical outcome.

My experience with neoadjuvant Chemo was for IBC, not IDC. IBC developes differently as it forms in 'nests' or 'bands' so neoadjuvant is needed to get 'it' to form into a 'lump with margins. Most who do neoadjuvant Chemo will do 2 different types of Chemo before surgery but not all - some of us do both neoadjuvant and adjuvant.

For me, my surgeon flattly stated that he would not do surgery without neoadjuvant Chemo first. I started getting response with DD A/C (Dense Dose Adriamycin/Cytoxan done every other week) almost immediately. When I had finished my 4 A/C, my Drs wanted to do surgery - so 2 weeks after last A/C I had a UMX and 3 weeks after UMX, I started 12/weekly Taxol. That was 6 1/2+ years ago and I'm still NED (No Evidence of Disease). I can speak about the experiences of those who are IDC and do neoadjuvant Chemo but there will be those who come and can.

There is no way to know how she will react to Chemo - rather it is neoadjuvant or adjuvant. We are each so unique and our bodies react differently. For me, A/C did not slow me down at all but Taxol completely EXHAUSTED me. But that is all in the past, I do it again in a heartbeat IF needed. For others, it is the other way around, A/C nasty and Taxol not nasty. There are other Chemo that I do not know anything about other than what I have read.

Just my experiences - others will have their experiences to pass on.

I'm IDC ER/PR + Her2 - and strictly due to the size of my tumor my oncologist and surgeon suggest neoadjuvant chemo. The idea is to shrink the tumor so that we have a shot at a lumpectomy. It seems to be working. I am a week out from my second treatment.

That being said, don't be afraid to get a second and third opinion. This is her life and your wife (you are very sweet - I'm so happy she has you!) She has the right to as many opinions as she wants and to go with the team that makes her and you the most comfortable.

Best of luck to her and to you. I swear this phase is one of the hardest - up until the decision is made, then it seems to get easier as you have a plan of attack.

Hi!

I had chemo first. What was nice about neoadjuvant chemo was watching the lump shrink and knowing that the chemo was killing the cancer. After five months of chemo, all of my active cancer was gone and I was able to have a lumpectomy instead of a mastectomy.

Chemo works best on cancer that is replicating quickly. (Mine was Grade 3.) You say that your wife's cancer is Grade 2-3. That means it would probably respond better than cancer which is Grade 1.

You also say that one node tested positive for cancer. My advice there would be to make sure that her doctors mark that node BEFORE neoadjuvant chemo. Maybe, they can insert a tumor marker (?). My surgeon didn't, and since the post-chemo MRI and PET scan indicated that my nodes were clear of active cancer, no one knew which node had been compromised prior to chemo. So my idiot surgeon ended up taking out ALL 20 of my Levels 1 and 2 lymph nodes. (Ugh. I am lucky that I didn't get lymphedema.) If my surgeon had inserted a tumor marker, he could have taken out ONLY the previously-compromised node and a few of its neighbors. Your wife should want to minimize the number of nodes removed. So, before she agrees to neoadjuvant chemo, she should make sure that her doctors have "marked" the compromised node.

Best wishes, and insist on a second opinion if you don't feel comfortable with your wife's doctor's opinion.

wifeismyhero,

It is common to place markers in the breast to alert the surgeon to the location of the tumor; it sounds like they did the same for the compromised node. My radiologist didn't mark my node because he used a fine needle biopsy to check it out. Sounds like you guys are all set! Yeah, insurance companies are not too thrilled about paying for PETs. A CT scan should do the trick. Best of luck with the tumor board! Hope they create the appropriate plan for your wife.

The Facility she is going to should also have a BC Nurse Navigator who will be there to help along the journey and can be talked to about all sorts of concerns. There should also be a Nuititionalist to talk with.

Before starting Chemo, she should get a 'class' (individualized one on one, not a group) with one of the Chemo RNs for education. Mine were immediately before first neoadjuvant A/C was an hour long. The one before first adjuvant Taxol was about a 1/2 hour. A lot of great info is given then and I was given a notebook that had so much 'general' Chemo info but also info on each of the drugs used during Chemo. There will be more than just the Chemo.

It would probably be a good idea to ask the Nurse Navigator about the "Look Good - Feel Better" class if they have it at the facility or at the local ACS. It is a class (through ACS) designed for those going through Chemo to give info on dealing with makeup, skin care, wigs, etc. There are a lot of 'things' that are taught (one thing comes to mind is how to use an eyebrow pencil to make eyebrows appear 'usual' once hair 'leaves' after starting Chemo.

I don't know your situtation , but if needed her facility may have wigs available. My Nurse Navigator gave me a really cute wig but when Hub y and Son (adult) saw it on me, they broke out laughing - I have to agree - as cute as it was it wasn't 'me' at all. So I took it back to the Look Good Feel Better class and there was a lady there who it was perfect for so she went home with it. At that class, I still had my hair but the Hairdresser who was doing it told me that she had a wig that a name manufacturer had sent to her that she thought would be great for me and to come to her salon the next day. She was right - I went home with with it. I also got another wig that VA got for me - so I could go with my longer wig or my short wig depending on my mood at the time.