too long to wait for surgery?

Tpralph · April 2017

I was diagnosed march 10 with idc at time was grade 2 and 1.4. Had a mri a week ago and it showed mass at 2.5 as well as a couple areas of concern birads 4 so another mammo and ultrasound with biopsy this friday. Mri didnt show any lymph node involvement. Doc says I will see him again nxt monday and then plan surgery for around 4 weeks or so. Tells me that not much will change in up to 6 months! Leaning toward masectomy due to other stuff in breast. Is this too long?

im a little put off and worried that it will spread.

MelissaDallas · April 2017

It's really pretty common to wait, sometimes weeks, for additional testing.

ksusan · April 2017

Agreed--pretty common. I asked my surgeon, "Are you comfortable with this interval, because I can be available earlier," and he said that he didn't see a need for that.

Goincrzy8 · April 2017

most breast cancer has been growing for years the hardest part for us is the waiting

Tpralph · April 2017

thanks ladies that makes me feel better. Although I was hoping for the dam tHing to come out like.... Today! Lol

MelissaDallas · April 2017

Tpralph, you'll be better able to make informed decisions with more complete information

Hopfull2 · April 2017

I agree. Waiting is tough. I wanted mine out too asap but PS told me we had a 4-6 week cushion from time of diagnosis so she was able to run additional testing . Your in good hands.

Wildplaces · April 2017

I am confused - on March 10th was that a tissue diagnosis? Did you have a biopsy?

Next Monday - 10th of April and then wait another four weeks that to ME stretches the envelope.

And yes breast cancer can be a very slow mover but there are also factors that stirs a cancer up and for a while it can be in its jumpy phase...it's an unpredictable bugger.

I totally agree that it is good to have all your tests done when you make surgical decisions - but two months from initial diagnosis seems a little long to me.

There can be some shuffling of tumour grades between biopsy and final pathology and scans are not always spot on when it comes to nodes - they are a little shaky on showing microscopic spread.

My instinct would be to get a treatment plan in sooner rather then later ( if you end up Not requiring further interventions GREAT - you have wrapped this up and are free to get on with things, and if you do need chemo/rads well the sooner you get yourstrategy the more likely you are to contain the beast to 2017!)

I am sorry - I do not mean to sound worrying - it's just my thought on it 😊

MelissaDallas · April 2017

Wildplaces, on what facts do you base your feelings? With rare exceptions, most cancers have probably been there years before even being even detectable and do not grow very fast. If she had an exceptionally agressive cancer her doctor would be acting accordingly.

What are these things that "stirs cancer up"?

Her doctor is correct and you are just scaring her for no factual reason. Women routinely wait weeks for BRCA testing, Oncotype testing, further biopsies as indicated she needs, etc

NotVeryBrave · April 2017

My MO told me that MRI's frequently show the cancer as larger and that tends to freak people out. I don't know about others' experiences, but mine was pretty consistent with what was seen and measured by mammogram and ultrasound.

It took a little over a month for me from initial mammogram to starting chemo (due to HER2+). While I think that we all agree with the need to "do something and quick" - we also all want to choose the best course of action so waiting for all of the info and then moving as quickly as possible seems to make sense.

Maybe they could look into doing the surgery sooner if they have all of that info?

Wildplaces · April 2017

I did not present the hard data because I did not want to sound alarmist.

Here is a summary

http://www.ascopost.com/issues/may-10-2016/improved-survival-with-shorter-delays-between-diagnosis-and-surgery-and-before-initiating-adjuvant-chemotherapy/

Feel free to look up the referenced JAMA oncology articles.

Anyway you put it a personwho states you would be the 'same in six months' is not correct - see initial post.

Yes you need the work up - and yes it sounds like this is a small low grade lesion - so totally curable.

Tpralph · April 2017

if the were giving me chemo i might not worry so much to wait but it is just growing there and is sometimes painful. Gotta take somes breaths . It will be at least 2 monthsapprox from time of dx to surgery if they can get the ps at same time. Butdldo they need him if they are just putting in te?

Yes biopsy positive IDC grade 2. Be says grade never changes but sometimes they get it wrong in the initial pathology.

Wildplaces · April 2017

TPralph - just try and see if you can get donea little earlier if possible - that is all I am saying.

As to Grade - breast cancer is not homogenous - even in a Grade 1 there can be more aggressive looking cells in the tumour but the majority are not ( nuclei, tubules, mitosis if you need specifics) - when they get a biopsy they only get a few cells - they can only report on what they see - not so much they report "wrong"

You need the entire specimen and then you make a decision on the majority of cells in the spec.

That why Grades can be shuffled between biopsy and surgery.

I am quiet certain you WILL be fine - just keep advocating for yourself.😊

SpecialK · April 2017

tpralph - the plastic surgeon is the doctor who places the tissue expander - so you need one at the time of mastectomy, the breast surgeon removes the breast tissue and does the sentinel node biopsy then hands off to the PS. I had a 2.6cm Her2+ tumor, my imaging was consistent on tumor size. I had the mammo/US that led to diagnosis on 9/9, biopsy on 9/22, diagnosis on 9/27 with BRCA testing done same day. Waited three weeks for BRCA results then planned BMX - had pre-surg MRI, consults with PS and BS, first available surgery date for both docs together was on 11/1, so a total of almost two months from suspicion to surgery, and more than 4 weeks from diagnosis. This is not uncommon. Something to consider if you are leaning toward mastectomy is to skip the additional biopsy (same breast as your existing tumor, correct?) and go straight to the MX surgery, determine what is in the breast tissue at the post-op pathology if this would speed up your timeline.

Kicks · April 2017

I do agree that it is good to get your complete TX (treatment) Plan sooner rather than later. The optimal TX is after you have met with not only a Surgeon (the 'cutter') but also the other members of your Team - your Chemo Dr/MO (Medical Oncologist) and your Rads Dr/RO (Radiological Oncologist). Also for your individual case to be presented to the Tumor Board at your Facility for evaluation/recommendation of the TX options. It is a Team Effort not just 3 Drs doing 'their own thang' without co-ordination.

Surgery first has long been the SOP for most types of BC (including IDC) BUT it is becoming more common in today's world for Neoadjuvant (pre-surgery) Chemo to be used for better outcomes/prognosis at time surgery - some getting a complete response. Neoadjuvant chemo has long been the SOP for IBC (not your type) but there are variables within TX plans for IBCers. Most will do 2 different chemo regimens both neoadjuvant but I didn't. I did 1 neoadjuvant and 1 adjuvant - my Chemo Dr and Surgeon 'thought out of the box' and it worked great for me. 7 yrs post TX and still NED (No Evidence of Disease).

The time frame you mentioned is not at all unusual for IDC based on what I've read in many places. It definately gives you time to check with your Team for the best TX Plan for you -if you haven't already met with them all or been 'presented' to the Tumor Board.

Lisey · April 2017

I'm throwing in the option of not doing tissue expanders or immediate recon. Try out how you feel being all natural and flat and fabulous.. if you don't love it, you can do recon later. I made the mistake of assuming everyone did recon, so I got TEs and it was a nightmare. (I'm F&F now and look great flat. )

Also wild places is right... my MO told me even a biopsy can stir things up and cancer to start growing or even a tiny amount of cells could spread when the tumor is punctured. Thus why we take hormonas or have chemo to kill off those stray cells. There is a 90 day window from biopsy (puncture) to chemo/surgery...

EastcoastTS · April 2017

Agree (mostly) on the TEs. I feel them and the first two weeks, the issues were more pronounced. Normal issues, perhaps due to BMX healing, I'd guess. But they are completely manageable. And, really, better than I expected. And time flies once all this gets rolling.

Until you have full plan in place, that is the crazy time. We all understand! (I'm still at the tail end of getting it all together myself.)

Also, I really took my time, too, getting surgery plan in place. I researched all and got 2nd opinions out of town -- and eventually surgery there too. (MD Anderson) Diagnosed 1/4, surgery 2/27 -- and the process for biopsy and initial appts took longer in Dec, too, due to holidays. So I feel like it was Nov -- Feb for the process truly. Take a breath. You have time. Of course I worried after biopsy but these are big decisions -- don't rush faster than you can. Don't make decisions completely out of fear, if that is possible. I went BMX despite fear of more surgery and am HAPPY I did.

too long to wait for surgery?

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