Just Diagnosed - Surgery Timing

Hi purple, and welcome to Breastcancer.org!

We're sorry for the reasons that bring you here, but really glad you found us. You're sure to find our Community and incredible source of information, support, and advice. Someone will be by shortly to weigh in with their thoughts and experience.

Please let us know if there's anything we can help with as you navigate your diagnosis and treatment! We look forward to hearing more from you soon!

--The Mods

That is how mine was described. My breast dr said surgery next month, mastectomy because lumpectomy would take too much of my breast. Then my HER test came back positive so it all changed overnight to chemo. I wanted it out of me immediately but now hopefully it shrinks enough. That HER test can change everything. I had no lymph node or and other place involvement

Purple - if it turns out you're HER2+, it's likely you'll have neoadjuvant chemo (before surgery). It they can eradicate or shrink the tumor (s) before surgery, so much the better. Good luck.

Hi everyone...I think being treated at a major university hospital is much more important than waiting several weeks for treatment. Good luck to all.

starting chemo first is great - it gives you lots of time to research and pick how you want your surgery done (reconstruction-wise). If you have the ability to use a Digicap for hair loss - I recommend it! 

I'm sure BarredOwl can weigh in here, NoWhyToIt, but although surgery first and ASAP, followed by adjuvant treatment (chemo, then radiation) is the usual order of things, not so in a larger tumor that is triple-neg and definitely in need of chemo. Removing the tumor first makes it very difficult to see how well the chemo is working (“pathologic response") throughout the body. If it’s not responding, some tweaks to the chemo regimen might be indicated. And if there is complete pathological response, the tumor might disappear, making the surgery unnecessary, or at least shrink enough to make breast-conserving surgery possible.

Here is a link with tips to get through chemo. I also joined a contemporaneous thread with women going through chemo as I was. Lots of good support. Like Chemo June 2017

https://community.breastcancer.org/forum/69/topics...

I agree that with a surgery-first treatment plan, unnecessary delays should be avoided. While unnecessary delays should be avoided, obviously, some time is required (and is reasonable) for appropriate preoperative evaluations, testing and consultations that may impact treatment decisions and advice.

It is important to understand that recent observational studies that assessed the potential impact of delays in surgical treatment were conducted in patients who all had a surgery-first treatment plan. Those receiving neoadjuvant chemotherapy were excluded from those studies (and the findings do not apply to them), because their situation differs materially, and because the safety and efficacy of neoadjuvant treatment followed by surgery has already been established in other clinical trials.

Per purplestargazer's subsequent post, she has now received a recommendation for neoadjuvant chemotherapy followed by surgery. A timely subsequent surgery following neoadjuvant chemotherapy is not considered to be a surgical "delay". With a primary tumor that is estimated to be over 2 cm in size (estimated clinical Stage IIA disease) and that is "triple-negative" (ER- PR- HER2-), neoadjuvant chemotherapy (administered prior to surgery) is within current standards of care as reflected in NCCN guidelines for the treatment of breast cancer. Many members here have such a plan.

In those who are suitable candidates for neoadjuvant chemotherapy (per their treatment team, including a Medical Oncologist), as noted above, such a plan may have certain advantages, including the ability to assess response to therapy (the degree of pathologic response) by imaging and subsequent surgical pathology, and potentially adapt treatment plan based on the information provided. For example, if there is sufficient tumor shrinkage due to neoadjuvant treatment, in certain patients, this may enable breast-conserving surgery in lieu of mastectomy (if desired).

The omission of subsequent surgery in exceptional responders is not currently used in clinical practice, but is an active area of research:

>> http://www.ejso.com/article/S0748-7983(17)30347-5/abstract

>> "Furthermore, tumor response to neoadjuvant therapy can significantly impact local regional therapy decision-making by down-staging disease without compromising local regional control. This includes facilitation of breast conserving surgery and increased eligibility for limited axillary surgery in selected patients. Furthermore, the omission of surgery in the setting of exceptional response to neoadjuvant chemotherapy, the ultimate breast conserving strategy, is being actively studied. With further refinement of systemic and targeted therapies, neoadjuvant systemic therapy continues to provide a robust mechanism for innovation in local regional management paradigms with increased attention to individualized breast oncologic care."

BarredOwl

I am Triple negative, grade 3 and will start chemo first in July and will have surgery in about 6 months. I am trying to be positive. Just be well!