Chemo before or after surgery

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Meredith_G
Meredith_G Member Posts: 2
edited July 2017 in Chemotherapy - Before, During, and After

I have two differing opinions as to how my treatment should be done. I have IDC ER/PR+ with one confirmed positive lymph node and maybe at least one more. The first surgeon and oncologist I saw said surgery, axillary dissection of the lymph nodes, radiation and tamoxifen for the next 5-10 years. They would then use the oncotype testing to help determine chemo or not. The second opinion from Dana Farber both the surgeon and MO say chemo will be needed regardless of oncotype and that I should do it first, only for the benefit of possibly not needing an axillary dissection and being able to preserve some of the lymph nodes. While I would like to avoid chemo because it's scary as hell, I'm 40, in good shape and in good health you know other than having cancer :-), and I feel that I can make it through fine. However, at this point I just don't know what the right decision is...I would like to avoid the possibility of lymphedema and am willing to do chemo up front, but it seems as though the surgeon and MO I want to go with feel differently, and I get it, why put myself through chemo if it may not be worth it or necessary. So, I'm here looking for stories of similar scenarios and how you all made your decisions, thanks!!!

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  • ElaineTherese
    ElaineTherese Member Posts: 3,328
    edited July 2017

    Hi!

    I did chemo before surgery. For me, doing neoadjuvant chemo was a good strategy because:

    1) it wiped out my active cancer and allowed me to get a lumpectomy rather than a mastectomy (was happy to avoid reconstruction);

    2) it showed that chemo worked for my kind of cancer;

    3) it allowed me to get Perjeta, the latest targeted therapy for HER2+ breast cancer.

    However, because my cancer was so aggressive (triple positive, Grade 3), I ended up getting ALND anyways. I have not been diagnosed with lymphadema (thankfully), despite losing all 20 of my Levels 1 and 2 lymph nodes.

    What kind of chemo was Dana Farber proposing? Chemo isn't any fun, but it is a temporary inconvenience. I haven't suffered from any long-term problems related to chemo.


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  • illimae
    illimae Member Posts: 5,710
    edited July 2017

    Ditto to Elaine's treatment only I had Abraxane instead of Taxol. I was diagnosed last year at 41 and was scared of chemo too but once I got into it, I found the SE's pretty tolerable and it worked really well.

    image

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  • MeToo14
    MeToo14 Member Posts: 493
    edited July 2017

    Would they be able to do oncotype testing from the sample they got from your biopsy? If so, that might help in your decision. Also, have you had an MRI? Do they have an idea the size of your tumor? I ask because I had a large tumor and was happy to be able to have chemo first and then a lumpectomy. I was thankful to be able to keep my breast. I had an excellent response to chemo, not perfect though. I'm sorry you are going through this, I hope you get the answers you need to make the right decision for you.

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  • april25
    april25 Member Posts: 772
    edited July 2017

    I had neoadjuvent chemo--

    1. Because of HER2+, would need chemo no matter what, and Perjeta in addition to Herceptin was showing to be beneficial and it had been tested and approved to be used neoadjuvently.

    2. It would help shrink my tumor (3cm) so I might possibly have less tissue removed and be less deforming with a LX.

    3. It would show if the chemo was effective in shrinking it.

    4. It is strenuous, so better to be gotten out of the way first. Also.. sometimes complications with healing after surgery can postpone chemo, so doing it first makes any delay less likely-- chemo right away... kill the cancer as much as possible, then have surgery.

    --

    I was glad to get chemo out of the way first! The treatment seemed to get easier and easier that way. Surgery and rads was a walk in the park in comparison. Not that chemo was that horrible... but it definitely wasn't any fun.

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  • PauletteK
    PauletteK Member Posts: 2,205
    edited July 2017

    I have surgery first then chemo and I'm much older than you. I just had my first chemo today and I did pretty well. I can't promise the next few days will be as good as today I just live one day at a time.

    If you have cancer on lymph node I think you should consider chemo. I'm no doctor so this is my opinion. Have you have PET scans

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  • Meredith_G
    Meredith_G Member Posts: 2
    edited July 2017

    Thank you all for your responses and comments. I don't know what drugs they are planning on using, and the oncologist at Dana Farber said she would do chemotherapy regardless of any oncotype results so sending out the biopsy sample wouldn't really matter. We are meeting with our oncologist today to formulate the plan, I have made the decision to go through chemo first with the hopes that we may not have to remove all of the lymph nodes; (the tumor is small so that is not a factor).

    I wish you all the best of luck on your journey, and thank you all again for your input.

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