Can someone explain why chemo first?

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Mojojennijo
Mojojennijo Member Posts: 173
edited September 2017 in Chemotherapy - Before, During, and After

I guess I don't have a good mental picture of what's going on in my body. It's funny I've studied so much in college and work about this kind of stuff. It seems foreign when it's your own body.

I have a preliminary stage of 2b with just the size of the primary tumor (7.3 cm) . I have clinical staging being done Tuesday. I don't know node status cause I haven't had surgery. But maybe the scans will shed more light. The MRI showed them effected but oncologist doesn't feel any tumors in them. So there's that :) oh and the her2+ thing.

So why do they do chemo before surgery. If I'm having a mastectomy wouldn't that take the cancer out (if it hasn't spread) so what is the purpose of chemo first? What benefit does it have over taking the tumors out?

Having a visual always helps me

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  • muska
    muska Member Posts: 1,195
    edited September 2017

    Hi Mojojennijo, I am very sorry you are on this board and facing treatment decisions. I am sure somebody will come along shortly and give you a detailed answer but in a nutshell, with large tumors - yours is large - chemo is usually done first to shrink the tumor so that the surgeon can get clear margins easier and also see how the tumor reacts to chemo.

    It also means you start systemic treatment right away, if you have surgery first it would delay your treatment start by at least two months (consider time needed to schedule surgery and time needed to recover from it before you can begin chemo.)

    Best

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  • Shellsatthebeach
    Shellsatthebeach Member Posts: 316
    edited September 2017

    Muska is right about size of tumor. I also want to add that if there is a lot of cancer found in lymph nodes on scans, it can shrink the cancer there too making surgery easier and more effective. Also, depending on what kind of cancer you have, some respond better having the chemo first. A newer reason is for cosmetic reasons.

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

    Hmmm, breast cancer cells aren't necessarily localized in the breast. They can enter the bloodstream and lymph system, and look for a new home. So, taking off the breast may not remove all the cancer cells from your body. Chemo is systemic treatment, and is designed to destroy the cancer cells that are circulating in the bloodstream and lymph system. For HER2+ cancer, the guidelines recommend Perjeta (a targeted therapy for HER2+ cancer) as part of a neoadjuvant regimen, though Perjeta has also recently become an option for post-surgical (adjuvant) chemo as well. I was happy to get Perjeta as part of my chemo cocktail.

    I also had a large HER2+ tumor, and had neoadjuvant chemo. After five months of chemo, there was no active cancer in my breast or compromised lymph node. So, I was able to opt for a lumpectomy.

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  • Meshell5324
    Meshell5324 Member Posts: 54
    edited September 2017

    Hi Mojojennijo, my surgeon explained to me that since my tumor size was borderline (4 cm -4.5 cm with the cut off at 5 cm for a lumpectomy) the best treatment plan would be chemotherapy first to shrink the tumor. Since I'm hormone positive he said I should be able to get good results. I'm meeting with an oncologist next week and reading articles here on treatment options.

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  • Mojojennijo
    Mojojennijo Member Posts: 173
    edited September 2017

    Thanks! I have t really read up on her2 and what that does because I've been feeling like I'm in a whirlwind of hurry ups.

    My surgeon said the tumor takes up the whole top of my breast and because it was missed for so long in gonna just have them both taken off completely so I don't have to go through that again.

    So perjeta is what they give in combination with herceptin? I can't remember exactly what he said as far as drugs but he said they could change depending on clinical staging. But I think I'm getting ac taxol first and then the herceptin with the other. But again I kinda was having trouble focusing at my appointment. I plan to write it down Wednesday when he has it all figured out.

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

    Hi!

    I had AC and then Taxol + Herceptin + Perjeta. The other common regimen for HER2+ cancer is Taxotere + Carboplatin + Herceptin + Perjeta.

    Yes, many women opt for a double mastectomy because they'd rather not get scans in the future. But, even if you have a double mastectomy, recurrence is still a possibility.

    Best wishes!

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  • Kicks
    Kicks Member Posts: 4,131
    edited September 2017

    Neoadjuvant Chemo has long been the standard for TX for IBC but is being used more now for other types also.

    With IBC, it is to get the 'nest' or 'bands' (how IBC forms) to form a 'lump with good margins and to shrink for a better potential outcome of surgery. With other types it is to shrink the 'lump' and get good margins for surgery. Sometimes a 'complete path. response' will be gotten at time of surgery with no cancer cells in the path. report. Neoadjuvant also starts 'attacking' any cells that are floating around in the blood stream or lymphatic system or have already 'found' a new site (mets).

    There are different protocohol with doing neoadjuvant Chemo. Most will do 2 different types of Chemo both neoadjuvant but not all of us do. For me, I did 4 DD A/C neoadjuvant to get it to form a 'lump' with margins and shrink which it did. Then had UMX and then 12 weekly Taxol adjuvant to 'mop up'.

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  • ChiSandy
    ChiSandy Member Posts: 12,133
    edited September 2017

    Shrinking the tumor with neoadjuvant chemo means a lower likelihood of cancer cells remaining in the skin, axillary tail, chest wall & clavicle after a mastectomy. And it also gives your oncologist a clue as to how well certain regimens are working and the opportunity to “tweak” them for optimal response.

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