Chemo first or Surgery first?!!!!!!!!!!!!!

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Danaqtr
Danaqtr Member Posts: 48
edited September 2018 in HER2+ (Positive) Breast Cancer

Hello

I want to hear from you your treatment plan if the tumor is 1.4cm. No obvious lymph node under arms.

The surgeon and the oncologist suggested to start lumpectomy based on the tumor size less than 2cm.

When I watched many videos on YouTube and read pairent stories I found many people who started chemo first eventhough their tumor is less than 1.3cm!!!!! Why you think some people starts chemo first for very small tumor not surgery?? And what your adv

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  • Murfy
    Murfy Member Posts: 342
    edited September 2018

    Perhaps tumor is located in spot easy to remove without needing to shrink. Once removed, treatment with Herceptin to make sure rogue cells bite the dust! Much also depends on your tumor's characteristics.

    Best of luck!


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  • WC3
    WC3 Member Posts: 1,540
    edited September 2018

    Mine was 2.54 cm on the US and about 3cm by the time I started chemotherapy a little over a month later. My facility likes to do chemo first for HER2 positive cancer but I am not sure if they have a size limit. Apparently doing chemo first originally came about because for some reason licensing for the targeted therapy was originally only granted for use with neoadjuvant chemotherapy. That changed in the U.S. at the beginning of this year but my facility likes to do the chemo first to see if the cancer is responding and to also give women the option of lumpectomy.

    I have no interest in lumpectomy and was not very keen on doing the chemo first as the safety and benefit of it has been called in to question. When I discussed this with my MO she was happy to do whatever I wanted to do. Ultimately I decided to go with the chemo first because it was what the MOs at my facility prefer and I am not a doctor and thought I might have just been missing something or not understanding something about the benefit, but in hindsight I think I made the wrong choice for me personally because I underestimated how much I would be disturbed by having active cancer in my body and I worry a lot about it spreading during chemotherapy if it hadn't already, and the role of my diet in that. I would have been much more at ease if I had had the surgery first. However I have heard from women in the opposite situation, who had surgery first and chemo second and were unnerved by the fact that they had no way to know if any post surgery cancer cells responded to the chemo.

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  • Becca953
    Becca953 Member Posts: 99
    edited September 2018

    I agree with WC3, there are pros and cons with both sequences. I was originally scheduled to have chemo first, until the MRI results showed nothing. At that point my breast surgeon wanted to do surgery first. I freaked out and said are you sure, I do not feel comfortable? She took my case before the tumor board and there was unanimous agreement for surgery first, then chemo.

    Things seem to be constantly fluid with HER2+ treatments and sequencing because much of it is so new. I would recommend, either a second opinion at a regional cancer center, if you have one within a days drive, OR ask your surgeon to present it to the local tumor board which is also basically a second expert opinion.

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  • NotVeryBrave
    NotVeryBrave Member Posts: 1,287
    edited September 2018

    I had chemo first with a 2.7 cm tumor. I don't think there was any size component discussed except that over 2 cm qualified for Perjeta as well as Herceptin for NAC.

    I'm glad that I did it that way. I was able to know that the chemo worked because the tumor was no longer felt shortly after starting. And at surgery - no cancer was left!


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