Trying to shrink tumor before surgery?

ILC is pretty sneaky and does tend to hide in imaging so not surprising that your MRI measured differently. I had completely different measurements from mammo, US, and MRI. It was finally decided at tumor board that it was 4.7 cm and my surgery path showed it was 4.8 cm. I was pretty impressed with the radiologist that determined that! Shrinking my tumor was never discussed, my BS said mastectomy was my only choice, we talked about nipple sparring but at my pre op she decided no. My tumor was also right behind my nipple.

Is your surgeon a breast oncology surgeon? I would consider a second opinion for sure You need to be comfortable with your treatment plan and deserve to have your concerns addressed to your satisfaction. Best wishes as you move forward I understand how hard waiting is

Hi Shamrock0310, and sorry to hear what you are going through. Based on what you are saying, it sounds like you would indeed greatly benefit from getting a second opinion, as Dani444 expressed. It is very important to feel comfortable with your treatment team, and your treatment plan right from the beginning! Please keep us posted.

I just wanted to share my story with doing neoadjuvant therapy before lumpectomy. I too was told to try an AI (Arimidex) to shrink the area for a better surgical outcome. We monitored it with MRI every 3 months. The first 3 months, the MRI showed very little difference, however, after 6 months the area was had reduced to about 85 percent as seen from the original MRI. I was hopeful that the lumpectomy followed by radiation would be enough for a good outcome.

I did get a good margin on the ILC. However, the pathology report then revealed PLCIS area which I am now getting second opinions on. I felt I could and always can have a BMX if needed. I thought that taking smaller steps and seeing the results would give me more information to make better decisions.

Had the lumpectomy path report been clear, I was well on the way to having this behind me after radiation and not faced with reconstruction decisions that come with the BMX. None of those options were or are appealing.

I was diagnosed almost a year ago. And if I had to do it all over again, I would still choose to try and shrink the area, see if the medication was effective before removing the ILC. I do now feel confident that the AI is effective for the ER positive biology. Our ages are different, I'm 61, post-menapausal with grown children and I calculate my absolute risk as 2% per year for the next 20 years for recurrence.

You are much younger, so maybe if I were in your shoes, I would make a different decision just based on the absolute risk percentage per year. You may want to ask your Dr. their opinion on that. I'm not sure this helps you, but I wanted you to know that there are those of us choosing the option to shrink the area for a better surgical outcome. I wish you the best in making your decision. I think the common surgical approach is less is more if successful and if not, the BMX is always on the table.

Emory is an NCI Designated Cancer Cente

Hi, it sounds like the surgeon is not a good listener. Can you get an opinion from another breast surgeon in the same practice/hospital?

I felt a lump and was then diagnosed at the end of May 2018, with ILC, Left, 2.9cm at 7:00, Grade 2, 1+ Lymph Node, ER+/PR+, HER2-, and Genetic Test PALB2+. I saw the oncologist on June 13, 2018 and then started chemo on July 3, 2018. I was given 16 weeks/8 sessions of chemo (didn't receive the 8th round due to numbness in feet and hands) to hopefully shrink the lump enough to spare my nipple. My MO told me Mastectomy was my best option as my size was not large enough to do a lumpectomy. When the genetic test came back positive the MO and I both agreed a double mastectomy was my only option. I plan to have a double mastectomy and flap reconstruction BUT am so confused now because the surgeon told me I would need radiation after surgery. NOW I don't know which route to take and none of the doctors want to give me their "best option" opinion. I know radiation can effect the reconstruction but can also effect the nipple with the expanders if I wait for reconstruction. SO I don't know which way to go - I only had chemo (since they weren't sure it would help since I am hormone positive and will end up on the hormones for 5 years) to help save my nipple and don't want to now lose it after going through the chemo. Has anyone else had to decide in regards to reconstruction whether to wait or not before radiation? I hope this made sense as I am very confused..

HI Shamrock, I received a similar diagnosis as you but a month after you. I just had and MRI and Petscan.I am trying to get an appointment with the referred oncologist. I believe they want to shrink the tumor before surgery but, of course, I want to get this tumor out of me. I have been watching your post and I will post what the doctor recommends to me. After reading all the comments, I feel my doctors are dragging their feet and I would like to have some game plan! I don't have nearly as much information a month after diagnosis as you do!!!

I thought I was the only one who tried shrinking the tumor first with hormone treatment. My MO put me on anestrozole for 4 months after the surgeon said he wanted the tumor smaller before surgery because it was so large. We just went by feel to see if it was shrinking because it was easy to feel it. After four months, it didn't feel like it was shrinking. The surgeon ordered a mammogram and ultrasound and said it looked about the same and I insisted we move forward with surgery. I was happy at least that it didn't get larger during that time so it must have heen doing something. My MO felt that we needed 6 months or more to shrink it but I couldn't stand having it there anymore. I had BMX. I'm back on the AI again. Best of luck.