Chemotherapy prior to surgery?

In the beginning it was suggested that I get chemo first to shrink the tumor and then do surgery, so that's what I was ready to face. While I waited and got my port placement, a team of oncologists discussed my case. The day after my port placement the breast cancer navigator called and told me that the doctors said that if I wanted to I could have surgery first instead of doing chemo first. I asked if it would make a difference which way I did things and she said no, I would get the same chemo regimen whether I had surgery first or chemo first. Since I had already gotten my port, I just opted to do chemo first.

I’m surprised the breast surgeon is offering a lumpectomy and not a mastectomy. I had two tumors in the same breast and a lumpectomy was off the table. I ended up having a double mastectomy and now going through chemo because my MammaPrint came back high risk of reoccurrence.

Olynn, maybe you should ask for a second opinion.

I chose to do chemo (taxol) and herceptin first...a lot of that decision is also because I smoke. Plastic surgeon won't touch me until I'm not smoking for 3 months. I'm having trouble with the mastectomy thing. At first I was to have a lump. Then within 1 months time I became multifocal and lump was out. So I chose treatment to give me time to think and become "comfortable" with the fact I gave to have a mastectomy. My Onco isn't exactly happy with me but oh well.

IMHO I also felt that surgery would heal better if I wasn't doing chemo after because it slows down the healing.

Just my thoughts. We're all different but yet we all have to make the same scary decisions.

~Nanette

My cancer was HER2 positive, and my facility likes to do chemotherapy first for that type of cancer. The rational of shrinking the tumor first didn't apply to me because they region the tumor occupied would have had to have been excised anyway and I was having a BMX. But my facility likes to have a way to know if the cancer is responding to the chemotherapy.

I had what they are calling a pathalogic complete response, which is unusual, meaning the chemotherapy killed all of the tumor, but in reality, they found one cell left in a duct.

From their perspective things went great and I had an amazing response to the chemotherapy but from my perspective I had a lot of anxiety about having the cancer in me for all of those months...I worried about it spreading. I worried about losing my insurance and being stuck with the cancer in me. I worried about a natural disaster causing delays in my treatment. And I also lost 30lbs which made immediate DIEP reconstruction impossible and I am not regaining the weight in the right spot.

Anyway those are my experiences. Some women who have had chemo after surgery have anxiety because they have no way of knowing if it's working on any remaining cancer cells.

I've talked to maybe three women who, by virtue of the fact that they did have chemo first, discovered their cancer was not responding to it and this lead to a re evaluation of the receptor typing and ultimately a change in the chemotherapy to a drug combination that the cancer ended up responding to, or, in one woman's case, an emergency mastectomy when it was discovered that her cancer didn't respond to any chemotherapy. But chemo probably would not have been recommended for her to begin with if she had had the mammaprint done.

With my initial diagnosis of ER/PR+, Her2- on the right side I was going to have a lumpectomy and no chemo. When my left side came back ER/PR+, Her2+ my surgeon told me that changed everything and I would need chemo. Originally they had decided to do surgery first. But my breast surgeon and my oncologist discussed the case and decided to do chemo first to try to shrink the tumors. I had an MRI after 4 of 6 rounds of chemo. The tumor in my left breast was all but gone. The chemo had done it's job.

Good luck with your treatments, Olynn. Whatever you decide with your surgeon & oncologist will be the right path for you. Every cancer is different and therefore the treatment is different. Sending hugs to you!!

Olynn:

The higher the score the more indicated chemotherapy is. In women with low scores, one thing that contributes to the lower score is that the cancer may be less responsive to chemotherapy to the extent that the cons of doing it out weigh the pros.

I didn't have oncotyping because chemo is standard with HER2 positive breast cancer. My cancer was as aggressive as cancer gets...grade 3, poorly differentiated (the cells were completely corrupted) and high mitotic rate (a lot of the cells were dividing quickly). Because it was growing quickly, it was more susceptible to the chemotherapy. The cells were more vulnerable to the chemotherapy than cells that were dividing slower.

Hi, I chose to do chemo before surgery because:

- The breast surgeon I wanted was not available immediately and I wanted to start treatment right away.

- I was more worried about the cancer spreading outside the breast already, and wanted something to kill those off first. Doing surgery first meant no systemic treatment for weeks.

- My breast surgeon mentioned that the chemo can kill off potential cancer in the lymph nodes, resulting in less lymph node removal during surgery, which would reduce the chances of lymphedema. My lymph nodes came back all clear so it worked out for me.

There’re a lot of debates on which approach is better, and so far there’s no substantial data to support one over the other. The MO I saw for 2nd opinion said it’s more a “philosophical” difference at this point.

The good news about high grade cancers is that they can respond to chemo very well.

My tumor was 3.3cm at diagnosis and then measured at 2.8-3.3cm a little over a month later, so not much difference in size via ultrasound measurement, even though it was high grade.

I did have a lot of DCIS along with the IDC within that 3cm area, so maybe during that time it was just growing into the DCIS...?

It was recommended to me that I have chemo first due to being HER2 positive. I really didn't worry about the tumor during that time because I thought the chemo would be working in it as well as any possible other cancer cells elsewhere in my body. And since I was the one that found the lump - I was also aware of it disappearing during chemo.

It was suggested to me that having chemo first would also help with the success of a lumpectomy. However - even though there was no evidence of cancer on imaging after chemo - the surgeon still planned to remove the same amount of tissue. I guess that helps to ensure clear margins?

BTW - a second opinion doesn't necessarily require more testing. You can just ask for their opinion for a treatment plan. I had second opinions on pathology, surgeon, radiation, and oncology - some before active treatment, some during, and some after.