Why should I have chemo before surgery?

I'm so sorry you found yourself here! I was diagnosed in August, just 3 weeks short of my 35th birthday. It has been a rollercoaster every since, but you will get through this! Looking back, I'm amazed at myself for putting one foot in front of the other at times where I could barely stand up...

What are your tumor markers? HER2+ typically are treated with chemotherapy before surgery. Another reason is surgeons like to shrink the tumor before surgery as it will help with getting clearly margins. How large is your tumor?

Good luck to you! You will get a LOT more information in the coming weeks and months and it will become your de facto hobby researching all possible scenarios; stay off the internet as much as you can during this time. You will do great and we will be here for you when you need someone! x

Hi Cdel,

So sorry you find yourself here, but glad you found our community.

In some cases, chemotherapy is given before surgery to shrink the cancer so less tissue has to be removed. When chemotherapy is given before surgery, it's called "neoadjuvant" chemotherapy. Only certain types of cancers respond well to chemotherapy before surgery.

However, it doesn't sound as though you've been given your full pathology report, or had an oncotype testing, if applicable. Did they give you any details from your biopsy?

What is the HER2 status? Positive means chemo. Women who are ER+/PR+/HER2- often have an Oncotype test to see whether or not chemo would be beneficial.

I also thought that I was going to have surgery first, and then go from there. But when my pathology report came back, it was grade 3 (aggressive) triple negative. My breast surgeon told me I had to go have chemo first. I didn't understand it, and then she said "surgery is secondary right now. Surgery will not save your life. You need to go get chemo now, to go after any cancer cells that may have left the tumor."

I don't know what your pathology looks like, but they must feel like they need to address the cancer in that manner first. I'm sorry, I know it's a shock. It threw me for a loop.

So sorry you're going through this, Cdel. When I was first diagnosed 10 years ago my head was on fire with all the info being thrown at me, and the struggle to make sense of this strange new cancer world I'd been thrown into. But you will get through this! It absolutely gets better. Those initial days and weeks after diagnosis are the worst -- worse for me than anything treatment did to me.

I had surgery first when I was first diagnosed 10 years ago, but now Im getting chemo first, and I find it very reassuring because when your tumour is still in place, your doctors can watch it shrinking on scans. When you have early stage cancer, there wouldn't be any markers in your blood, so the tumour is actually the one way you and your doctors can know for sure that the treatment is working. That said, the chemo is expected to work -- and the drawback is that they can't stage the cancer as effectively without removing it, and any lymph nodes, first. In any case, the research shows neither method has an advantage in prolonging life when they look at overall numbers.

But there are many individual reasons why one method makes more sense for each cancer patient, and your medical team would have considered these. For me, my oncologist really wanted to give me a lighter dose of chemo since I'd already been blasted with it the first time and sustained some bone marrow damage. So it became more important to make absolutely sure that this lighter chemo was working. As well, the biology of your tumor matters a lot too (i.e. hormone positive vs. her2+ vs triple neg).

I think you're smart to be asking these questions now, and I would make an appointment with your oncologist to ask him or her to explain why they want to do chemo first in your case, and to talk you through the benefits vs. drawbacks of this approach. If your onc has decent communication skills, thist should set your mind at ease and give you confidence in your team. Good luck!

They wanted me to do chemo first but I didn't do it. My tumor was 5 cm. I just didn't want it in there any more. Looking back, the plus side to chemo first is that they can see if they are getting a response to the chemo. If there is nothing there to check you just hope that the chemo protocol you are on is best for you. In the end you have to go with your gut feeling and what makes you more comfortable. The stress level of leaving the tumor in just wasn't what I wanted. You do what's best for you!

On 10/25/19 I was diagnosed with triple negative infiltrating ductal carcinoma, grade 3 breast cancer. My oncologist and breast surgeon are in agreement that I need to do 22 weeks of chemotherapy first. I start my chemo on 11/08/19. It should end on 04/10/20. 3 weeks after this I should be able to have a double masectomy(there are no signs of cancer in my right breast) but I am opting to just remove both.I had 2 biopsies(one of my lymph in left armpit was benign) biopsy of left breast was positive for cancer. I am 52 years old, married and have 1 daughter(she is 17 years old). My only child will be graduating high school next year and I am starting chemo a week from tomorrow. To say, "this was not the plan" is an understatement. My daughters senior year of high was suppose to be about her. I'm super sad about that part, but I will fight like hell to kick cancers ass. I feel like I am doing the right thing. I had never heard of doing chemo first, but it does make sense to me now. I know that everyone is different, but I feel like I am seeking other people that have been diagnosed with triple negative like me.

Thank you all for sharing and listening.

I think another advantage is that by shrinking the tumor the amount of tumor left is much smaller (or none) so that the surgery is less invasive.

rjross, there is a set of posts specifically for TNBC patients. You can find it here

https://community.breastcancer.org/forum/72