Topic: Neoadjudvant Chemo no surgery needed

I had that response.. FULL response to Chemo.. it was unbelievable news...

If they do not do surgery... how do they know ANYTHING after Chemo... ?

Rads might not be needed.. but  some type of surgery IS IS IS...

PM me if you wanna chat about it.. ok?

Laura

From my MRI after neoadjuvant chemo I may have had a pCR, but after the mastectomy the pathologist could see viable cancer still in the breast.  I'm not sure anything short of surgery can assure you of a pCR, even if the surgery is a lumpectomy of the former tumor site.  For this reason a clip is often placed in the tumor before neoadjuvant therapy, so the surgeon will know exactly the site of the tumor if it disappears.

DITTO-Throw everything you can at it now because this is the best time to stop it in its tracks.  Boobs are overrated when your talking about certainty of a complete response.  I would much rather say I didn't need to than oh my gosh I should have.

Congratulations on a great chemo response!  At least you know it responded and you are WAY ahead in the game.

Chemo may show a complete response via MRI, but it cannot see the microscopic cells that can remain and continue to grow back. Removal of the tumour site is the minimum you would need (lumpectomy), along with a pathological examination.  Quite often, the path report still shows a small amount of active tumour cells.

The others are right about surgery.  As far as rads, even with a complete response, if you have/had positive nodes, then radiation is needed to clean up any stray cells in the area.  I think the cutoff for rads to the axilla is 2+ nodes.  Anything over two and you need rads.  Hope this helps.

A PET/CT will not show anything until there are something like a billion cells present or a centimeter.  I had another clean scan the other day.  But, although my onc. thinks I may have finally had a complete clinical response, he says there is no way to see micromets that are too small.  Either way, i'm celebrating the clean scan.  Not gonna borrow trouble.

Hi precioustime,

Like you, I had a PET/CT after chemo which showed no more cancer in IM node (i had mastectomy and node dissection prior to chemo). I still had radiation in 6 fields and am convinced the benefits outweigh the risks (at least for me) being a stage 3! didn't want to take any chances. Let us know how your PET goes!

Jackie

I too had a complete clinical response with fully negative mammo, MRI, and gamma, and was FIGHTING mad when my onco team insisted I have a mastectomy with full lymph node removal.  Why would I want to do that?, I thought.  I ended up having it done, however, and path came back clean, clean, clean, so there was NO cancer in me after chemo.  I followed it with the max rounds of rads.  I was still mad about the mast until my onc explained that I still had a 30-50 percent chance of recurrence (WHAT????) because of my stage (IIIa) and grade (2-3) of tumor.  Once I got this into my thick skull, I then opted for a prophy mast on my "good" side (during my bilateral DIEP reconstruction last month) and the path report for that breast was also fully clean.  (((I close my eyes and raise them to heaven in thanks.))  Until the docs figure out a way to be close to 100 percent sure that the cancer is gone, the standard of treatment is still to take the breast and examine it microscopically ... although in many cases it turns out to be a perfectly clean healthy breast. 

Now because of the choices I've made so far, supposedly, there is only a miniscule chance I can get a recurrence of BC in the breast areas because I have no breast tissue left ... my new "breasts" have been made from my abdominal tissue.  I could get it elsewhere, however, if it decides to pop up, say, in the lungs or bones.  I just don't want to even go there....

All my best to you, precioustime, as you decide  what is best for you

Gayle

I'm glad you explained about the positive mediastinal node.

In that case, what your doctor is suggesting makes logical sense to me.  Please let us know what the cancer board says.

tl

I had a complete response to chemo.Then had a mast to be sure.Recently had a second mast. Pathology is now clear. Do all that you can to be safe.

Precious I believe you are making a wise decision.  Hit it hard now with all you can as others have said.  The scans are just not capable of picking up smaller tumors or circulating cells.  My cousin just completed neoadjuvant chemo for her Stage 2 Grade 3 Triple Neg BC. She also had a "complete pathological response" to the chemo but still followed up with lumpectomy and will now be starting radiation. 

I just celebrated the 4 year anniversary last Saturday of my bilateral mastectomy w/o reconstruction, followed by chemo and rads for a Stage 3C ILC with 23 positive nodes and so far remain NED. I have no regrets at all for doing everything possible to kill this cancer.

The surgery is very doable and not having reconstruction was one of the best decisions I made in this whole process.  Be sure to check out the BreastFree website for helpful information for both pre and post operative issues.  Tons of good information about your choices of going flat, wearing prosthesis, clothing choices and general adaptation to an unreconstructed chest.

Best wishes and prayers are coming your way!  You can do this!

Awesome that you are 4 years NED LindaLou!  These stories give so many women hope that there is life beyond diagnosis and treatment! 

I am starting to count down the days before surgery December 14th.  I sure hope that I will be up and around before Christmas-- I have a 3 year old and would really like to make his Christmas bright!  He was such an inspiration to me while I was going thru 18 weeks of Chemo and I really don't want him to go through anymore of Mommy being sick and too tired to play with him

Question for those ladies who have had bilateral mastectomy with nodes removed on one side-- Do you think I will be able to take care of my 3 year old alone a week after surgery?

Thanks again for all your prayers and words of encouragement 

I had a bilateral mast w/o recon with 29 nodes removed on the right side.  I was up and around within a week of the surgery, doing things like shopping and laundry.  However, I wouldn't have tried to lift a three year old!  I think my surgeon said my limit was 5 lbs on the right side.