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Topic: Why should I have chemo before surgery?

Forum: Just Diagnosed — Discuss next steps, options, and resources.

Posted on: Oct 15, 2019 11:01AM

Cdel wrote:

I was just diagnosed a couple of weeks ago. I saw the breast surgeon this morning. She told me I would need chemo before surgery. I see the oncologist next week. I'm hoping he'll have a different plan in mind. I just didn't think I would need chemotherapy at all, but especially not before surgery. I still don't even know what stage I am. I'm having an MRI next week - two days after I see the oncologist.

How can they already say I'll need chemo? This just seems overly aggressive and makes me cynical about the whole thing.

Any advice or encouragement is appreciated. 😃

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Oct 15, 2019 11:30AM berries wrote:

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

Dx 8/6/2019, DCIS/IDC, Left, 5cm, Stage IB, Grade 1, 4/4 nodes, ER+/PR+, HER2- Surgery 9/18/2019 Mastectomy: Left; Reconstruction (right) Chemotherapy 10/24/2019 AC + T (Taxol) Surgery 2/17/2020 Reconstruction (left): Silicone implant Radiation Therapy 3/31/2020 Whole-breast: Breast, Lymph nodes Chemotherapy 4/30/2020 Xeloda (capecitabine) Hormonal Therapy 5/8/2020 Arimidex (anastrozole)
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Oct 15, 2019 11:32AM OCDAmy wrote:

I am sure someone with more knowledge will reply. I’m sorry you find yourself here. What do you know about the tumor? They generally go chemo first to shrink the tumor before surgery. How large is the tumor?

Dx 2/2017, IDC, Left, 4cm, Stage IIB, Grade 2, 2/13 nodes, ER+/PR+, HER2- Surgery 11/15/2018 Reconstruction (left): Fat grafting; Reconstruction (right): Fat grafting, Silicone implant Surgery Lymph node removal; Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy Cytoxan (cyclophosphamide), Taxotere (docetaxel) Hormonal Therapy Arimidex (anastrozole) Surgery Reconstruction (left): DIEP flap Radiation Therapy Whole-breast
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Oct 15, 2019 11:57AM Moderators wrote:

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?

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Oct 15, 2019 12:53PM Cdel wrote:

Hi guys. Thanks for the responses.

Here's what I know right now. I have a 2 centimeter invasive ductal carcinoma that is estrogen and progesterone positive. I'm paraphrasing from the paperwork I have so I may not be using the common nomenclature.

My appointment today was my first appointment since the biopsy so it was alarming to hear any chemo talk. I thought I would need more tests before talking about treatment.

I'm seeing the oncologist next week. So, I'm just going to try not to think about it too much until then.

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Oct 15, 2019 01:20PM Ingerp wrote:

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.

Dx 3/11/2016, DCIS, Left, 6cm+, Stage 0, Grade 3, ER-/PR- Surgery 3/22/2016 Lumpectomy Surgery 4/19/2016 Lumpectomy: Left Radiation Therapy 5/17/2016 Whole-breast: Breast Dx 3/2/2018, IDC, Right, 1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2+ (FISH) Surgery 3/12/2018 Lumpectomy: Right; Lymph node removal: Sentinel Chemotherapy 5/17/2018 Taxol (paclitaxel) Targeted Therapy 5/17/2018 Herceptin (trastuzumab) Radiation Therapy 8/19/2018 Whole-breast: Breast
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Oct 15, 2019 02:27PM puppylover wrote:

My tumor was a whopper and they needed to try and shrink it. So yes I was one of those chemo, surgery, radiation people.

Dx 1/15/2013, IDC, Right, 6cm+, Stage IIIC, 6/12 nodes, HER2+ Dx 12/2018, ILC, Both breasts, 6cm+, Stage IV, metastasized to bone/lungs/other, Grade 3, ER+, HER2-
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Oct 15, 2019 06:55PM Cdel wrote:

Thanks for replying. It's my understanding that I'm ER+/PR+/HHER2- so maybe I'll get more testing to find out if I need chemo.

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Oct 16, 2019 05:30AM - edited Oct 16, 2019 06:05AM by tjpj

This Post was deleted by tjpj.
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Oct 17, 2019 01:40PM StAuggie wrote:

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.

Dx 4/12/2019, IDC, Left, 1cm, Stage IB, Grade 3, ER-/PR-, HER2- Chemotherapy 5/9/2019 AC + T (Taxol) Surgery 10/29/2019 Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement
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Oct 22, 2019 03:05PM AngieB92 wrote:

Being Her2+ was the deciding factor for chemo treatment for me

Dx 8/8/2019, IDC, Left, 1cm, Stage IA, Grade 2, 0/6 nodes, ER+/PR+, HER2+ (IHC) Targeted Therapy 9/16/2019 Perjeta (pertuzumab) Targeted Therapy 9/16/2019 Herceptin (trastuzumab) Surgery 3/3/2020 Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Targeted Therapy 4/9/2020 Kadcyla (T-DM1, ado-trastuzumab)
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Oct 22, 2019 04:22PM Brooklyn1234 wrote:

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!

Dx 11/1/2009, 1cm, Stage I, 0/9 nodes, ER-/PR+, HER2+ Dx 9/2019, IDC, Left, 1cm, ER-, HER2+ Chemotherapy Taxol (paclitaxel)
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Oct 28, 2019 03:46PM msphil wrote:

hello sweetheart I was just 42 planning our 2nd marriage when diagnosed was told also chemo before Lmast to clear margins is what I was told also I wanted to do all that would give me. I'm now Praise God A long term Survivor. msphil idc stage2 0/3 nodes chemo before and after Lmast Got Married 3mo chemo before and after. Then 7wks rads and 5 yrs on Tamoxifen. Praise for we celebrated our 25 anniversary.

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Oct 31, 2019 04:48AM bettysgirl wrote:

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!

Dx 6/20/2008, IDC, 5cm, Stage IIIA, Grade 3, 2/13 nodes, ER+/PR+, HER2- Surgery 7/16/2008 Lymph node removal: Right, Underarm/Axillary; Mastectomy: Right; Prophylactic mastectomy: Left Chemotherapy 9/18/2008 Cytoxan (cyclophosphamide), Ellence (epirubicin), Fluorouracil (5-fluorouracil, 5-FU, Adrucil), Taxotere (docetaxel) Hormonal Therapy 4/15/2009 Radiation Therapy
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Oct 31, 2019 08:08AM Cdel wrote:

Thanks everybody for the comments. I'm still not sure what my treatment plan will be. I saw the oncologist for the first time last week. He wants to wait for results from an MRI and Oncotype test. I feel a lot better after meeting with the Oncologist. Maybe is't just because I've had more time for it to sink in, or maybe he just had a better approach than the surgeon. I feel like the surgeon just burst through the exam room door and gave me the worst case scenario without explaining why.

My next appointment is in two weeks. I've had the flurry of doctor visits and now I get a two-week reprieve. It feels weird.

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Oct 31, 2019 06:15PM rjross24 wrote:

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. :)

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Oct 31, 2019 08:23PM Euphoriaa wrote:

A great advantage of receiving chemotherapy before surgery is that you can use both arms for your IV if you don't have a port.

I also suspect that there is less chance of developing lymphedema if you have the chemo before, since the steroids that are applied along with the taxanes produce fluid retention, which is not a good idea if you are newly operated and several lymph nodes have been removed. It has no disadvantage in relation to adjuvant chemo. Good luck!

Dx 9/24/2018, IDC, Left, 3cm, Stage IIA, Grade 1, 1/8 nodes, ER+/PR+, HER2- (IHC) Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Chemotherapy AC + T (Taxol) Radiation Therapy Whole-breast: Breast, Lymph nodes, Chest wall
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Oct 31, 2019 09:26PM Cowgirl13 wrote:

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.

Be the kind of woman that when your feet hit the floor each morning the Devil says: 'Oh crap! She's up! Dx 5/28/2009, IDC, Left, 2cm, Stage IIA, Grade 3, 0/4 nodes, ER+/PR+, HER2+ Surgery 6/17/2009 Chemotherapy 8/2/2009 Carboplatin (Paraplatin), Taxotere (docetaxel) Radiation Therapy 12/21/2009 Hormonal Therapy 2/22/2010 Arimidex (anastrozole)
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Oct 31, 2019 11:12PM - edited Nov 1, 2019 06:58AM by Moderators

Welcome, rjross24 and Euphorbia! Thank you for sharing your story - we hope you find support on these boards as you begin down this road!

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Nov 1, 2019 07:01AM MountainMia wrote:

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

The rain comes and the rain goes, but the mountain remains. I am the mountain.
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Nov 1, 2019 11:04AM rjross24 wrote:

Thank you MountainMia. I will check this out. :)

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