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Feb 22, 2021 09:35PM
"So, would chemo be prescribed just as a measure to reduce the size of the lumps if metastatic cancer is not a concern at this point?"
No. Chemo is a systemic treatment with a significant risk of side effects. To my understanding, it will not be prescribed for localized (breast) treatment only. It is only prescribed as a means to reduce the risk of mets. The localized benefits (shrinking the tumor, reducing the risk of an in-breast recurrence) are a bonus.
Here's the thing with metastatic cancer. By the time it is large enough to find on any imaging scan (bone scan, MRI, CT scan, PET scan), it is a Stage IV metastatic cancer. At that point, chemo is no longer given to reduce the risk of mets, because the scan shows that mets have already developed. For Stage IV patients, chemo is given as a treatment to extend life. With early stage patients, chemo is given to stop a metastatic cancer from ever developing. This means that chemo is given to patients who show no evidence of mets, but who nevertheless face a not insignificant risk of mets. Most cancers have been in the breast for 3-5 years, or maybe even longer, before they become large enough to be found. During that time, a few cells might break away from the main tumor and move into the body, either through the bloodstream or through the lymphatic system. If it's just a few cells, they will be completely undetectable, and they might sit somewhere in the body for years before they start to grow and develop into a metastatic recurrence. The role of chemo is to track down these rogue cells and kill them off. This is why chemo is regularly given to patients who have clear scans, and this is how chemo saves lives, by stopping a metastatic recurrence before it can happen.
Not all early stage patients get chemo. It is only recommended if the risk of mets is assessed to be high enough to warrant the treatment. Certain breast cancers are considered more aggressive and early stage patients are usually prescribed chemo. This includes cancers where the tumor is very large, or where there are several positive lymph nodes, or cancers that are HER2+ or hormone negative (ER-, PR-). For patients with ER+/PR+/HER2- cancers, chemo is less commonly given. For these cancers, there are tests (Oncotype, Mammaprint) that assess the aggressiveness of the cancer cells based on their genetic make-up; a recommendation for or against chemo is given based on these test results.
A long explanation to say that chemo won't be given just to shrink a tumor. If a tumor is large enough that it would benefit from shrinking prior to surgery, then it is large enough that chemo will be recommended to reduce the risk of mets. And it's not a choice between having chemo + a lumpectomy vs. having a MX and not needing chemo. If an oncologist decides that a patient will benefit from chemo, then chemo will be recommended whether the patient has a lumpectomy or a mastectomy. Chemo is given to address the risk of metastatic cancer beyond the breast, so it makes no difference if the patient has a lumpectomy or a mastectomy.
What this comes down to is that there is more that you need to know about the biology of the cancer itself before any surgery and treatment decisions can be made. Most important is ER and PR status, and HER2 status. This information should be available from the biopsy pathology report. If your tumor is either HER2+ or triple negative (ER-/PR-/HER2-), then not only is it likely that will chemo be recommended regardless of your surgery choice, but chemo may be recommended prior to surgery if the tumor is 2cm in size or larger, again, regardless of your surgery choice. But if your cancer is ER+/PR+/HER2-, then surgery would normally come first but if chemo will be recommended to reduce the risk of mets (which might be the case with a large tumor but not necessarily), then you could opt to have chemo first to help shrink the tumor.
If you don't have copies of all your imaging reports, ask for them tomorrow when you see the surgeon. And also get a copy of your biopsy pathology report as soon as it is available.
I hope this isn't too confusing... there is a lot to this!
“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke