Anyone who has done chemo before surgery?

wingingit said:

Hi, laurab! This is only my second post to the group. I just found this site a month or so ago. I wish I had known about it when I was going through my treatments in 2002. It has been interesting searching and reading old postings. I still have questions about my treatments. Very few discussions here have seemed to address chemo prior to surgery although I think it is fairly common.

I also had preoperative (neoadjuvant) chemotherapy. I first had 12 weekly treatments of Taxol and then 4 rounds of FAC. My mammogram showed that I had a 4.5 cm mass in my breast prior to chemo (also grade 3, ER+, PR+, HER2-, no apparent lymph node involvement), but my ultrasound, MRI, and core biopsies suggested that my tumor might be in the 5-6 cm range (Dense breasts and fibrocystic changes tend to confuse the results.).

I had MRIs, ultrasounds, and mammograms during and after the completion of my chemo treatments. I too felt uncertainties when tests at times would show little or no change in the tumor size. I am a patient at one of the leading cancer centers in the country, where I think they tend to recommend patients with larger-size tumors (maybe >3 cm?) have chemo prior to surgery. After my Taxol treatments were completed and my oncologist termed the treatments a moderate success, a fellow (oncologist in training) told me some of the outside tumor area showing on the mammogram might be fibrosis--a hardening of tissue around the tumor--and that perhaps the tumor was shrinking more than we could tell. This reassured me considerably. I went on then to have FAC. Once again upon completion, nothing definite could be told about shrinkage and the mass could still be palpated easily. By the time I went to the surgical oncologist, who only performs breast surgeries, for a consultation six months after beginning chemo, I had already figured I would need a mastectomy. However, he threw me for a loop when he told me I would definitely need radiation after surgery (standard with tumor size >5 cm). Well, there went the possibility of immediate reconstruction, but most of all, I was scared that an experienced surgeon who knows odds was trying to prepare me for something worse than I had been thinking for the past several months. Well, my post surgical pathology report showed that the tumor had shrunk to 3 cm and residual tumor cells made up less than 1% total tumor volume; the rest was made up of extracellular mucin. My sentinel node biopsy showed a few degenerative keratin-positive cells of uncertain significance in one of the nodes (I am still not sure what that means . . . just another question mark to keep things interesting!) I had known that my cancer was mucinous ductal carcinoma (a subtype of ductal carcinoma occurring in about 3-5% breast cancers, usually with a favorable outcome), but the doctors had downplayed it from the beginning and I had not given it much thought for six months. Anyway, the surgical and radiation oncologists decided with the pathology results that I did not need radiation after all! For that, I felt God had blessed me, but it did leave me with a lot of questions for the doctors that to this day are unanswered.

As you can see, I had lots of ups and downs during my chemo experience but I wanted you to see that some doctors (and mine are considered some of the best) are very proactive in fighting the cancer in every way possible. I went on to have reconstructive surgery 3 months later. In October, I will have my one-year anniversary for completing chemo, and in November I will have been cancer free for one year (as far as I know!) I have had to put a lot of things behind me (including a diagnosis that I feel could have been made perhaps years earlier) and move on. I do feel stronger now and much more forgiving of others and myself. I also feel great and have little side effects from Tamoxifen. I feel grateful to all my healers, first and foremost God and those in the medical community. I will pray for guidance in your decisions. E-mail me if you would like. (I apologize to you and others for the lengthiness of this reply. I do not have the knack of short responses yet. I have been hanging around the site awhile now and I guess I felt a need to tell my story here.)