Anyone who has done chemo before surgery?

laurab

This is my first post to the group. I am 36 and newly diagnosed in July. Had a hysterectomy 11/99, and lost 2nd ovary 12/02. In July, 6 months after HRT I found a lump on left breast. Saw dr immediatly who referred me to a breast surgeon. Mammo showed 2 tumors and an enlarged lymph node.
Invasive Ductal Carcinoma, grade 3, ER+, PR+, HER2-. Bone scan and ct scan ok, ct scan did show a few enlarged lymph nodes. Surgeon and oncologist agreed chemo before surgery. Said it would be to my benefit because it will shrink tumor and allow for a posibble lumpectomy, destroy any micro cells that may have spread, and dr's can monitor how well the cancer responds to the therapy. I've now done 3 of 4 rounds of A/C.
Thought I would be going to surgery in November when out of the blue onc said I will probably do taxol now before surgery but wants surgeon to see me and give his input. I'm not 100% comfortable with my onc, so I am getting 2nd opinions. I see the surgeon again next week. I've been really positive until now -- I can't seem to find any one else who has had chemo before surgery and beginning to think that my case is more serious than dr's are leading me to believe.

rizzo15

Hi Laurab. I'm one of those people who did 4 rounds of A/C chemo before surgery (and 4 rounds of Taxotere after surgery). My chemo therapy oncologist gave me the same explanation as yours...that if they do chemo before surgery, they can actually feel and see the tumor(s) shrink to nothing before surgery and they know that the cancer is definitely being killed by the chemo. When the cancer is only on the microscopic level and has not metasticized elsewhere (lung/liver/brain/bone), it's harder to tell.

I don't know if this is encouraging, but in my mastectomy pathology report, there were absolutely no cancer cells left at the original tumor site...and my tumor was originally estimated to be fairly large (4 cm).

My chemo therapy oncologist was the guy who has been calling the shots on all my treatment. It's hard to know whether you can trust your doctors at the beginning because the whole situation is so new. I learned early on that my case was regularly being reviewed by a chemo committee that included members of several universities (Stanford & Univ of Calif). Later, through a lot of independent research (mostly internet), I learned that their recommendations were considered the current "gold standard" of treatment. Still later I started running into a number of patients who wanted my oncology team because they are considered so good, but they were turned away. It think you definitely need an oncologist that you trust 110%. How that comes about, I'm not sure.

jeancmici

It is common to get chemo first - then surgery - I wish I had had that looking back but my lump was smaller. I know of a young women who posted here at the time and went to M.D.Anderson and you can't do much better than that. She had chemo first - then surgery - and said to me she feels great now tho' she was young and got the full arsenal the first time round and it was hard at the time.

Let us know how things turn out - decisions - 2nd opinion etc. because you then help others here who maybe are just reading answers for now.

Wishing you good luck - stay positive - nothing is certain with cancer. We just want the best we can get and then hope and pray for good results.

Hugs,Jean

sandytrif525

Laura, Hello, I had 6 mos of chemo before surgery. My tumor was stage 3 invasive lobular. It was very large and they wanted to shrink it down before surgery. 4 rounds of AC and 4 of Taxotere. It worked because the largest piece of tumor left was a little smaller than a dime. It went from 3 oclock to 8 oclock on the Breast clock. All of my 24 lymph nodes taken at the time of mastectomy were clear. I had a tram flap reconstruction at the same time. I also had 6 more months of chemo after surgery (5FU) that time. I then had 6 weeks of rads. If you have any questions or want to talk e mail me at strifiletti@safeplace.net. I was 41 at the time of diagnosis now am 43. God bless. Will pray for you. sandy

wingingit

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.)

jeancmici

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.)

Enjoyed reading your long story - and wish you continued good health. I wanted to add that the good doctors you mentioned who are very proactive know the only time to beat cancer is the first time round.

Jean

lindatn

I had chemo A/C four rounds before surgery. It did make the the tumor nearly disappear. Surgeon had to put a marker in the area. When they did surgery they were able to get clear margins so was able to have a lumpectomy and of course radiation. This was done at Vanderbilt and the surgeon only does breast. So far by the grace of God and hopefully excellent treatment I'm cancer free. It will soon be 13 months since surgery. I have a mammogram coming up in a few weeks so of course nervous about that. I have had no further bone or CT scans and probably won't unless I have problems. I think chemo first is getting to be fairly normal. another gal at radiation was having radiation and taxol together before surgery.I think your Drs are probably giving you good advice but questioning is part of healing. Has anyone used Nomi juice? Linda

bullfrog13

Dear Laurab
I had 3 or (maybe 4) rounds of chemo before surgery. My tumor was so large that they would not touch it before it shrunk. I had another year of chemo after surgery. Hope that helps you feel ''not so alone'' good luck sweetie and God Bless
Jerilynfrog13@yahoo.com

Kimm

Wow when I read your story you mirror me exactly! Well until Taxol... Diagnosed 17 Apr with large lump in left breast and enlarged lyphnode in left arm pit. Did chemo 12 weeks (weekly doses) lumps shrunk down to pea size...then was suppose to have surgery but surgeon was having a bay so waited an extra week and I contracted pneumonia, went to hospital for 10 days..I am 47 and strong weird to get the virus so hard..then finally had surgery 9/11...great day? I am recovering but my surgeon looked uncomfortably as he told me 30 or 30 nodes were psotiive wioth cancer. As with you I am stage three ect etc etc. I have a terrific onocologists i fully turst you need to find one. Fire who you have and get one you trust. One who no matter what feels they can cure you. Mine has tough challenges ahead but still thinks he can give me great odds on not getting it back and effectively curing me. His plan is for me to start back on chemo again real soon ...another 12 visits (weekly) and then definitely radiation. This will lower my chances of reconstruct but will greatly increase my chances of cured.. No Brainer I want life so I will do as he says. being positive is the key to survival so find a Dr who gives you confidence!
Kimm
P.S. would like to hear from you direct email me robbkimm@hotmail.com
I live in Seattle, Washington

nlbm

Hi laurab -- this is my first introduction to the chat room. I was diagnosed in late February 2003. Biopsy showed that along with the mass in breast, the 5 nodes they tested were positive also. My treatment regimen began with 4 cycles of cytoxan/adriamyacin and then taxotere. The taxotere was to be in 4 - 3 week cycles, but my oncologist had just returned from a meeting where it was discussed that results of taxotere given in lower doses on a weekly basis were as good as taxotere given on the 3 week cycle and with less side-effects. We opted for the once a week treatment and my last chemo was on August 22.

After completion of chemo, the cancer couldn't be found clinically (by feel). I opted for a mastectomy which was performed a week ago yesterday. Preliminary path report showed a residual amount in the breast 3mm and 3 of 7 nodes were positive. I haven't met with my oncologist yet....she will be more definitive about the results and follow-up treatment. From the beginning the treatment was to include chemo, surgery, radiation in that order.

I feel comfortable with having done the chemo first. Seems appropriate to treat the entire body first and attempt to kill any of the cells that may be in the body, but not visible to all the scans. The chemo did definitely reduce the cancer in my breast and nodes. Since it was not all gone I don't know if I will have to have more chemo or not.

The one thing I do know is that trust and a comfortable relationship with your oncologist is very important and your positive attitude is extremely important. If you don't feel comfortable with you doctor....get another one.

I am going to a breast clinic within a cancer center. I feel that is really important too, because all the doctors (oncologist, surgeon, radiologist) work together. My records are computerized and available to each doctor at each visit. The doctors meet once a week to discuss the cases. If I had gone to my local doctors I would have gone from gynecologist/mammogram to surgeon. He would have done surgery and handed me over to an oncologist who would have worked with what was left.

Sorry to be so windy. Keep a firm positive attitude, find a doctor you are comfortable with and CHARGE!!!!!

By the way....anyone out there that has had their neoadjuvant chemo and surgery that produced some positive pathology? Would love to hear from you.

nlbm

rizzo15

nlbm said:

Hi laurab -- this is my first introduction to the chat room. I was diagnosed in late February 2003. Biopsy showed that along with the mass in breast, the 5 nodes they tested were positive also. My treatment regimen began with 4 cycles of cytoxan/adriamyacin and then taxotere. The taxotere was to be in 4 - 3 week cycles, but my oncologist had just returned from a meeting where it was discussed that results of taxotere given in lower doses on a weekly basis were as good as taxotere given on the 3 week cycle and with less side-effects. We opted for the once a week treatment and my last chemo was on August 22.

After completion of chemo, the cancer couldn't be found clinically (by feel). I opted for a mastectomy which was performed a week ago yesterday. Preliminary path report showed a residual amount in the breast 3mm and 3 of 7 nodes were positive. I haven't met with my oncologist yet....she will be more definitive about the results and follow-up treatment. From the beginning the treatment was to include chemo, surgery, radiation in that order.

I feel comfortable with having done the chemo first. Seems appropriate to treat the entire body first and attempt to kill any of the cells that may be in the body, but not visible to all the scans. The chemo did definitely reduce the cancer in my breast and nodes. Since it was not all gone I don't know if I will have to have more chemo or not.

The one thing I do know is that trust and a comfortable relationship with your oncologist is very important and your positive attitude is extremely important. If you don't feel comfortable with you doctor....get another one.

I am going to a breast clinic within a cancer center. I feel that is really important too, because all the doctors (oncologist, surgeon, radiologist) work together. My records are computerized and available to each doctor at each visit. The doctors meet once a week to discuss the cases. If I had gone to my local doctors I would have gone from gynecologist/mammogram to surgeon. He would have done surgery and handed me over to an oncologist who would have worked with what was left.

Sorry to be so windy. Keep a firm positive attitude, find a doctor you are comfortable with and CHARGE!!!!!

By the way....anyone out there that has had their neoadjuvant chemo and surgery that produced some positive pathology? Would love to hear from you.

nlbm

nlbm. I did A/C chemo, mastectomy surgery, weekly taxotere chemo for 12 weeks, then radiation for 28 sessions. In the pre-A/C chemo biopsy, the tumor was estimated to be 4 cm or so. In the pathology report that was issued after mastectomy they could not find any trace of the original tumor, nor any cancer cells at all anywhere near the original tumor site. The margins were inked, of course, so they knew exactly where the tumor used to be. However, 7 of the 13 lymph nodes had cancer. They said it was a good sign that cancer had not "broken through" the lymph node walls, nor had the lymph nodes become attached to each other with cancer.

However, as they say, the mastectomy pathology was done after A/C. So, who knows what it was like before the A/C beat the cancer back to that point?

I continue to find it interesting that although it is agreed that no cancer in the lymph nodes is a good thing, there is no explanation for why 20% of the women with no lymph node cancer have remaining lifespans similar those of the average cancerous lymph node women. And 20% of the cancerous lymph node women have survival statistics similar to the noncancerous lymph node women. So, it goes to show this characteristic alone is not an absolute predictor of future breast cancer progression.

I absolutely agree with your comments about all the oncology staff being in close contact with each other, be it through joined computerized records or weekly chemo committee meetings. Trying to keep my regular family practice physician on the same page as the rest of the doctors has been a gigantic pain. No matter how carefully I've asked that my test results make it to my family physician, I always have to follow up and half the time find that he has not been copied on stuff.