1. < Breast Cancer

Chemo first vs Surgery first?

Posted by journey99 @journey99, Mar 13, 2023

I am scheduled for a lumpectomy next week and from a biopsy we know lymph node (s) have to be removed. The original plan was I take Letrozole for 3 weeks, test Ki 67% from surgery to see if my body responds to the Letrozole. My numbers are all borderline so concern has been over treating. If it was responding then probably would not recommend chemo. Last week we learned my Oncotype DX is 30 therefore now chemo is recommended.

So my dilemma is do I go ahead with the surgery as originally planned, knowing I will then do chemo. Or do I change course and start chemo and then surgery? The benefit of chemo first would be to possibly lower the number of nodes that may have to be removed. I am struggling with the decision. Any advice is helpful.

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zeerj | @zeerj | Mar 19, 2023
In reply to @lisakinpa "Perhaps they want you to have chemo first because they know you have cancerous cells within..." + (show)
@lisakinpa

Perhaps they want you to have chemo first because they know you have cancerous cells within your lymph nodes. They might want to begin chemotherapy treatment to reduce the risk of having those cells circulating throughout the body.

Also, for some of us (I was Her2+), having chemo first helps gauge how effective treatment is/was for our tumors.

Hope this helps. ♥️

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Mine was her2+. I went thru the same steps you described. Chemo, surgery, radiation and chemo. The initial chemo killed all the cancer in the breast. It did shrink the ones in the lymph nodes. Since there was still positive residual, I’m doing kadcyla to kill anything that would have went outside of the lymph nodes. Had the initial chemo killed everything, the plan was to give me 6 treatments of immunotherapy. Wishing you the best. It’s a tough journey but I found out once I trusted my medical team and was comfortable with the treatment plan, I am more sane.

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1 reply
lesleyjt | @lesleyjt | Mar 19, 2023
In reply to @zeerj "Mine was her2+. I went thru the same steps you described. Chemo, surgery, radiation and chemo...." + (show)
@zeerj

Mine was her2+. I went thru the same steps you described. Chemo, surgery, radiation and chemo. The initial chemo killed all the cancer in the breast. It did shrink the ones in the lymph nodes. Since there was still positive residual, I’m doing kadcyla to kill anything that would have went outside of the lymph nodes. Had the initial chemo killed everything, the plan was to give me 6 treatments of immunotherapy. Wishing you the best. It’s a tough journey but I found out once I trusted my medical team and was comfortable with the treatment plan, I am more sane.

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Thanks for sharing.

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boathouse | @boathouse | Mar 19, 2023
In reply to @lisakinpa "Perhaps they want you to have chemo first because they know you have cancerous cells within..." + (show)
@lisakinpa

Perhaps they want you to have chemo first because they know you have cancerous cells within your lymph nodes. They might want to begin chemotherapy treatment to reduce the risk of having those cells circulating throughout the body.

Also, for some of us (I was Her2+), having chemo first helps gauge how effective treatment is/was for our tumors.

Hope this helps. ♥️

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Hello,
I thought like you when I first heard chemo first then surgery…
Mayo had a plan and I learned that it was the right plan.
It was to see how the tumors and other microscopic cancer was reacting.
After surgery…they were able to add radiation and keep with chemo and not just the immunotherapy. Lifesaving for me.
I will be a year out of surgery Wednesday March 22. A long road but cancer clear and start the survivorship program April.

Follow your doctors lead but keep informed so you understand why they are providing these plans.
Every journey is different and it isn’t always easy, but knowing you have a great team behind you helps to keep on the path.
If I can do it each of you on this connection can do it! We all are courageous!

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bpknitter53 | @bpknitter53 | Mar 20, 2023
In reply to @lesleyjt "My dr wants to treat my stage 2B IDC with node involvement HR+ HER2 - cancer..." + (show)
@lesleyjt

My dr wants to treat my stage 2B IDC with node involvement HR+ HER2 - cancer with chemo first approach then surgery then radiation. While I wait for an apt with her March 28th, trying to understand rational to do chemo first Vs surgery first.

Logically I feel like removing the primary tumour then treating the body makes more sense to me. My breast can’t be saved as the tumor is surrounded by calcifications that cover over a third of my b cup breast.

Any insight you can share would be much appreciated. Thanks in advance.

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I was dx 11/21 with TNBC BRCA+ after doing a lot of research after dx learned there were instances where they did chemo before surgery and that is the course my onco recommended. I had lump in breast and lump in left lymph area. Chemo shrunk everything down significantly original breast was just under 5cm reduced to about 1.7 after chemo; lymph shrunk from 2.7 to .8 - clear evidence Chemo worked and this was after my first round of just the A/C. By the end of Taxol there was almost nothing there but since when I had my biopsy I had a marker inserted; which probably didn't make much difference since I was having bilateral performed and choosing to go flat. Chemo, done; surgery, done; now I'm having radiation since there was a miniscule spot in one of the lymph pathology samples. After this I believe I move onto maintenance meds and monitoring. It's been a journey - I did my research, informed my husband of what I found and what I was choosing and my reasons and asked him to join me in those meetings I felt he was needed for information I was going to receive. I also told him the information I wanted to know and asked him to help be get those answers or to find out when and where I could get those answers. I was actually surprised at how calm I was and how focused I stayed during the meetings. I carried with me a note pad and was able to get answers to most everything I had questions about each time I had an appointment - even if it was for treatment so I could pose the question before my next appointment.

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2 replies
lesleyjt | @lesleyjt | Mar 20, 2023
In reply to @bpknitter53 "I was dx 11/21 with TNBC BRCA+ after doing a lot of research after dx learned..." + (show)
@bpknitter53

I was dx 11/21 with TNBC BRCA+ after doing a lot of research after dx learned there were instances where they did chemo before surgery and that is the course my onco recommended. I had lump in breast and lump in left lymph area. Chemo shrunk everything down significantly original breast was just under 5cm reduced to about 1.7 after chemo; lymph shrunk from 2.7 to .8 - clear evidence Chemo worked and this was after my first round of just the A/C. By the end of Taxol there was almost nothing there but since when I had my biopsy I had a marker inserted; which probably didn't make much difference since I was having bilateral performed and choosing to go flat. Chemo, done; surgery, done; now I'm having radiation since there was a miniscule spot in one of the lymph pathology samples. After this I believe I move onto maintenance meds and monitoring. It's been a journey - I did my research, informed my husband of what I found and what I was choosing and my reasons and asked him to join me in those meetings I felt he was needed for information I was going to receive. I also told him the information I wanted to know and asked him to help be get those answers or to find out when and where I could get those answers. I was actually surprised at how calm I was and how focused I stayed during the meetings. I carried with me a note pad and was able to get answers to most everything I had questions about each time I had an appointment - even if it was for treatment so I could pose the question before my next appointment.

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Thank you so much for sharing your story. Really helpful to hear.

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Critically Thinking | @timbrownfl | Mar 21, 2023
In reply to @bpknitter53 "I was dx 11/21 with TNBC BRCA+ after doing a lot of research after dx learned..." + (show)
@bpknitter53

I was dx 11/21 with TNBC BRCA+ after doing a lot of research after dx learned there were instances where they did chemo before surgery and that is the course my onco recommended. I had lump in breast and lump in left lymph area. Chemo shrunk everything down significantly original breast was just under 5cm reduced to about 1.7 after chemo; lymph shrunk from 2.7 to .8 - clear evidence Chemo worked and this was after my first round of just the A/C. By the end of Taxol there was almost nothing there but since when I had my biopsy I had a marker inserted; which probably didn't make much difference since I was having bilateral performed and choosing to go flat. Chemo, done; surgery, done; now I'm having radiation since there was a miniscule spot in one of the lymph pathology samples. After this I believe I move onto maintenance meds and monitoring. It's been a journey - I did my research, informed my husband of what I found and what I was choosing and my reasons and asked him to join me in those meetings I felt he was needed for information I was going to receive. I also told him the information I wanted to know and asked him to help be get those answers or to find out when and where I could get those answers. I was actually surprised at how calm I was and how focused I stayed during the meetings. I carried with me a note pad and was able to get answers to most everything I had questions about each time I had an appointment - even if it was for treatment so I could pose the question before my next appointment.

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Congratulations for stepping up and doing your research, and then getting answers on things that weren't clear. I think that way of handling things gives confidence in your plan and helps calm that anxiety that comes from "not knowing." I think you are a great example for everybody including us.

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Moderator
Colleen Young, Connect Director | @colleenyoung | Mar 26, 2023

@journey99, just checking in. Have you made a decision about when to have chemo - before surgery (neo-adjuvant) or after surgery (adjuvant)? What factors helped you make your decision?

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lk565656 | @lk565656 | Nov 1 4:34pm
In reply to @marciapell "I did chemo first. I also had lymph node positive for ER+ cancer, oncotype score of..." + (show)
@marciapell

I did chemo first. I also had lymph node positive for ER+ cancer, oncotype score of 28. My surgeon is the one who suggested I do chemo first in hopes of having a lesser surgery. I saw the oncologist a week later who did the oncotype DX test on my original biopsy, and also started me on Letrozole for 3 weeks. My KI67 score responded well during those 3 weeks but because of the lymph node involvement and high oncotype DX my oncologist said I would benefit from chemo. He agreed with to surgeon to do chemo first. Because my cancer isn’t palpable I had a breast MRI done last week, after AC chemo and before Taxol. My cancer has shrunk significantly.
Bottom line, my medical oncologist was a huge help in helping me decide what route to take. I asked questions and he helped me understand the treatment plan and then I was comfortable with going through chemo. I didn’t want to have chemo at first but it is doable and gives the best chance for a cure so I’m good now.

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I do not want to do chemo. I have no peace about it. My o score js 26 and I have chronic fatigue, chronic Epstein Barr and lots. Any advice?

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2 replies
Mentor
Laurie, Volunteer Mentor | @roch | Nov 2 9:10am
In reply to @lk565656 "I do not want to do chemo. I have no peace about it. My o score..." + (show)
@lk565656

I do not want to do chemo. I have no peace about it. My o score js 26 and I have chronic fatigue, chronic Epstein Barr and lots. Any advice?

Jump to this post

@lk565656

Welcome to Mayo Connect. The idea of chemo can be scary. I actually had few problem with chemo, I was fatigue and lost hair, but had no problem with nausea. It was something I needed to do as part of my treatment plan.

Is there something specific your concern about with chemo?

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Mentor
Chris, Volunteer Mentor | @auntieoakley | Nov 2 9:59am
In reply to @lk565656 "I do not want to do chemo. I have no peace about it. My o score..." + (show)
@lk565656

I do not want to do chemo. I have no peace about it. My o score js 26 and I have chronic fatigue, chronic Epstein Barr and lots. Any advice?

Jump to this post

I was terrified about chemo, because well, we have all seen family or friends who went through chemo and suffered. I can say there was some hardship but it was “do able”. Like @roch I had fatigue and I lost my hair, I also had some nausea. That being said, not all chemo is equal, some will cause more side effects, some less, and some different.
My decision process was hard because I had seen family go through chemo and struggle. I decided that if I was going to be able to look back and say, I did all I could do to stop this thing, I would have to give it try. My doctor assured me that I could terminate treatment if I needed to and still be treated in other ways.
I am 20 years out from diagnosis this year and looking back, it was really hard but emerging out the other side, I had a newly found peace about life, about death, about all the small stuff too.
This decision is a personal one and each treatment regimen is different. I hope you can make the best informed decision for YOU. I will be here either way to support you if I can.
Have you talked to your doctor about the Epstein Barr, which might be contributing to the other chronic issues?
Is it possible to treat it, maybe before chemo?

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