Do I choose surgery or chemo first?

Good to hear @JoB - all the best with your recovery and then chemo 

Always good to have your mum around.  Good luck with the chemo (I start mine on 5th).  Gaye

@JoB, good work - surgery, one box ticked. Make sure you rest plenty in the time prior to chemo starting. Biggest hugs to you. Bec xx

I had surgery 23rd Jan and I am still in hospital due to having blood clots on my lungs.  Fingers crossed home tomorrow.  I feel fine within myself and had 3 drains after surgery with just one left at the moment. The surgeon was very pleased with how everything went and so am I.

The medical staff have been fantastic and they all do such a fantastic job.  I am pleased I did the surgery first and I know I have a long road ahead of me, my first chemo session is booked for 23rd Feb and the best news is my mom is flying over from the UK in the next week.

I am having chemo first and was trying to work out the treatment order a month ago. With mine it’s too big to take out the tumour, so  I would have had to have a mastectomy straight away. This way they said my tumour could shrink and reduce the surgery extent, plus chemo can kill all those stragglers..... I started chemo in December, can’t say I am enjoying it, but it’s just something I have to do. It also gives me time to think about surgery and recon etc, and get more information. I also get this time with both breast intact, even though Cancer is in one of them, 

Hi @JoB, how did you go with your appointment with the oncologist and decision-making?

Another benefit of neoadjuvant chemo for her2 is the possibility of having both herceptin and perjeta. Can't do that for adjuvant chemo, although i have heard of one hospital offering if self-funded. Best wishes with your decision.

Hi @JoB, 

I am currently undertaking neoadjuvant chemo and, like a couple of women who have posted here, I've been lucky enough to see dramatic results.  Within 3 or 4 weeks of weekly chemo I could no longer feel the tumour.  I'm yet to have any imaging to see what's really going on in there but such a response to the chemo has been reassuring for me (especially as I'm triple negative).  I was also preparing myself for the idea that my tumour might not respond to the chemo protocol I'm on.  I would still consider neoadjuvant a good decision as the only way to know that the chemo isn't having any effect and that changes need to be made is if there is a tumour there to test it on.

It's completely understandable that you'd want the cancer out as soon as possible.  I was very nervous to have 2 grade 3 tumours kicking around in my breast while treatment started, actually, it still bothers me but it's just one of many things about BC that bother me!  It's also frustrating that I don't have a confirmed stage as the lymph nodes won't be checked until surgery. Imaging shows they're fine but that's not the same as a microscope. 

Ask your oncologist to explain why the chemotherapy is considered necessary for you.  Chemo is not just for mastectomy patients, it depends on the stage and the grade of cancer and most likely a bunch of other things as well. 

Have you read "A guide for women who are considering breast cancer treatment with chemotherapy and/or hormonal therapy before surgery" on the breast cancer trials website?  Here's a link to copy:  https://www.breastcancertrials.org.au/file/44/Neoadjuvant-Patient-Decision-Aid.   If that doesn't work there's a link from the BCNA website page on neoadjuvant chemo. I found it really helpful when i was making my decision for chemo or surgery as my first treatment. 

I hope your appointment with the oncologist tomorrow clarifies things for you and you walk our feeling more confident in whatever choice you make. 

Hi @JoB,
 
LIke many of the other women here, I too had chemo first and am about to have my last one before surgery in a month. My tumour was HER2+ but negative for progesterone and oestrogen.  I too was booked for surgery first but once the pathology came in, the recommendation was to do chemo first to see how the tumour and node responded and to see if they shrunk to reduce the size of the operation. I am pleased to report that clinically they have quite significantly and this is the advantage of the chemo first as you see if it and the Herceptin affects the tumour and hence you can assume it will also attack any circulating tumour cells - the ones that do cause the problems with the potential to turn into metastasis. My surgeon did say he would remove the tumour and node first if I really felt I couldn't cope with knowing they were there but I decided I was ok with this.  If you really don't feel you can cope psychologically with the tumour being there then that it is perfectly reasonable to go with the surgery first. All the best. 

I had triple positive BC with multifocal tumour.  We knew at least one node was positive. 

There was discussion regarding chemo first however after the team meeting with several oncologists, surgeons etc present the recommendation was mastectomy. I elected bilateral. 

Nodes were 2 positive and 9 removed. 

I’m coming to the end of paclotaxol.

Most people are happy with their choices because it’s what was recommended at the time and it can’t be changed now. I’m the same. 

From what I have read there are no differences in DFS only breast conservation.  Best wishes to you with a decision that is not easy.
x