Totally confused after seeking second opinion

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GinGin
GinGin Member Posts: 135
edited August 2023 in Newly diagnosed
Hi my dear virtual friends,
I have Hormones positives and Her2 negative. Grade 3 and Stage 3(Tumor size 35 mm).

Surgeon A:
Treatment plan Option 1: 6 months chemo ( neoadjjuvant), if tumor size shrinks > lumpectomy. If it doesn’t shrink > mastectomy > radiotherapy (will have to take Tamoxifen/AI)
option 2: mastectomy > chemo> radiotherapy (will have to take Tamoxifen/AI)

Surgeon B:
treatment plan: lumpectomy immediately, tablets for hormones +ve (Tamoxifen/AI) > radiotherapy > chemo (depends on outcome of lumpectomy surgery).
surgeon B doesn’t see the need to do 6 months chemo to shrink the tumor. He says he will have a better idea after surgery if chemo is necessary.

hubby and I are still processing all these information and have some further questions written down. Keen to hear what other questions we should be asking both surgeons, please. Sincerely value everyone’s input.
Xx
Gin

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Comments

  • Aska
    Aska Member Posts: 71
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    Oh Gingin it is so hard! I was told if my tumour was >2cm on MRI I would have chemo first before lumpectomy. I had a 1.8 cm grade 2 stage 1 LC. I was operated in Melbourne 
  • Blossom1961
    Blossom1961 Member Posts: 2,419
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    Ask surgeon B if they will need to do a mastectomy if he does not have clear margins. I had neoadjuvant and the tumours shrunk to virtually nothing BUT I went ahead with the mastectomy anyway as I had a haze of cancer right across the top half of my breast additionally to three tumours so a lumpectomy was never an option. Chemo isn’t fun so both options have both negatives and positives. Sorry, not much help. 
  • Cath62
    Cath62 Member Posts: 1,343
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    Grade 3 is rapidly aggressive growth and more likely needing chemo treatment but not sure before or after surgery. What's your likelihood of returning? Ask if they have that pathology now or if that will be available after surgery. It is another factor for your consideration. I would be concerned about reducing that likelihood too as well as addressing that grade 3 cell. Good luck.
  • FLClover
    FLClover Member Posts: 1,555
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    I’d definitely opt for surgeon B. Definitely. Sounds like he’s genuinely interested in getting rid of the cancer in the quickest and safest way possible for you, not to mention cheaper. Just my thoughts. 
  • arpie
    arpie Member Posts: 7,755
    edited August 2023
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    @GinGin - what a shame they didn't both have the same opinion! grrr  It just mucks with your brain a bit more than it already has!  xx  It is a very personal decision that only you can make - but it really is about the 'what ifs' ...... ie What if I get a recurrence ..... did I make the right treatment decision?  

    Have you considered joining the Breast Reconstruction Group, or Flat Chat (about possibly choosing no reconstruction) - you'll be able to chat with others who may have had to make the same decision?

    I was lucky & just had a lumpectomy, rads & tabs - but I was fully prepared for them to go ahead with mastectomy once they started the surgery, if they thought it warranted it, as sometimes the size of the tumour 'on the screen' can be smaller than the actual size of it, once in surgery.

    Quite a few cancers have chemo prior to surgery, to manipulate it & hopefully make it smaller, which may mean less aggressive surgery is required ... 

    It sounds like Surgeon A is throwing everything at it, to give you (as he sees it) the best outcome possible and his 2nd option goes for the bigger surgery but without the chemo first .....  tho Surgeon B seems quite convinced the earlier chemo isn't required ....  ay yi yi

    I think my question to both of them would be: What would you recommend your wife/daughter if it was their biopsy results, for their best possible outcome?

    Have either of them mentioned a Sentinel Node Test being done? (mine was done prior to surgery [and was clear] to see if the nodes closest to the breast have been infiltrated by the cancer at all) - as this will also give them even more information to work with re the level of surgery/chemo requirement ...   
    Hmmm, Some sites indicate that Stage 3 may have already infiltrated the nodes ..... which means it may also have escaped into the body already - which means, maybe throw the kitchen sink at it!?

    As @Cath62 said - it is the aggressiveness and size of the tumour that normally dictates the amount of surgery & need for chemo before and/or after surgery (or not at all.)  

    Can you talk to your Breast Care Nurse about it?  She may be able to put unbiased opinions/explanations to help you in your decision making xx

    take care & all the best xx
  • Afraser
    Afraser Member Posts: 4,390
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    This is one of the problems with options - unless you are virtually a qualified oncologist, you are not in the best position to choose! I have been grateful I didn’t have to, my surgeon was clear about what was required, the only choice to make was a full mastectomy or partial and half a boob didn’t seem like any real benefit! 

    Given a general move towards chemo first, I’d align somewhat with Surgeon A. If chemo significantly reduces the tumour, a lumpectomy is more likely to be the option and remove all the cancer (the latter is the cruncher). While no-one wants chemo or a mastectomy, more than a decade of a happy life with (touch wood) no sign of recurrence tells me that chemo was worthwhile. It’s sometimes nowhere near as bad as it sounds, and there are better ways now of avoiding some side effects. Best wishes. 
  • Julez1958
    Julez1958 Member Posts: 1,160
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    Hi @GinGin
    Problem with any advice we give is that we are all different and none of us are oncologists.
    My decision was pretty easy - I had a 5.5 cm lobular ER positive cancer and my breast cancer surgeon ( who is very experienced) said lobular cancer was notorious for being more extensive than shown in the MRI.
    He also said that if he did a lumpectomy and didn’t get clear margins he would have to do a mastectomy anyway.
    I went with his recommendation of a mastectomy and had reconstructive surgery ( my story and photos are in the private  group “ Choosing Breast Reconstruction”.)
    No one said this was easy .
    Take care 🌺
  • Tarma
    Tarma Member Posts: 73
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    Hi, have you considered gene activity testing, if you're ER+ & Her- it can help determine if chemo is necessary..  I'm no expert,  that's just some tid bit I came across in my own research,,  im ER- & HER + 

  • Tarma
    Tarma Member Posts: 73
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    Ok im still learning myself, so please forgive my silly question 😁 isn't HER neg the slowest growing grade, so can't be  grade 3 ? 
    HER pos is the high grade,3 fast growing ? 
    OMG IST SO CONFUSING 😃😳

  • Aska
    Aska Member Posts: 71
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    My understanding is that the grade relates to how abnormal the cells look like under a microscope,  compared to normal cells. The Estrogen, progesterone and Herceptin status, ie pos or neg, relates to if the cancer cells have receptors for 1 or more of those hormones which help it survive and thrive. 
  • GinGin
    GinGin Member Posts: 135
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    Hi everyone, firstly sincerely thank you for all your feedback and writing to me. I’ve added them to our list of questions to ask the surgeons. 
    Separately, i have just looked at all my reports. My cancer is grade 2-3 (as per the reports). My nodes is positive and the reports shows it has gone to my armpit (Surgeon A has confirmed I will definitely require axillary clearance while Surgeon B states he will determine if it will be axillary clearance during the ops and wants me to be prepared for ax clearance). Both surgeons have told me they cannot feel the lump under my armpit and when I asked them if they should have felt some/anything- all I hear is crickets). The PET scan results shows it hasn’t spread to other areas.

    @Tarma: will you be able to tell me more about gene activity testing ( what this this?). I don’t have any relatives who has BC. I am the first to break our family record.

    Surgeon B did mention he will know if I need chemo only after he “opens” me up! :neutral: Surgeon B is considered an elite breast surgeon in Melbourne.

    If we are going by our gut feelings, my hubby and I both felt significantly more comfortable with Surgeon B even though Surgeon A have a very clear plan when compared to B.

    Go Matildas!!!! :smile:
  • GinGin
    GinGin Member Posts: 135
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    @Tarma: Surgeon A main objective wanting chemo (6 mths) is to shrink the tumour. Having Chemo will also kill the cancer along the way. Surgeon A also states it’s a 50/50 probability it may shrink. 
  • Tarma
    Tarma Member Posts: 73
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    @GinGin I'm the same, first in my family too.. 
    I'd be happy to do a little more research for you but id hate to give you bad advice,,  maybe professional advice would be better.. 
  • GinGin
    GinGin Member Posts: 135
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    @Tarma, no worries. I’ll check in with my breast care nurse on Monday. 


  • Tarma
    Tarma Member Posts: 73
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    @GinGin I've probably given you a bum steer already, ignore my advice lol im a complete noob at the cancer thing too . But seriously,  I wish you all the very best, and keep posting, I read everyone's and I find it very helpful .. 
     lotsa 🩷 T