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.XxGin

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.

@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 yiI 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 xxtake care & all the best xx

Hi @Tarma, the trouble is,you don’t know if the chemo is working or not for sure until a few months down the track when they rescan.If it wasn’t effective then the cancer is growing and possibly spreading. If cancer returns years later it can sometimes morph into completely different pathology so the original chemo might not be the one of choice.I’ve seen that happen too. Having a mastectomy reduces your risks of a local recurrence to about 1% of coming back in that chest area.With a lumpectomy and no radiation,it’s around 30% risk and with radiation afterwards it’s drops down to around 8%. These are the stats given to me for my situation many years ago so don’t quote me but at least it’s a rough guide. Ofcourse there’s no guarantee that a cancer cell might be lurking dormant elsewhere in the body.We’ll never really have 100% peace of mind but over time,you learn to live with it and enjoy life.

My sister has found Day 3 is the tell tale as to side effects for her

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.

Totally confused after seeking second opinion

42 Replies

Tarma
Member
3 years ago
But while I'm here ,, hears my opinion on your stitch @GinGin I opted for neoadjuvant , I figured it was better to have as much information about how best to treat My cancer as possible.. and if its been removed Before chemo, you have no way to see how Your cancer or you will respond to the different drugs they give you.. and as we know the effects of chemo on cancer cells vary greatly, some even grow during chemo,,, so, if the worst happens and it returns again some day down the track, you're ahead of the game already because you have a very good idea of how stubborn Your cancer is or isn't..
To me, it was kinda simple,, how can you really fix something if you can't see what your trying to fix ..
Anyways that's my 2 cents worth 😃🤣
✌️&🩷
GinGin
Member
3 years ago
Hey @Tarma, I managed to find what gene activity testing is on the https://www.cancercouncil.com.au/breast-cancer/diagnosis/tests/tests-on-breast-tissue/#HER2-status and your idea is totally logical! I now understand why Surgeon B says chemo in my case is a ‘maybe’ and he wants to do the lumpectomy on me first…..
xx
Tarma
Member
3 years ago
@Aska my understanding is that your HER2 status is determined by the presence of protein in cancer cells ,, Human Epidermal Growth factor Receptor 2 ,, the more of that protein determines its grade, the higher the level the more aggressive, grade 3 being the most aggressive and therefore classified HER2 + ... That was my understanding anyways ,, so I was just a little thrown with Gingins grade 3 HER2 neg status.. lol it's enough to make your head explode 🤣 I need to stop ..
GinGin
Member
3 years ago
Hi @TonyaM, that’s interesting and good to know. I thought chemo will definitely shrink a tumor and thought the surgeon was being conservative by telling me it’s 50/50 chance of shrinking.

I happened to just finished reading an interesting article about lumpectomy vs mastectomy and the corresponding recurrence rate. The article mentioned that having a mastectomy does not mean the cancer will not recur (it provided recurrence stats but I can’t recall the % - sorry, am already having brain fog lol). I was under the impression if one chooses mastectomy- the silly cancer will no longer be shopping in our body!

xx
Gin
GinGin
Member
3 years ago
Hey @Tarma, you are only trying to help and I genuinely appreciate it. Please don’t feel you have given me a bum steer. This is a first for so many of us. I have found reading other’s comments/ personal posts very helpful too. And have found a number of virtual friends as well :smile:
xx
Gin
TonyaM
Member
3 years ago
Hi @GinGin, I know a few ladies who went chemo first- didn’t shrink the tumour. By 6mths ,when breast was rescanned,the tumour had actually grown bigger! They needed a mastectomy and then had to do a different chemo.Ofcourse this isn’t the norm but it can happen. So a question might be:how will you know if a particular chemo is being effective ?I had similar pathology to you back in 2003 (neg nodes) had a full aux clearance,lumpectomy,radiation.Cancer came back in the same spot 7yrs later- yes,that can happen too. I then had a mastectomy and chemo + Tamoxifen. That was 12yrs ago and I’ve been fine since. I believe having a really good breast surgeon is important,especially if you need a full node clearance. Mine did a great job and I never got arm lympheodema.
All these bc decisions are awful. Once you have all your questions answered, go with what feels right for you at this time.
Tarma
Member
3 years ago
@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
GinGin
Member
3 years ago
@Tarma, no worries. I’ll check in with my breast care nurse on Monday.
Tarma
Member
3 years ago
@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
Member
3 years ago
@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.

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Totally confused after seeking second opinion

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