Breast cancer chemo to start 11 weeks after first surgery should we be worried?

Hi

You have come to the right place for advice and support. There are lots of ladies on this site who will be able to respond to your questions.

I had to wait 11 weeks after my mastcetomy before my first session of chemotherapy this was during lockdown. My oncologist said I should start chemo before 12 weeks. This appears to be the deadline she gave. Usually they like to wait about 6 weeks after surgery for healing.

It is an extremely worrying time but speak to your Oncologist next week who will hopefully be able to put your mind at ease about the delay in starting chemo.

Good luck

Linda xx

Hi

I had 10 weeks between my first (of 3) ops, and started chemo 4 weeks after the last op - so would definitely ask the question.  I had no clear margins after the third op and then had a mastectomy after the chemo. The surgery that your partner will get is the “cure” and everything else is to mop up anything stray , so the surgery and removing the cancer is more important than the chemo, they know there is potential cancer in the breast remaining , they don’t know there is anything else anywhere else. 

There seem to be more patients who have twists and turns in their journey than don’t and I know it can be very stressful , but 4 years on from the start of my journey it is easy to look back - what you want to be able to do is look forward isn’t it, but unfortunately that’s not possible!

Best wishes to your partner

Jo

Thanks, yes just getting worried about the delays, if they miss it this time that will be another delay - yes hopefully the Oncologist will suggest something? Hormone receptive so maybe start meds early, to stop stray cells growing if there are any, I don't know? The surgeon/nurse don't seem overly concerned about the delay to starting chemo. I guess making sure it has all been removed is more important but if it had been chemo would be starting about now instead of another op. and waiting yet more weeks. Thanks.x

Thanks, yes it started so easy, small lump to remove followed by radiotherapy and bingo that was going to be it. We suggested mastectomy at the start but were told it wasn't necessary. Now every week brings more delays and bad news. We'll chat with the oncologist and see if it would be possible to bring chemo forward or perhaps at least do something just in case stray cells are circulating maybe start her meds as she is hormone receptive. Its all very confusing.X

That was my initial diagnosis, mine was then found to be HER2+ (So always chemo) and ER+, lumpectomies failed and I ended up with a mastectomy with implant reconstruction and no radiotherapy. I too wanted a mastectomy at first , and was glad to be rid of it, but in reality if you can keep your own breast that is by far the best result, everything else is just a reconstruction and although aesthetically okay , not the same - I had my implant removed last year and another reconstruction (Diep) done, so it is difficult to move on when there is more surgery constantly looming. 

I think it is unlikely that your partner will be offered Tamoxifen whilst surgery and chemo are still ongoing , due to conflicts and potential complications, but your oncologist will be able to advise much better than me!

jo

I know that your first reaction will be that the wait between surgery and chemo is too much. Six years ago I had my MX on 13 August and chemo started on 20 October. PLEASE, PLEASE  stay away from online research it doesn't help 

In an ideal world it would start within 30 days,  but many people have a second operation  for margins or because something is in the nodes.  Thr real difference starts after 3 months,  and remember it's a percentage of the benefit of chemo,  not 100%, so 30% of thr 3.5% benefit is really not a lot  it takes time to heal,  and chemo messes with healing so it takes longer. Wishing her all the best! X

Hi

i was told by my Oncologist that they have a 3 month window to start Chemotherapy. Mine was delayed due to COVID 19 and started 8 weeks after surgery. I’m halfway through it now.

Thanks, hope its going ok (as ok as it can be). Yes we are just over five weeks from first op, second margin op tomorrow, then the two week wait to see if margins are clear again. We asked if it would be better to do a mastectomy to make sure the margins were clear this time but were told we would have to rearrange the op which would be more delays. We are seeing the oncologist on Monday and all being well with clear margins are going to push for chemo ASAP, if we can start it within four weeks that will put us at 10 weeks post initial surgery (hopefully get that down further to 8 weeks?). The NHS says they aim to start chemo/radiotherapy withing four weeks so we will be well over that. Just wondering if anyone else had margin op and how long was it before they started chemo from their initial op - it seems to be a long wait and a lot of delays. Hopefully the oncologist will get things moving on Monday.

I had clear margins with my first operation, but one of my sentinel nodes was positive despite looking clear. I was told that happens to about 20% of women.  With a positive node staging scans are done,  and I had a nuclear bone scan and two CT scans.  I had  a two week wait to be told my surgery results,  and it took two weeks for the scans to be done and see my oncologist before further axillary node surgery.  That's normal for 20% of all women with apparently clear nodes, putting their chemo well beyond the 4 weeks,  as there is then a wait for either further surgery or chemo to be agreed. In my case I had a small liver hemangioma show in one CT scan so then had to have an MRI scan. My surgeon was great, and penciled me in anyway to speed things up as we all thought it was nothing (lots of women have them and mine was small) but I still waited 6 weeks from my initial surgery to nodal surgery then had to heal. 

About 20-25% of women don't have a clear margin,  and in most cases have further surgery. Obviously there is a crossover of the two groups,  but a you can e write a large number if women have delayed  chemo. I ran the details you gave on Breast Predict (which doesn't include if LVI is found or not,  and if it's present increases the risk of recurrence) and women with her type,  grade,  size,  stage,  nodal status and age have a 3.5%. Her oncotype suggests a moderate risk of recurrence,  though she also has hormone blockers,  which my oncologist said were more important than the chemo as my theoretical gain is 4.5%. The data is based on Tamoxifen which is less effective than AI's so the gain is potentially more. I thought that chemo would be terrifying and I'd have a bad reaction.  I have to say in my case that thr Letrozole is more of a challenge! I already had an ankle and back injury from years ago and it has caused them to flare up.  I've also had a retinal detachment and an ulcer in my other eye,  which should have healed in a couple of weeks,  but after 6 weeks of no improvement I have stopped the letrizole and after 5 days it's half healed!