Deciding whether chemo first or lumpectomy first for tnbc.

FormerMember
FormerMember
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Please comment to help me with your experiences.

I saw a surgeon. She said it was a matter of chemo first or after lumpectomy. Chemo could shrink the cancer and make lumpectomy more possible- the mri being unclear- cancer could be 13mm or 3omm. - could be my dense breast tissue making it look possibly bigger - she could not tell from feeling it. On the ultrasound it looked small - very defntie dark shape.

 I had phone consultation with oncology. The doctor said surgery is always the best treatment for cancer. He said it could remove it entirely and me be ok  - possibly - they could find more and have to have a second operation to remove the breast after examining the tumour and its margins. He said I could avoid chemo - which is so harsh to bear - and have radiotherapy and a bone treatment after surgery. he said the larger area could be pre-cancer and that is not affected by chemo.

The chemo he offered is 12 weekly paclitaxel followed by 4 three weekly ec - epirubicin and cyclophosphamide- or is it cyclphosphamine?

My husband died of docetaxl induced pulmonary fibrosis two years ago so I am very wary of Chemo and I saw him suffer exhaustion 4 days each month also. This was 2 years ago.

I am 71, able to walk and dance, only on lisinopril and statins at present. i am not overweight, get chest infections badly, mild diverticulitis sometimes, not very fit and tire easily.

So after that conversation I changed back to asking for a lumpectomy first. At least it will stop the pains in my breast from the tumour and my immune sytsem won't be lowered during the virus crisis - but that will persist anyway until a vacine is found.

They are not yet testing for virus antibodies.

The oncology doctor quoted statistics that chemo only prolongs likely ten years more life by 3 - 7%

At 71 without cancer I would have had 78% chance of living ten more years.

Its only recently I felt less like dying as grief made me want to die every night for over a year.

So its not dying but suffering that bothers me most.

Chemo could start in 3 weeks, lumpectomy I think she said 4 weeks. I started with this just before lockdown.

So I have changed my mind back to lumpetomy first. Has any one else done that?

Vibraphone

  • FormerMember
    FormerMember

    Hi vibraphone

    im not sure I fully understand the chemo or surgery first options entirely but there definitely seemed to be a size consideration for myself(15mm) and no suggestion other than lumpectomy and sentinel lobe excision biopsy followed by chemo /radio or both depending upon results

    I scored the hat trick and just finished radiotherapy after 6 cycles of docetaxol/carboplatin which was bloody tough

    my friend refused to have surgery first as she was hoping chemo could shrink it and prevent a mastectomy-that was not the case so mastectomy followed chemo and finally radiotherapy -she’s now awaiting a reconstruction 

    so I think you can have a say in the matter and there are some guideline sizes etc but I just wanted it out which I believe has to be within 30 days  of diagnosis and I’m glad he went wide and big so good margins and total axillary clearance so no having to go back for second op

    if the option is to try to preserve breast by using chemo first and that’s important to you then go for it-like I say I just wanted it out whatever it took(think that might be my profession as a veterinary surgeon showing through!)

    hope this helps 

  • FormerMember
    FormerMember in reply to FormerMember

    Hi Wizz, Thankyou for your reply and very best wishes to you.

    You point out usefully that the op may change what happens next. It’s just possible chemo won’t be needed .

    There e is no prospect of anything being within 30 days of diagnosis here in Cornwall - delay of over a week between every consultation or procedure and maybe a month before an operation. Having changed my mind really because of the chance to avoid chemo I now await the surgeon contacting me again.

    x vibraphone

  • FormerMember
    FormerMember in reply to FormerMember

    Do you know how they make sure they operate on the correct breast? Do they mark it whilst you are awake? 

  • Hi there, Vibraphone. 
    I think it’s the right call, especially under the circumstances. I was diagnosed in July 2016 and decided after a second opinion to start with chemo (Lymph node biopsies were positive) to mop up any cells that might have leaked through, so didn’t have mastectomy til end Dec 16. The chemo was stopped early and made little difference - 55mm diffuse HER2+ tumour. 
    Bottom line seems to me now that chemo response is individual in a way that’s surgery isn’t (and I’m back on it btw). Surgery has a guaranteed outcome as far as the tumour is concerned! 

    With hope and love, D 

  • FormerMember
    FormerMember in reply to Dosydo

    Thankyou Dosydo and best wishes to you. All the waiting is terrible- I went to my gp before lock down. My triple negative cancer is said to be fast growing and urgent but I suppose resources are lacking so it all takes ages with waiting for apt’s.

  • Yes, waiting is a pain and I very much hope you don’t get held up - hopefully some services are reorienting back to normal and you will be ready and waiting to go. 
    You already have a bit of leeway - if the lump is larger than expected you can go for a mastectomy. This may seem a horrific prospect, but it is a matter of getting your head and heart used to the idea. Hope for the best outcome but consider the back-up options too. Try to discuss them with your family and med team, so they are not buried as fears in the back of your mind. You’re on a pathway and the prospects are good, getting better all the time! 

    With hope and love, D