A question about breast cancer

Parent Cafe
1

<p>My daughter’s dance teacher is 29 and has a very aggressive form of breast cancer. The tumor is about the size of a lime. She will have 6 months of chemo, followed by a mastectomy, followed by radiation. Reports are that the tumor is responding to the chemo.</p>

<p>My question is why the heck didn’t they cut the tumor out immediately and THEN do the chemo? Don’t they usually cut out as much of the cancer as they can, and THEN do chemo and radiation?</p>

<p>Please forgive my ignorance. The last thing she needs is me second guessing her doctors, so I thought I’d ask my stupid question here.</p>

2

<p>My wife had a very aggressive form, and started chemo first, then had a double mastectomy, then more chemo. No radiation. The reason is that the first thing they wish to do is ensure there is no further spread systemically (which is where the big risk is). The second reason is that they want to make sure this particular chemo regimen works - if they cut out the tumor first, they won’t know (they could know if they see the size of the tumor shrink). </p>

<p>This has been the common regimen in Europe for years, but it has only gained currency in the U.S. in around the past five. (For certain aggresssive forms, the Europeans use a different standard regimen which also has better outcomes.)</p>

<p>A lime-size tumor is actually pretty large. Fortunately, generally speaking, aggressive forms of breast cancer are also those that respond to chemo best - apparently, when subdividing, cancer cells are at their most vulnerable.</p>

3

<p>Thanks for the info.</p>

4

<p>This is called neo-adjuvant therapy, and is the common treatment sequence for larger breast cancers</p>

5

<p>Mini, my best wishes to your wife; I hope all is now well.</p>

6

<p>Pre surgery chemo, when effective can also shrink the tumor and make for an “easier” and “cleaner” surgery. A lime size tumor is a lot of area to deal with - they want to get it all without having to go any farther than necessary - such as into muscle. When they ultimately remove that tumor they want to feel as confident as possible that they cut out as much as possible.</p>

<p>My best wishes to the dance teacher - it’s a scary business.</p>

7

<p>Both approaches are used, with chemo first (neoadjuvant chemo) more popular these days. That is the approach Elizabeth Edwards, for example, used.</p>

<p>One advantage of the neoadjuvant approach is that it may be possible to shrink the tumor enough so that only a lumpectomy, rather than a mastectomy, is necessary. Also, as **mini **says, by noting the effects on the tumor the oncologist can verify if the chemo is working.</p>

<p>I was given the choice of approach. I chose immediate mastectomy followed closely by chemo (the time difference was very little in my case as I was out of the hospital and functional the day after the mastectomy and was able to start chemo pretty promptly.) This way I knew, when I got the pathology report from the mastectomy/sentinel node surgery, that not only were my lymph nodes cancer clear at that point, but that the cancer had never gotten that far. I wanted a full data dump on whether the cancer might have spread to the lymph nodes. Had I had chemo first, the lymph node reading at time of surgery would have indicated their cuurrent status, but **not **whether cancer cells had made it that far at an earlier point (and been done in by the chemo).</p>

<p>Had I had neoadjuvant chemo I could not have fully relied on the lymph node data. That info was psychologically important to me, as the risk of recurrence is a concern for any breast cancer patient. The knowledge made no difference in my outcome, but gave me more reliable data, and more faith in a favorable long-term prognosis.</p>

<p>My oncologist said from her dealings with me she knew that was the appropriate choice for me. Based on the pathology of type of tumor I had, the specific chemo agenda was a given (along with a new targeted therapy).</p>

<p>We are fortunate to have such choices and advances available to us, and many more are in the pipeline. My oncologist attends ASCO every spring, and there are already even more new therapies for my type of BC now than there were in 2007, when I was treated.</p>

<p>That at least is the way I see it. I got a real education through this process. There are NO “stupid questions” and there are a lot of resources. You may want to refer your D’s dance teacher to the breastcancer.org website, which has LOTS of info and a discussion board as well, including a forum specifically for younger women with breast cancer. Both my surgeon and my oncologist are among the medical experts involved with the site .</p>

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<p>I think my daughter’s dance teacher is very well informed and I’m sure she is making the best decisions based on her own situation. That is why I didn’t want to ask her a bunch of questions that would sound like I was second guessing her decisions, because in reality, it’s me who doesn’t know much about it. God knows I’m learning. The dance teacher is unusual due to her age, but among ladies my age, I’m beginning to feel like it’s not “if” but “when.” (The dance teacher also had a lot of lymph node involvement.)</p>

<p>We hear a lot on CC about kids who think out of the box. I’m starting to think that a whole lot of the out of the box kids need to figure out a better way to treat cancer. I hear that the side effects are less than they used to be, but the poor dance teacher is SO SICK for at least one week out of every three…in a bit she’s going to start weekly chemo, so she’ll have no in between time when she feels good. Someone really needs to come up with a better way.</p>

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<p>Last year, my mother had double mastectomy followed by chemo for the reasons jyber describes. At the time (pre-surgery/chemo), docs were debating whether to call a couple of her nodes positive for cancer cells and she wanted to know exactly the status of her cancer. She had a lobular form of breast cancer…fortunately post-menopausal and pr/er positive. However, the area of tissue affected was quite large and there was concern about the nodes. Btw…she never had a lump, just an area of density barely visible on a regular mammagram. </p>

<p>One of my close friends also had lobular and chose to have chemo first. Her tumor was literally visible on her upper chest and the size of a small egg. Even though she eventually had a mastectomy, the location on the chest wall muscle and size of the tumor demanded chemo to avoid a disfiguring surgery with limited reconstruction possibilities.</p>

<p>btw…I also have those days where I feel ‘not if, but when’. My mom had the genetic testing and is negative for the breast cancer gene; but I have to wonder about environmental factors.</p>

10

<p>In a better world, women with potential risk profile (breast cancer in the family) would automatically be tested for some of the genetic markers (BRCA1 and BRCA2 would be first on the list). Future breast cancer is roughly 30 times higher for those with BRCA1. It would be a far better investment of health care dollars than teaching self-breast exams. </p>

<p>BUT, then there are problems. We had my d. tested - fortunately, she is negative for both genes. But we knew it was a risk, not in just having to decide about future potential treatment (early age prophylactic surgery), but also knowing that unless she worked for a big company, she might never get health insurance again. And then…is having a gene a “pre-existing condition”, so that, even if she got insurance, would breast cancer be covered?</p>

<p>Insurance companies have to go.</p>

11

<p>I found that the discussion boards on breastcancer.org are very, very helpful.</p>