Chemo before Surgery or Vice Versa

[mHardikshah]

Hello Doctor,

My Mother was recently diagnosed with Breast Cancer. We did the biopsy whose preliminary report reveled that it was a grade 3 lump. The complete report will be available in few days.

Since its a grade 3 lump we have been suggested to act fast

So we quickly consulted a Medical Oncologist and he suggested us to start with Chemo and then surgery.

The reason was to reduce the tumor size before performing the surgery.

We do want to start the treatment asap, but want to ensure that we select the right course of action.

1) Can you please put some light on what factors should be considered before starting the treatment.

2) Also it is advisable to start the chemo and perform surgery at later stage.

3) What all reports (pathological) are needed so as to understand, Analyze and decide the treatment plan?

4) Should we also consult a surgical oncologist to get his opinion ?

Greatly appreciate your help.

Thanks!

[kontak TeamBCI]

Hi Hardik - welcome to the forum. Very sorry to hear about your mother. Yes in some cases first chemo is performed then the surgery - this is to shrink the lump. Share whats her age, whether lymph nodes are affected. What is her ER,PR status. Pl share the pathological report in details so that Doctor will be able to help more precisely

[manish_vkg TeamBCI]

Dear Hardik, sorry to hear about your mother, we know its tough time for you...and you want to give the best possible treatment for your mother..so i would suggest take care of her food and emotional support, rest leave it on doctors/God...keep posting..below find the answer of your query..

1) Can you please put some light on what factors should be considered before starting the treatment.

good doctor, affordable treatment, in case of emergency u should able to reach there...

2) Also it is advisable to start the chemo and perform surgery at later stage.

Your oncologist is the best person to take the decision on this part..bcu there is so many reason to start the chemo before the surgery and the most important factor is tumor size..

Neoadjuvant therapy is treatment given before primary therapy. A woman may receive neoadjuvant chemotherapy for breast cancer to shrink a tumor that is inoperable in its current state, so it can be surgically removed. A woman whose tumor can be removed by mastectomy may instead receive neoadjuvant therapy to shrink the tumor enough to allow breast-conserving surgery

3) What all reports (pathological) are needed so as to understand, Analyze and decide the treatment plan?

i think u should not worry about it you oncologist will take care of all this..but just for knowledge point of you...Grading, Staging, and Hormone status will help the Medical Oncologist to decide the action plan.

4) Should we also consult a surgical oncologist to get his opinion ?

If you would like to discuss...you can discuss with surgical oncologist also...ultimately surgical oncologist only perform the operation..no one else this is the most important point..

Thanks

Manish

[sumeet_shah Administrator]

Manish has perfectly replied above. I do not have anything to add at all.

I just have one suggestion, seeing your fourth question "Should we consult a Surgical Oncologist". Remember, breast cancer should treated preferably by a team of Oncologists (Medical, Surgical and Radiation). There are very delicate decisions involved. If there is a Surgical Oncologist in your area, you should definitely consult once, if you have not consulted.

Go ahead with neo adjuvant chemotherapy. That is the right thing to do, especially if the tumour is on a bigger side.

Any more doubts, feel free to let us know.

[dm2009]

hi hardik sorry to learn about your mother but dont worry the disease is very much manangeable in this age and treatment quite standard but the initial shock is very individual......the dilemma what to do how to go about it ..... as dr shah suggested the treatment comprises of surgery followed sequentially by chemo and radiation and hormone therapy so as suggested its best to see a team or at least a good oncosurgeon who can then refer to a good medical oncologist or radiational oncologist .always feel free to reach out for support best wishes

[mHardikshah in reply to dm2009]

Thank you everyone for the blessings and wishes.

I was waiting on the test results before posting back -

Age - 65

ER - Moderate positive 50%

PR - Negative

HER2 - Score 3+

Ki-67 - 90%

PET -CT Scan : Case of Carcinoma Right Breast (IDC grade 3)

Stage 4 - It appears to have spread in lungs.

- What protocol is recommended given the report findings ?

- What additional care should we take to ensure her good health - Like Diet , Exercise, etc

- We live on 3 floor, and there is no lift in the building. I am concerned if she will be able to climb the floors after the therapy starts. What do you recommend doctor ?

Thank you everyone for care and support via this forum. It really helps.

[sumeet_shah Administrator]

Mr. Hardik,

1. The protocol will be best decided by your Oncologist.

2. Diet should continue as usual. It's always better to give good caloric diet, as it will help during chemo. Ask her to drink lots of water to reduce the side effects

3. Climbing third floor should not be a problem at all, unless she has some heart problem or the lung metastases are causing too much breathlessness or water collection around the lungs.

[mHardikshah]

Dr.Sumeet,

Thank you so much for taking out time and responding.

Appreciate all your help!

Best Wishes!

Hardik