If the metastasis is not severe (ie widespread) why not surgery first?

[JustFoundOut51]

Hi All,

I was just wondering why surgery is not more a conventional method in stage 4 metastatic breast cancer? If one has a breast tumor, and only a few areas of metastasis - why isn't surgery to remove the breast tumor, and then radation/targetted treatment on the areas of metastasis?

Any insight you can share will be deeply appreciated. Has this been an option you explored but were given a reason why this did not make sense?

Thanks so much and God bless,

[Aprilfoolz1]

JustFoundOut51, it sounds like your sister has not had breast cancer before so this diagnosis is a de novo stage IV case. Your question is a good one , and I do know of a few de novo stage IV breast cancer patients that were allowed to have a mastectomy or the breast tumor removed . However , studies have shown that the surgery does not prolong overall survival in stage IV cases. Pretty much , in the US , oncologists follow "standard of care " guidelines for overall survival . There is the chance that the patient has complications from the surgery . Your sister will not be able to take the Kisquali while recovering from surgery so it also could delay treatment .

I agree with you that surgery should be a consideration as it would reduce the overall tumor burden which seems like it would be helpful ?

In my case my stage IV was a recurrence and the spread was in distant lymph nodes in my chest cavity and neck . Surgery would have been complicated due to the locations . Also it was good to see visibly my superclavical node disappear within a few weeks on ibrance / faslodex. Not only did it shrink but the subsequent pet scans eventually did not detect any metabolic activity or enlargement in any of my previously seen Mets.

If you have time , do a search on De Novo stage IV breast cancer mastectomy or surgeries and see if you have find a recent study that supports surgery .

[JustFoundOut51 in reply to Aprilfoolz1]

Thank you so much Aprilfoolz❤️❤️ I will do this research.

[Marzili in reply to Aprilfoolz1]

What was your supraclavical node like? How big? Soft or hard? (Do you have IDC or ILC?) Thanks for answering.

[Aprilfoolz1 in reply to Marzili]

I had (have ?) IDC - the superclavical node was enlarged but under my clavical bone so was not really visible to the eye . After two ultrasound guided biopsies (the first one was inconclusive ) it was more enlarged - both inflamed from biopsies and the cancer ? By that point, the oncologist knew it was cancerous and it was harder and enlarged , they could feel it when they felt my neck . It immediately started shrinking and getting softer to the touch per the oncologist once I started faslodex and Ibrance.

[Nocillo]

I was diagnosed in 2015 and there was no question between my oncologist and the surgeon that getting rid of my tumors was the only way to go. There was never any discussion about trying to shrink them first. I wanted them gone as well and would not have liked it knowing they might still be there. After my surgery is when they discovered the metastasis was in my entire skeleton. Never any radiation at al. My doctor had 40 years experience, maybe he was more old school.

[China40]

When I was diagnosed with bone cancer I was told it had metastasised from breast cancer and that as the breast cancer had done its job by spreading the cancer around then there was no reason to remove the initial tumour. Medication has shrunk the tumour and regular scans show it as calcified . A surgeon has said that he would remove it if I wanted but it may cause more problems to me and in no way would it alter what I already had. I decided that as it was checked every 3 months then I would leave well alone, the surgeon agreed. I have already had surgery on my back due to a tumour on my spine so didn’t want any more. Hope this helps, its only my opinion .

[Iwasborntodothis in reply to China40]

This matches what I was told - also I was denovo Stage 4 and post menopausal. My breast tumors have basically disappeared and the original spread to lymph nodes and lungs have gone but this cancer is still alive and well 4 years later and seems to find new places to hide when we think it have it beat - first bones, now liver. I am glad not to have had surgery, not because I really care what I look like but because I think any time in the hospital is bad for us.

[JustFoundOut51]

Thank you so much China40, this is very helpful. ❤️❤️

[NShaft]

My onc explained to me that surgery didn’t increase overall survival. Also since I have lymph node involvement those would need to be removed creating a risk for lymphedema. More risk than reward in my case.

[Andersl in reply to NShaft]

If the disease has spread I'd question why lymph node removal is necessary.

[NShaft in reply to Andersl]

Along the same lines it would seem to make removing the breast tumor unnecessary also.

[Gmaoftriplets]

I was diagnosed with stage 4 de novo in 2017, I had one small lesion on my acetabluem. I was on Ibrance and letrozole all my scans have been stable until the one in September showed the tumor had spread to my lymph node, biopsy showed same cancer as first diagnosis. I will now be seeing a surgeon to discuss surgery since I have been metastasis free for over six years. I will see what the surgeon has to say.

[JustFoundOut51 in reply to Gmaoftriplets]

I wish you the best Gmaoftriplets❤️❤️ Thank you for sharing

[Gonnawin]

In my situation, my oncologist said because of the mets (to brain, bones, lymph, lungs) that surgery wouldn't help the overall situation. I had the same question in the beginning as well....why not remove the source of the cancer and treat from there....but I guess its kinda like once the horse is out of the barn, then its time to just try and catch him. So, treatment was chemo/radiation to try and catch all the areas involved.

I hope your sister (and you) are staying hopeful and positive! There is so much great information on this site from others who have been on this road road for many years. And they are an encouraging group of people.

🌺

[JustFoundOut51 in reply to Gonnawin]

Thank you so much Gonnawin❤️❤️I thank the good Lord that I have found a community of great supporters here.

[Ntash01 in reply to Gonnawin]

Wow Gonnawin - that’s a lot! How are you doing. Every time I settle into treatment something else pops up…. I’ve accepted it’s a game of ‘whack a mole’ for sure! How were brain mets dealt with? 2 pests… fingers crossed nothing has changed.

Nx

[Andersl]

Surgery to remove the breast lump provides tissue for analysis to determine the best treatment. Radiotherapy to the breast (after surgery) helps to prevents the breast cancer recurring.When the disease has spread, systemic treatment (eg chemotherapy or immunotherapy) is required. This travels throughout the body aiming to seek and destroy cancer cells.