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Chemo necessary before surgery??

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luvs2run27 View Drop Down
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    Posted: Apr 06 2017 at 6:26pm
Hi, I was recently diagnosed and my tumor is on top of breast, rather painful, stage II.  PET scan indicates is has NOT spread.  Oncologist is pushing for 5 mos of chemo even though I've already decided on a bilateral mastectomy.  Anyone else able to skip the pre-surgery chemo?  Trying to figure out what the benefit of being miserable for 6 months first, when I can just get this removed now...
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SusaninVA View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote SusaninVA Quote  Post ReplyReply Direct Link To This Post Posted: Apr 07 2017 at 6:56pm
Hi Luvs2run, I just want to encourage you to have your chemo - there are several different protocols out there, and your oncologist can suggest what he/she deems most effective. I am thankful to hear your PET scan came out clear; the chemo is given because there is a chance (your onc can give you statistics) that microscopic cells can still be out there. You need the chemo to go after them if they are there. Chemo is very doable, and you will probably not be as miserable as you think. I had the TAC protocol every three weeks for 6 sessions. I'm sure others will share what protocol they had - I was pleasantly surprised by chemo. No, it's not a pleasant experience, but most people hold up pretty well and you will be monitored very closely for side effects. Right now, this is the most effective treatment to guard against a recurrence. Being stage II, (that was also my stage), I could not have slept at night without my chemo - I was very thankful for it. PLEASE get your chemo.
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Tulips View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Tulips Quote  Post ReplyReply Direct Link To This Post Posted: Apr 08 2017 at 8:12am
Hi Luvs2run,
So sorry for your diagnosis.  It's quite a shock, but you will get through your treatment with flying colors.
I agree with Susan.  I was also Stage 2 and had ACT chemo before surgery (12 weekly Taxols, then 4 ACs every 2 weeks).
It is definitely recommended that everyone with a TNBC tumor that is 5 mm or larger get chemo.  Timing-wise and survival-wise, it doesn't make too much difference if the chemo is before surgery (called neoadjuvant chemo) or after surgery (called adjuvant chemo).  But it seems to me that more than half of TNBC patients have neoadjuvant chemo with TNBC instead of adjuvant.  One advantage of having your chemo first is that it enables you to observe if your primary tumor is responsive to chemo.  About a third of patients have their primary breast tumor completely eradicated by the chemo so that by the time of surgery, there is no tumor left.  That's called a pathological Complete Response (pCR), and bodes extremely well for prognosis (because if the primary tumor is so responsive to chemo, then probably any rogue cancer cells that may have left the tumor to travel around your body would also be highly responsive to chemo, and get destroyed before they can metastasize in other organs).  So having chemo first provides good information to you about how effective the chemo is.  If your tumor does not respond to the chemo you had, it can give you a chance to add more treatment or otherwise be aware of the situation.  So in my situation, I had a partial response to my ACT chemo (when I had surgery, they removed my tumor and it had shrunk significantly, but there was still residual tumor).  I therefore decided to have another type of mild chemo afterwards as sort of an insurance policy, and that has given me tremendous peace of mind.  I have no way of knowing if it was needed (perhaps my tumor never sent out little rogue cancer cells and just surgery would have cured it....but TNBC is notorious for metastasizing early which is why chemo is recommended for almost all TNBC patients).
Like Susan, I found chemo to be surprisingly tolerable.  Of course everyone has their own experience, but I never vomited, only felt nauseous about 4 half-days total.  I did feel very tired and went to bed early, had a metallic taste in my mouth, lost all my hair, and a few other complaints, but overall I kept up my lifestyle, exercised a lot, traveled, etc.  I would definitely say I was NOT miserable for 6 months at all.  Of course I was glad when it was over, but I was so grateful to have that weapon against TNBC available.  
I do recommend you might want to read a copy of the book Surviving Triple Negative Breast Cancer available on amazon.com.  I can't remember the author's name but it is something like Patricia Prijatel.  I found it extremely informative and encouraging.
Also, ask all the questions that you want on this forum.  I found this forum to be absolutely invaluable when I was going through treatment.  Take care!
Tulips

Dx April 2015 IDC TN 2.2 cm, Grade 3, Chemo started May 2015: Taxol/Carbo then AC, Lx with SNB Nov 2015, 33 Rad Dec 2015-Feb 2016. 6 months Capecitabine starting March 2016
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SusaninVA View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote SusaninVA Quote  Post ReplyReply Direct Link To This Post Posted: Apr 09 2017 at 10:53am
Tulips and Luvs2run, I have to tell you part of my story - I did not even know what a pCR was until I finally read enough posts on this forum to realize what you guys were talking about! My surgeon did not give me a choice - told me surgery would be first, then chemo. I remember asking him how would we know the chemo was working? He said that we just had to hope that it was. Mind you, he is an excellent surgeon, and I have great respect for him. But apparently he was adhering to a strict protocol and was not about to educate me on options. This became a problem when he started chasing DCIS found by the pathologist, and wanted to delay chemo to do a third surgery. His Nurse Practitioner became my advocate, and convinced him to move me on to chemo. The DCIS wasn't going anywhere that soon and could be addressed later. Thankfully, this ended up being resolved with boosts of radiation instead of a third surgery. Boy did I learn to be proactive and ask a lot of questions! Sometimes I wish I had that info which a neoadjuvant chemo would have provided - don't know how effective the chemo was for sure. However, I am trying to eat better - someone on this forum posted an article about the Mediterranean Diet being recommended for TNBC prevention (for post-menopausal women). Also, adding more exercise and losing weight is a priority now. I continue to cherish each day and remain thankful for all the treatment given. Tulips, you were diagnosed a month before I was, so we are about on the same timeline. Luvs2run, let us know what you decide, and please ask some more questions if you are not sure about what to do.
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123Donna View Drop Down
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Post Options Post Options   Thanks (1) Thanks(1)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Apr 09 2017 at 11:05pm
DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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HollyO View Drop Down
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Post Options Post Options   Thanks (1) Thanks(1)   Quote HollyO Quote  Post ReplyReply Direct Link To This Post Posted: Apr 29 2017 at 1:42pm
I am new here, so I hope Im posting correctly. I began with chemo first. I think the doctors look at history, stage, etc. My MRI on 7/11/16 showed 5.5cm x 4.5cm. Then PET on 7/28 showed me at 6.7cm x 4.9cm. My onc. Thought I was breast met when she first met me, but after PET scan, told me 'advanced stage 3'. My cancer as all Triple Negs are, was aggressive and growing fast.I began chemo on 8/1 with 4 A/C, then I was put on carboplatin and 12 weekly taxol. After chemo I had my bi-lateral mastectomy and 21 lymphs removed. At time of mastectomy, tumor was 2cm and 1 out of 21 lymph was positive for cancer. I just finished 25 rounds of radiation 3 wks ago and am scheduled for a PET scan on 5/30.

I remember hoping that I wouldn't need radiation, mastectomy, etc. I can say now, that even though each phase took a toll on me, I am very thankful for each treatment I received. I am more positive than ever before and have hope. I am nervous and excited at the same time for my upcoming PET scan. It's important to laugh, and yes even joke about yourself. (I can tell a few that still make me laugh) My 14 and 16 year old girls shake their head at me. Lol.

Holly
43yrs old
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gordon15 View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote gordon15 Quote  Post ReplyReply Direct Link To This Post Posted: Apr 30 2017 at 10:09am
HollyO: thank you for posting your story. My wife had a large tumor similar to yours, and had chemo before surgery . It reduced the tumor to 1.25cm from about 5, and the 4 lymph nodes that were enlarged showed "necrosis (dead tissue) from chemotherapy". They staged her at 3A after results although she was 3C before chemo.

Even though it wasn't a pCR (pathological complete response- to chemo before surgery) we are optimistic. It should be very encouraging for you also in that only one lymph node was involved, and radiation hopefully took care of anything left. Wishing you the best future...
wife: IDC/Lobular Stage2B 2008 lumpectomy/TAC+rads
TNBC Stage 3A/w/metaplastic/squamous Nov2015 Carboplatin-Gemzar chemo/masectomy Taxolchemo+rads 4-16
PET scan stable 9-2016/ 1-2017
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LouWM View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote LouWM Quote  Post ReplyReply Direct Link To This Post Posted: Aug 06 2017 at 8:37pm
I am 74 with TN BC, stage 2a. The primary tumor was 1.9 cm and cancer was found in two lymph nodes on biopsy (which didn't hurt at all!). The surgeon sent me for chemo first, because if the tumor responded, then she would need to take fewer lymoh nodes and thus hopefully avoid lymphedema. I had my first taxol treatment last Monday, and my tumor is barely detectable by palpation seven days later. I discovered the lump myself with breast self-exam on June 28, and was horrified by how fast it is growing. Was growing. It seems to have been stopped in its tracks, which bodes for a good outcome. I am also using oral CBD marijuana, 12.5 mg twice a day, and a nighttime Relax capsule of raw marijuana with RSO oil in it. The marijuana people swear that RSO oil cures cancer. I am not a believer, but dang, having my tumor practically disappear in a week seems pretty amazing to me. I am expecting a complete pathological response from chemo.

My protocol is 12 weeks of taxol, followed by four of A-C, unless the oncologist changes his mind. I am tolerating the taxol really well, with one day of nausea (fixed by Pepsid) and some constipation, fixed with prunes. So far, so good.
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