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tests after diagnosis?

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NinaE View Drop Down
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    Posted: Dec 12 2009 at 4:06am
I asked this question on the "new members" thread too but would like to repeat it here.

I was just diagnosed this week by biopsy. I'm getting BRCA testing done, and the results should come in late December. My surgeon says I can expect to have surgery in the second week of January. And I won't see the oncologist until after surgery.

I looked at the BC flow chart posted by MD Anderson and noticed that their intitial assessment  includes a number of blood tests, a fine needle aspiration biopsy of the lymph nodes, and a scan -- so it sounds like these things are being done *before* surgery. Is that part of the standard of care these days? Should I be concerned that I'm not having that done?

It does seem like it would be a good idea to know if I have node involvement and mets sooner rather than waiting till mid-January or even later, which is what the timeline looks like right now. Knowing that might help me make some decisions.

How many people here had a needle biopsy of the nodes and scans done *before* surgery? Why or why not, and did you get useful information from it?
Stage IV at dx in Dec 09, at age 38. Mets to lung, axillary, IM and mediastinal nodes.

4xAC-->dd Taxol. Dbl mast, 6/10. Radiation, 8/10. NED since June 2010.
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elaineb View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote elaineb Quote  Post ReplyReply Direct Link To This Post Posted: Dec 13 2009 at 9:34am

The type of biopsy is dependent on what they are looking at.  In my case, they told me after u/s that I had a 90% chance of IDC based on what they saw on the u/s.  Because of that, I went directly into a core biopsy rather than a needle biopsy.  I then had a bilateral breast MRI.  Following the MRI, I went back for a lymph node biopsy which was negative.  Because the MRI looked weird, I also followed it up with a bilateral MRI biopsy (whole different thing).  I did not have any blood drawn or tumor markers done.

Do you remember if they measured your lymph nodes during any of the procedures?  A lot of times if the lymph node is not inflammed, they will not biopsy it but will take out nodes during the surgery.  My surgery was one month to the day after my initial mammogram.  Even though I was freaked out at the delay, everyone kept telling me it wouldn't change my course. 
 
Hang in there!  I still remember what a fog I was in for the first month after diagnosis.  It's so scary and your depending so much on the advice of everyone else.  This website is also a great resource.
 
Dx 7/09 1.1 cm, Stage 1, Grade 3, 0/3 nodes TNBC
Lumpectomy 7/23/09
PB Rads x 1 week 8/31
TC x 6 9/8
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Post Options Post Options   Thanks (0) Thanks(0)   Quote mainsailset Quote  Post ReplyReply Direct Link To This Post Posted: Dec 13 2009 at 10:35am
NinaE: you would be well served to look at the San Antonio thread and see Steve & Denise's reports back to us. Steve, on page 3 I think, talks about surgery and if I read your question correctly it would pertain to you.
 
I take it your care is in Denver, not Texas with MD Anderson? The question I think you need to ask your 'team' (which needs to include an oncologist) before surgery is whether your TN status determines that you should have chemo first followed by surgery, not the other way around. Now is the time to have that discussion with an oncologist, not after the surgery. Sorry to be so opinionated but I truly want you to know the whole playing field before you start treatments of any kind.
dx 7/08 TN 14x6.5x5.5 cm tumor

3 Lymph nodes involved, Taxol/Sunitab+AC, 5/09 dbl masectomy, path 2mm tumor removed, lymphs all clear, RAD 32 finished 9/11/09. 9/28 CT clear 10/18/10 CT clear
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unklez View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote unklez Quote  Post ReplyReply Direct Link To This Post Posted: Dec 13 2009 at 11:07am
Dear Nina,

Waiting a month for the surgery can seem like a lifetime....

I'm not a doc and can't comment on whether you need a fine needle aspiration of the nodes before the surgery but in general they biopsy the nodes during the main breast surgery. There are certain times when they biopsy the nodes ahead of time too. Do you have any swollen nodes?

The only blood tests that my wife went thru' before surgery were part of the pre-surgery testing.

What I think you do need to do now is to meet a medical oncologist AND a second opinion surgeon before the holidays shut everything down. The oncologist would probably advise a PET-CT scan before the surgery. They may also advise you to get chemo before surgery. The second opinion surgeon may have an earlier available date for surgery. The highest likelihood of getting unbiased medical opinions are from doctors at reputed teaching hospitals.







Edited by unklez - Dec 13 2009 at 11:09am
Wife Dx: Jul/09. Age: 37. Size: 3cm. BRCA: -ve. Lumpectomy: Aug/09. Micromet 1/9 node. Chemo Start: Sep/09. E5103. DD ACB-> DD Abraxane (Taxol reaction). Zometa (S0307). Canadian Fraction Rads.
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123Donna View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Dec 13 2009 at 12:16pm
NinaE,

I didn't even meet my onc until after surgery.  Until then, no one told me anything about TN.  It wasn't until I met with the onc she told me I needed chemo because I had the bad kind.  That's when I went home and started searching out TNBC on the internet and found this forum.  I agree with the discussion thread from the San Antonio conference that maybe us TN people should be treated differently upon dx and maybe chemo prior to surgery regardless of stage.  At least we should have all this discussed upfront about our disease and treatment options.

Donna
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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NinaE View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote NinaE Quote  Post ReplyReply Direct Link To This Post Posted: Dec 13 2009 at 6:39pm
Thanks for the advice.  I am trying to see an oncologist before surgery. When I asked the first time, I was told I wouldn't get to see one until after surgery, so mid to late January. But they're willing to try to make an appointment for me, though they said it would take at least two weeks. But it seems like there are reports that neoadjuvant chemo may be a good idea even for women who are planning a mastectomy, and I'd like to talk to someone about that.

Because of my estimated tumor size, the lymphvascular invasion, and my age, I supposedly have between an 84 and 94 percent chance of positive nodes. The ultrasound didn't show any swelling. But I still wondered whether it would be useful to do a biopsy given the high likelihood of node involvement. But it really depends whether knowing if I have positive nodes earlier would help me. If it doesn't help with my decision-making now, then I'm not sure what purpose a fine needle biopsy would serve.

And yes, I'm going to be treated here in Denver. If anyone has any experience with tn treatment locally, I'd be interested in hearing about it.

I'm feeling pretty calm right now, for the most part.  The information I'm reading here is helping with that.


Edited by NinaE - Dec 13 2009 at 6:40pm
Stage IV at dx in Dec 09, at age 38. Mets to lung, axillary, IM and mediastinal nodes.

4xAC-->dd Taxol. Dbl mast, 6/10. Radiation, 8/10. NED since June 2010.
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MsBliss View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote MsBliss Quote  Post ReplyReply Direct Link To This Post Posted: Dec 14 2009 at 12:33am
What about getting a breast MRI to see the extent and if there are any additional issues.....
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sharon in Mich View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote sharon in Mich Quote  Post ReplyReply Direct Link To This Post Posted: Dec 14 2009 at 10:30am
Dear NinaE--I want to join those who are recommending you see an oncologist before deciding when to have surgery.  Neo-adjuvant, ie before surgery, chemo has worked well for a lot of us TNs.  One big advantage is that the docs can tell if the cocktail is working if your lump is shrinking.  Back in 2005 when I was dxed they were saying there was no statistically significant mortality difference between neo adjuvant or post surgery chemo.  My own common sense reaction was that if it was already out there circulating from my lymph system (I had a positive lymph biopsy), it made sense to treat it systemically with the chemo first and then take out what was left of the bugger locally.  It worked well for me.  I am now nearly 5 yrs post dx and NED.  My bet is when they can track a large enough group of us TNs who had dose dense neo-adjuvant chemo vs post surgery they are going to see a difference. They've only been doing the dose-dense for 5 or 6 years as I understand it

Good luck.

Sharon
dx 03/05 tn with lymph involvement, dd neo adjuvant AC+taxol, bil 08/05, 38 rads, BRCA-, NED.
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