Member
Posts: 366
Registered: ‎09-10-2016

Re: When would chemo and radiotherapy but *not* surgery be the recommended course of treatment?

Hi Marla, I heard of a case like this literally last week from a colleague at work.  Like someone else has said, I am always v sceptical of stories commencing with “my friend... etc”. Anyhow she stated her sister found a lump, had chemo to shrink prior surgery and this irradicated it, no need for the surgery.  Got to admit I am really  sceptical, but wasn’t going to cross examine her.  I looked through the cancer network guidelines, and could not find this as a recommended pathway of treatment, so I can only assume it is highly un-usual. 

Member
Posts: 341
Registered: ‎13-03-2018

Re: When would chemo and radiotherapy but *not* surgery be the recommended course of treatment?

Hello again, 

 

Yes I know what you mean - I felt I had the  and am still having the whole works too - the scans,  chemo,  surgery,  radiation,  herceptin,  Anastrazole and Bishphosphonates.

 

By the way,  Just in case there was a misunderstanding,    I was not saying that the chemo treatment would differ with her2+ if not in the nodes. I also did not have node involvement.    I was just saying that after neo-adjuvant chemo,  someone can have a PCR in tthe breast tissue and yet still have active cancer cells still in the nodes. 

 

Hope all your treatment went well, 

 

Chick 🐣 X

 

Community Champion
Posts: 779
Registered: ‎26-06-2016

Re: When would chemo and radiotherapy but *not* surgery be the recommended course of treatment?

I am by no means an expert on it all Chick I have just been immersed in it and some things have taken root in my memory.

 

Possibly because I have had surgery, chemo, radiotherapy and Herceptin - in other words everything they can hit it with I have dealt with a greater range of treatments than average. The only thing I have not had to have are the hormone tablets such as tamoxifen.

 

Before you get chemo they give you scans to check the spread and to be honest the treatment is the same if it is your nodes or not. It was not in my nodes but I was still prescribed 6 sessions of chemo. I did not get 6 only 4 because my blood counts went too low and had I been triple neg they would have lowered the dose or left me longer til the next dose. As it was because I was having Herceptin they just continued with that and brought the rads forward.

Member
Posts: 341
Registered: ‎13-03-2018

Re: When would chemo and radiotherapy but *not* surgery be the recommended course of treatment?

Hello Blueish, 

 

That is interesting.  Has there been recent new developments as  I thought even if it appeared it had shrunk to oblivion or that  there appeared to be a complete response to chemo,  surgery still occurs/is recommended  as they can not tell whether there has been a complete response until tissue is examined after surgery, including at least SNB to examine lymph nodes.  However like you say,  due to size changes the surgery may be downgraded to a lumpectomy and mastectomy avoided. 

 

Absolutely right -  it is individual and can vary. I had chemo before surgery and had a pathological complete response (PCR)  i. e. There were no active cancer cells left.   Still ended up having a mastectomy though. 

 

 Going off topic a bit but I was triple positive and, according to what I have read,  it is less likely that PCR after neo-adjuvent chemo  occurs with triple positive or hormone receptor positive.  For triple positive,  I think I was told at the time that there was a 6% chance of PCR.  However hormone treatment before surgery may be more apt for hormone receptor positive  type.  PCR from neo-adjuvent chemo is more likely to occur with triple negative or Her2 positive and hormone receptor negative types. 

 

Of course, as with anything there are further complexities. I never showed any evidence of spread to lymph notes either pre or post surgery examination.  Some people may have PCR in breast tissue but still show active cells in lymph or  there may be other variants. 

 

Best wishes to all, 

Chick 🐣 X

 

Member
Posts: 258
Registered: ‎13-08-2018

Re: When would chemo and radiotherapy but *not* surgery be the recommended course of treatment?

Thanks very much Blueash-that makes lot of sense.

xxxxx

Community Champion
Posts: 779
Registered: ‎26-06-2016

Re: When would chemo and radiotherapy but *not* surgery be the recommended course of treatment?

It has been known for chemo to shrink a tumour so much that it has more or less melted away so there would be nothing to remove. I don't know if that is common but it is very common to have chemo before surgery in order to shrink the tumour and have far less breast tissue removed. I think if you are lucky you can avoid a mastectomy that way.

 

As always every case is different and  treatment is tailored to the individual.

Member
Posts: 258
Registered: ‎13-08-2018

Re: When would chemo and radiotherapy but *not* surgery be the recommended course of treatment?

Thanks very much Chick! What you say makes sense. (and I appreciate the disclaimerSmiley Happy though I want to promote you to Dr. Chick! Smiley Happy. Thanks again for doing the research...

xxx 

Highlighted
Member
Posts: 341
Registered: ‎13-03-2018

Re: When would chemo and radiotherapy but *not* surgery be the recommended course of treatment?

Hello Maria,

The only reasons I can think for no surgery but other treatments being given are:

1. Someone has declined surgery for primary breast cancer for whatever reason. It possibly could be after having chemo or radiation first.

2. Someone has been diagnosed at stage 4/secondary breast cancer and the primary tumour can not be located.
or it can be located but it is judged that removal will make the situation worse

As far as I know, research into this situation has shown surgery of the primary tumour in the breast, and axilla if affected, may stimulate further growth of any secondary sites. I think research has also shown no specific overall survival benefits if surgery to the primary tumour occurs.

Treatment, I think, is focussed initially on the secondary site or sites. Systemic treatments such as hormone treatment if applicable, or chemo may make more sense. Radiation may be helpful for some secondary sites as well as surgery. Perhaps after review of responses to treatment at secondary sites, surgery to the primary site may take place.

Anyway, I am just speculating somewhat so not saying the above is fact.

Take care,

Chick 🐥 X


Member
Posts: 258
Registered: ‎13-08-2018

Re: When would chemo and radiotherapy but *not* surgery be the recommended course of treatment?

Thanks Ann & Mai-I agree with you which is why I am loathe to ask for more info from herSmiley Happy.

 

I may ask my surgeon the Q. at some point but I'm not convinced that is the right treatment regime for me anyways, otherwise I suspect I would have been given that as an option. Just to be clear: my cousin was in no way implying that I, too, should have that same treatment regime, but merely that she knew someone who had. In the same email she referred to someone else who had a mastecomy and reconstruction (which is what I will be having)-I think she was just trying to say "I know people who have had cancer-I'm here if you need me". 

xxxx 

 

 

Community Champion
Posts: 3,165
Registered: ‎17-03-2016

Re: When would chemo and radiotherapy but *not* surgery be the recommended course of treatment?

You’re right Marla, well meaning third party info from those not affected by the situation is not necessarily that reliable🤔
ann x
Community Champion
Posts: 1,572
Registered: ‎19-04-2017

Re: When would chemo and radiotherapy but *not* surgery be the recommended course of treatment?

Marla, the worst stories begin with "a friend/relative of mine had breast cancer........."  and they are full of good intention to be empathetic but lack detail and knowledge.  Some people seem to delight in telling you about someone who died of breast cancer and some try to warn you about the treatments. Someone tried to warn me that Tamoxifen caused her neighbour to get cancer of the uterus later on.  At the time I'm thinking "Tamoxifen now please so I can hopefully have a later on as cancer of the uterus is something like 1% of people on Tamoxifen".  The point is that her "help" didn't  help at all, it just caused more anxiety.  Steer clear of these people. Smile pleasantly and walk away! Xx

Member
Posts: 258
Registered: ‎13-08-2018

Re: When would chemo and radiotherapy but *not* surgery be the recommended course of treatment?

Thanks very much Mai-I agree, it doens't make that much sense to me (which is why I am loathe not to talk to people who aren't or haven't gone through this themselves. I don't feel it is my place to ask my cousin to please ask her co-worker why she didn't have surgery and only radio/chemo (and perhaps my cousin hasn't even got the info. correct)! What I've learned since my diagnosis is that *everyone* has a story-even if it's not themselves...it's someone they know and I do wonder if they all know what they are talking about! But presuming my cousin did get the story right, I don't feel I can ask her to please seek clarification (we're not that close and I wouldn't want to put her in that position). 

 

If she volunteers more info. I'll be sure to update you hereSmiley Happy.

xx 

Community Champion
Posts: 1,572
Registered: ‎19-04-2017

Re: When would chemo and radiotherapy but *not* surgery be the recommended course of treatment?

[ Edited ]

Marla, I understand your need to type in bold! It's rare to not have any surgery, even lumpectomy for small tumours.  I don't have the answer, I'm afraid but share your curiosity.  Chemo is usually given for larger tumours or if there is lymph node involvement or more often for triple negative as there is no adjuvant treatment for TNBC.  Even if the chemo resulted in a pathologically complete response there would usually be markers where the tumour has been and the tissue removed.  This case sounds quite unusual. Xx

Member
Posts: 258
Registered: ‎13-08-2018

Re: When would chemo and radiotherapy but *not* surgery be the recommended course of treatment?

Thanks very much Ann! I just want to know that I'm not being passed up for something less permanent, like a breast removalSmiley Happy. Your conjecture makes sense to me and I'm open to hear others' thoughts on this as well.

 

Thanks for your input-it does help!

xxxx 

Community Champion
Posts: 3,165
Registered: ‎17-03-2016

Re: When would chemo and radiotherapy but *not* surgery be the recommended course of treatment?

Hi Marla,
It’s just conjecture really, but from what I’ve seen here there could be 2 scenarios - either chemo was needed in the first instance, which melted the tumour to nothing, so radio was given to mop up afterwards or there might have been spread already.
But, hey ho, maybe I’m talking rubbish, perhaps one of the others may be able to advise.
It’s not really possible to compare treatment plans, as our plan is specific to us.
ann x
Member
Posts: 258
Registered: ‎13-08-2018

When would chemo and radiotherapy but *not* surgery be the recommended course of treatment?

[ Edited ]

Hi all,

 

I'm just throwing this out there-I have yet to have my surgery (unilateral mastectomy) and was 100% certain that this was the right option for me (mainly based on surgeon's recommendation) but had an email from a cousin who in passing mentioned that her colleague had chemo and radio but no surgery (presumably she still has her own breast). Under what circumstances would a woman have chemo and radio but no surgery? I presume you'd have to have a certain type/size of cancer? Mine is spread out-a bit spotted so to speak (not confined to one lump) and relative to my breast size it's large which is why I'm being recommended mastectomy rather than WLE but at no point was a chemo/radio combo offered instead of surgery-so I'm just curious. I realise you aren't surgeons but some of you may have more knowledge than me about this and I want to have as much info as possible before I go under the knife. Truthfully, when I learned of my diagnosis it was the thought of having chemo that frightened me more than surgery but now that I know more about the DIEP I am anxious about the surgery (though admittedly the ratio of positive versus negative DIEP experiences on here seems to be 1:4), hence no surprise I'm worried. Thanks to another thread I've recently learned of one lovely lady who had a + experience/recovery. 

 

I just want to know more about when chemo and radio would be the recommended treatment over surgery-any thoughts?

xx