Lumpectomy vs. masectomy?

[vpfeiffer]

Has anyone been through the decision-making process about surgery in a situation similar to mine:

Diagnosed 11/24/04 (stage IIB likely--her2 pos, Er/Pr neg) - left breast
Had a PET scan and MRIs on each breast
No mets (they don't think there is any node involvement, but they aren't positive about that)
Began weekly chemo 12/2/04 (herceptin, taxol, carboplatin)
Surgery expected 2/05 or 3/05
Excellent tumor shrinkage (5% of original size after 6 weekly treatments)
Weekly chemo (same meds) for 3 months after surgery.

When my tumor has achieved maiximum shrinkage, surgery will be scheduled. There is another woman who has Her-2 BC and has weekly chemo with me. When she had surgery (lumpectomy), her tumor had gotten so small that the surgeon had trouble finding the tumor, mkaing lumpectomy a viable choice. I have read that lumpectomy with radiation offers the same chances for recurrance as a masectomy. I am leaning toward a lumpectomy with radiation, but I am interested in hearing from others who have also made this decision (although in reading some of these posts it sounds like there aren't many stage II patients getting Herceptin on a course like mine).

Also -- when you had surgery, did you let them take any nodes?

thanks :-)

[Kristen]

V.

I had the same treatment with chemo's as you. I was stage III. I had a masectomy due to the size they had to take to get clear margins. I know people with larger tumors than I had and had a lumpectomy. They were bigger breasted than I. I think it is a personal decision and would talk to my surgeon and what there opinion is and then take that info and decide for yourself what you feel comfortable with. Ask your surgeon what would be the chances of not getting clear margins and having to have another surgery. The two women I know, both had to go back because the doctor didn't take enough to get clear margins.

I had node involvement and my surgeon, feels that auxillary node disection is the best way of determining if it is in the lumphnodes. I know sentinal node and the dye test are becoming more popular. Again your decision.

You are a pioneer in having the chemo before surgery. A lot of folks wish they had that option. I was dx a year ago and it was never discussed. I didn't even hear about it until MD Anderson has such great results with a test they were performing. You can add a lot to this board by keeping us posted of your experiences. Best wishes and Take Care. K

[al from canada]

Linda had chemo before surgery. We opted for lumpecomy beause reseach has indicated that there was no survival advantage to masecomy. She was node + and had clear margins.
Al

[Val Pfeiffer]

I am beginning to realize that I am in the minority with my treatment. The Herceptin has worked wonders...I am examined each week before my chemo session and my oncologist estimated that my tumor size has changed as follows:

12/2/04 8x8x5 cm (320 cubic cm)

12/23/04 6x5x4 cm (120 cubic cm)

1/6/05 barely detectible
(I then asked if it was perhaps down to 10 or 20 cubic cm and his response was "MAYBE that big")

1/13/05 smaller still

So those are the details of the reduction down to about 5% of the tumor's original size. My oncologist and my surgeon (who is also a very close friend of ours) said that if we did surgery first it would be too difficult to get a clean margin -- that we needed to shrink down the tumor first. At the time I had no idea that this technique was so new.

During the biopsy they placed a small metal marker at the tumor site so that when the surgeon goes in he will know where to look. He said that with the expected tumor shrinkage that many times they go in and can't find the tumor at all, so the metal marker helps them locate the correct spot.

I am not sure if I have node involvement because the day of my mammogram, the surgeon examined me and found no evidence of nodes. Then I had the biopsy, which tend to inflame the nodes. They were still inflammed three days later when I first saw the oncologist. In his report, the pathologist stated that his opinion was that the nodes were inflammed due to the biopsy, but we don't know for sure.

[JKrak1975]

I had a 3 cm. er/pr-, her2+++ stage lllA tumor. Did adriamycin/taxotere at 4 dose dense. The chemo shrunk my tumor by more than half. I have small breasts and a large tumor and could not have gotten a decent cosmetic outcome without shrinking the tumor. I had decided on a mastectomy until the oncologist convinced me that I didn't have to do that. They were able to do a lumpectomy...I have had a very good cosmetic outcome. Did 3 more taxotere after surgery (had to stop one early due to skin toxicity)...then rads....and have been on herceptin since last March. The plan is that I will go off the herceptin this March. Before surgery, they did a "wire localization" using the original mammograms to mark where the extreme edges of the tumor had been. The surgeon was able to get clean margines. I did have nodes removed. It was clear to the surgeon and the oncologist that I had node involvement before surgery from a PET scan. So far so good:-) I wish you well! Judy