Question about being Stage 4 and Primary Tumor to Remove or Not..

[Lala]

My original dx 6 months ago was stage 4 her2+ er/pr+.
I have been thinking about removing my primary breast tumor or at least having another biopsy done all to be frozen for future testing. I am also wondering about the survival possibilities too. I did see the previously posted article from Lani. I found that article very interesting but still had this question.

My question is:
Has anyone had their primary tumor removed or biopsies after treatments began or between the changing of treatments?

Thanks in advance for reading this.

[Cathya]

Lala;

I will try to find a report I was reading in the last couple of weeks that discussed the removal of stage 4 primary tumors. I believe the recommendation was to remove them as with the new treatments now available stage 4's now had a better, longer prognosis and this helped the treatments. It was an article discussing the attitude towards stage 4 patients by doctors. Perhaps Lani has seen it?

Best regards,

Cathy

[Cathya]

Lala;

I missed the point of your question...sorry. I have a friend and know of others who have treatment with chemo to reduce their primary and after have it removed and receive additional chemo and radiation. It is quite common particularly for inflammatory bc. I had a second tumor that was inoperable myself (stage 3) and it was treated with chemo and lots of radiation.

Cathy

[Taffy]

Hi Lala,

I am stage 3 but have a large tumour in my left breast. I was originally diagnosed in 2003 and had a mastectomy on my right breast. My new tumour is being treated with Arimidex at the moment and is shrinking (I think). I was told that I could not have an op because the skin is involved and there would not be enough skin to close the wound. I am due to start Herceptin next week. If the tumour shrinks right down then I will ask again about an op.

love
Sue

[Sandy H]

Hi Sue: I did not have enough healthy skin being inflammatory so had a graft to the chest wall. The skin was taken from the other breast after it was tested to be cancer free. It was my idea to use the other breast as I was having a double mastectomy otherwise they was going to take it from my leg above the knee. May want to speak to your doctor about the graft. Hope this helps. Hugs, Sandy

[Lani]

another long-held dogma of the oncologists may have to bite the dust
For those who are Stage IV at the time breast cancer is diagnosed--Why haven't they been looking critically at this before?

1: Ann Surg Oncol. 2006 Apr 17; [Epub ahead of print] Links

Effect of Primary Tumor Extirpation in Breast Cancer Patients Who Present With Stage IV Disease and an Intact Primary Tumor.

Babiera GV, Rao R, Feng L, Meric-Bernstam F, Kuerer HM, Singletary SE, Hunt KK, Ross MI, Gwyn KM, Feig BW, Ames FC, Hortobagyi GN.

Department of Surgical Oncology, Unit 444, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas, 77030, USA, gvbabiera@mdanderson.org.

BACKGROUND: Currently, therapy for breast cancer patients with stage IV disease and an intact primary tumor is metastasis directed; the primary tumor is treated only when it causes symptoms. A recent review suggested that surgery may improve long-term survival in such patients. We evaluated the effect of surgery in such patients on long-term survival and disease progression. METHODS: We reviewed the records of all breast cancer patients treated at our institution between 1997 and 2002 who presented with stage IV disease and an intact primary tumor. Information collected included demographics, tumor characteristics, site(s) of metastases, type/date of operation, use of radiotherapy, chemotherapy and hormonal therapy, disease progression (time to progression and location of progression) in the first year after diagnosis, and last follow-up. Overall and metastatic progression-free survival were compared between surgery and nonsurgery patients. RESULTS: Of 224 patients identified, 82 (37%) underwent surgical extirpation of the primary tumor (segmental mastectomy in 39 [48%] and mastectomy in 43 [52%]), and 142 (63%) were treated without surgery. The median follow-up time was 32.1 months. After adjustment for other covariates, surgery was associated with a trend toward improvement in overall survival (P = .12; relative risk, .50; 95% confidence interval, .21-1.19) and a significant improvement in metastatic progression-free survival (P = .0007; relative risk, .54; 95% confidence interval, .38-.77). CONCLUSIONS: Removal of the intact primary tumor for breast cancer patients with synchronous stage IV disease is associated with improvement in metastatic progression-free survival. Prospective studies are needed to validate these findings.

PMID: 16614878 [PubMed - as supplied by publisher]For

[Sherryg683]

I had my primary tumor removed which was 1.5 cm. Then they discovered my lung mets right after, so I was a stage IV when removed. I am now NED after 4 months treatment...sherryg683

[Lani]

found this:
Local therapy benefits stage IV breast cancer
OB/GYN News, May 15, 2005 by Patrice Wendling
ATLANTA -- Contrary to conventional belief, results of a new study suggest that surgical removal of the primary tumor can benefit women with stage IV breast cancer.

Although overall survival was unchanged at 5 years, there was a better progression-free survival for women who underwent local therapy of the primary tumor when initially presenting with metastatic disease, Roshni S. Rao, M.D., reported at a symposium sponsored by the Society of Surgical Oncology.

"This is important, because any time you can slow down the progression of the disease, it potentially gives other therapies a better chance at working." Dr. Rao told this newspaper. "It's entirely possible that as medical therapy improves, the metastatic progression-free survival seen in these patients will translate into a survival benefit."

The study joins a growing body of evidence that challenges traditional beliefs by suggesting that aggressive local therapy may prolong survival, said Dr. Rao, a breast-surgery fellow at the University of Texas M.D. Anderson Cancer Center, Houston.

[clisa]

Hello there;

I do still myself struggle with the decision on this. At the time of my intial diagnosis - the decision to do chemo first and try to shrink the size of the tumour before surgery made sense. But since that time I have been diagnosed with multiple liver mets that have caused more concern ( due to locations and pain) and so the focus is there.

My oncologist continues to feel that the focus needs to be maintained on the liver until we get it NED and then surgery on the affected left breast. I agree with his opinion most days until I see my breast in the mirror and look at it's disfigurement and wonder if I made the right decision.

Scans show mostly tumour shrinkage in my breast and my multiple chemo regimens have not been as effective with shrinkage of the tumours in my liver so I try to take that as a positive sign that I have made the right decision.

Then, also I try to see my liver as a more vital functioning part of my body and understand the importance of getting it healthy.

I will continue on the newest chemo plan of navelbine, herceptin and xeloda as long as we can maintain my overall health and we will check the next scans and see if this is working on my stubborn liver mets yet and I will go on...

sounds like a sappy song but the decision is hard and I hope for the best for you. Let us know what you decide to do and why as I would be interested very much in your opinion.

Lisa

[callen03]

I have Stage IV Breast Cancer, and I am scared of the statistics. I am 49 years old, and I am raising my 12-year-old grandson. He needs me. I would love to watch him grow up and play sports in high school. He is very athletic. I am not afraid of death, but I am not ready to go.

Mentally, I need to find some positive stories from Stage IV survivors. Also, what does NED stand for?

Thanks in advance.

[chrislmelb]

NED means no evidence of disease. There are many positive stories from Stage IV survivors on this board. Do a search for Stage IV and i am sure lots of posts will come up.
Christine

[kk1]

lala;

I am stage IV and had the primary removed after chemo to clear my liver mets. Been NED for 18 months so far so good. The article that Lani posted suggests that removal is the way to go.

kk1

[Lala]

Thank you Ladies for taking the time to respond to my question.
I need to research this a bit more before doing any thing about my primary tumor. I found the articles posted by Lani to be helpful too. I think my next step will be discussing my options with my oncologist. I will let you know what I decide to do.

Thanks Again,
Lala