[Lani]

Why not make the most the situation and have your treatment as if yours was a neoadjuvant case ie, try to shrink it with surgery first and in so doing get near-instant feedback as to whether the treatment you are undergoing is effective or not! That would require serial biopsies and would probably only happen in the UK if you are in a trial--what trials are open to you for first-line treatment of Stage IV?

Again, I would not start on anything until they determine whether what is in your right and left sided supraclavicular nodes is the same or different as what is in your breast node. Where in the breast is it?

At Stanford they have one of a handful of open MRIs in the world in which surgeries can be carried out including core biopsies. I thought there was one in Norway--not sure if they have the same capabilities and perhaps the UK has one???? Otherwise, biopsy under US of the breast seems to be done.

If you take all macroevidence of disease away without knowing what you are fighting ie, nodes with radiation and it is not clear that what is in your breast is the same as is in your nodes, and then start therapy how will you know if the therapy is working?

With regular neoadjuvant therapy, they usually leave the nodes in situ and then biopsy them later to see if the treatment cleared them as I understand it. The term neoadjuvant therapy is incorrect in your case (unless this is a new tumor/cancer), but I am simply trying to refer to pre-operative systemic treatment to shrink the tumor (if not eradicate it) which has the benefit of assuring you the treatment you are on is effective, and if not, will be switched very early on. Lots to be said for that I would think