Oncologist Questions Breast Cancer

For a breast cancer case, is a surgery done first or is the chemotherapy started first?

My sister has been diagnosed with breast cancer and we are just evaluating the options. The doctor has suggested that she will have to undergo a breast removal surgery. Can there be an option where we can try chemotherapy to help in removing the cancer instead of going for the surgery first?

5 Answers

Definitely! Chemotherapy can sometimes shrink tumors, making the patient eligible for breast conservation.
If the tumor is small and lymph nodes normal clinically, then surgery first is usually the best option. If the tumor is larger or lymph node or skin involvement is present, we often shrink the tumor first with medicine (neoadjuvant treatment) and then do surgery second.

My recommendations are the following:
If she is younger than 70 yr old, I would perform bilateral mastectomy with immediate reconstruction by our plastic surgeon. If she is older, a lumpectomy followed by radiation therapy and adjuvant chemotherapy. The role for pre surgical chemotherapy is only indicated for metastatic axillary lymph nodes detected at the time of the original diagnosis or to shrink the tumor in preparation for the mastectomy.

Massimo Arcerito, MD, FACS
There is no distinct benefit of receiving chemotherapy before surgery as opposed to chemotherapy after surgery. Chemotherapy before surgery will make the tumor more easily resectable(assuming that the tumor responds to chemotherapy). This is reserved for women who want breast sparing surgery (not a mastectomy). Chemotherapy before surgery can afford this reduction in the tumor, but has no different outcome when compared to chemotherapy given after surgery.
Chemo can only make surgery easier, less extensive for some. It rarely changes prognosis or need for S. Generally, neoadj isn't reserved for big tumors and dome receptor profiles tumor tests. Some more difficult tumors have found a role for immunotherapy target therapy. A very specialized option it needs. Opinion of "Expert" is, Don't think of preop as a way of preventing surgery.