Cancer After Neoadjuvant Chemotherapy: Is it Really Gone, Zip, Nada, Zilch?!

Question: With infiltrating ductal carcinoma, triple negative, does the agressiveness of the condition warrant an agressive treatment even if DR.'s state that the lesion (6.8 cm circumference) has totally dissapated and that the cancer is 'gone'? Pet/CT scans, MRI, and recent mamography all suggest that the cancerous lesion that I battled with this past Summer has now been resolved. My question, considering the agressiveness of the tumor, should I continue to be agressive in treatment, or as is an option, forgo a prophylactic intervention and immediate vs. delayed reconstruction in exchange for a breast-conserving surgery and a watchful eye every six months for possible recurrence?

Any thoughts?

I would like to assume that being

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Answers: With infiltrating ductal carcinoma, triple negative, does the agressiveness of the condition warrant an agressive treatment even if DR.'s state that the lesion (6.8 cm circumference) has totally dissapated and that the cancer is 'gone'? Pet/CT scans, MRI, and recent mamography all suggest that the cancerous lesion that I battled with this past Summer has now been resolved. My question, considering the agressiveness of the tumor, should I continue to be agressive in treatment, or as is an option, forgo a prophylactic intervention and immediate vs. delayed reconstruction in exchange for a breast-conserving surgery and a watchful eye every six months for possible recurrence?

Any thoughts?

I would like to assume that being

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All below is based on one thing: the tumor was 6.8 cm diameter, not circumference.

There is a rule of surgical oncology that you do not change your initial surgery after neoadjuvant therapy based on the response; that is, you were a mastectomy candidate initially, and even though you had a great response (truly, given the size), a mastectomy should most likely still be done. We violate this rule all the time for patients with larger tumors which shrink enough to allow later lumpectomy. However, most surgeons I know wouldn't violate that rule in your case as your tumor was extremely large. Conservation surgery is not irrational, as you will receive radiation therapy in any case due to tumor size (or at least be offered it). It is a personal choice but you are at significant risk for local recurrence and mastectomy provides best control in your particular situation. One reason for this is that knowing you have clear margins after lumpectomy doesn't guarantee the tumor didn't cross those margins initially (unless surgeon placed clips all around tumor to start); if so then the possibility of straggler cancer cells within remaining breast tissue is real.

I think your sense of "too good to believe" is correct, but a thorough discussion with your surgeon is what is best. There is some debate about whether sentinel node procedure is as good as axillary dissection after neoadjuvant therapy. Either one is standard. More chemo indeed may be in your future depending on how much you received up front. Triple negative breast cancer is a nasty actor as you know.

God bless, best wishes

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my choice, bilateral prophylactic wi reconstructive surgery ...delayed. I'm scares as hades, yet bravely going forward....<smile>

Thanks for the input. Your great at it... Report It

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