Which comes first, chemotherapy or surgery?
When you are going through a process like cancer treatment, you don't necessarily know what others have done or why. You don't know that you are doing something different. You assume everyone has done the same thing.
When I went to see the plastic surgeon who will be doing my reconstruction, he indicated that he generally sees the patient for surgery before the chemotherapy has been done.
Two weeks ago at a coping with cancer class, I heard several women say that they had surgery first. Actually all of them that I heard from said they had. I was asked why I had chemotherapy first, and I could not think to articulate at that moment all the reasons why.
I began to write about it but then set that topic aside.
Last night I was asked by another couple, who said that they had been asked by others, so I decided to revisit the topic.
Why did I do chemotherapy first?
First, doing chemotherapy first would allow for clearer margins for the surgery. When surgery is done, they want to ensure that they remove all the cancer and that there are no stray lines. They want to know that they have cleaned the body out. Chemotherapy allowed for shrinking of the tumors to allow the surgeon to clearly see the margins.
Second, my body was stronger to handle the chemotherapy. Some have been amazed that I have handled the chemotherapy so well. While the greatest reason for this has been all the prayer support, it is aided by the fact that my body was not already weakened by surgery. I have gained weight, which surprised some people, but this is actually common with chemotherapy for breast cancer. While I have lost almost all my hair, I still have most of my eyebrows and eyelashes, which is not common with my chemotherapy drugs. My strength and ability to bounce back from treatments has been better than expected.
Third, chemotherapy before surgery allowed us to see that the chemicals were actually doing their job. If we had removed the tumors first, we might not have known that the drugs were having any effect. Instead, the doctor was able to tell that the tumors were shrinking to the point of having nothing to really palpate toward the end of treatment.
Fourth, chemotherapy was going to be required if the cancer was in the lymph nodes. At the time that we started chemotherapy, we did not know for sure that it was, because we were still waiting on results from the lymph node biopsy. When we got the results, it confirmed that we made the right choice because the cancer had begun to spread to the lymph nodes.
In conclusion, there was no scenario where my oncologist was going to feel comfortable with me not having chemotherapy. For my surgeon's sake, she could have done it before chemotherapy, because she is just that awesome, but the clearer margins will hopefully make her job easier. Personally, doing chemotherapy allowed me to use my best strength for what could be the most taxing and gave me peace of mind that the chemicals were not going into my body for no reason. Over time, it was revealed to be the best and wisest decision for me.
So....
Why a bilateral mastectomy if the tumors have already shrunk?
The first surgery option is a lumpectomy, where they merely cut away the actual tumors. In my case, more than one tumor and their spacing in different areas of the breast meant there would be too much cut out. Thus it would make more sense to go straight to a mastectomy.
While choosing to just have the infected breast removed was an option, there was still a ten percent chance that the cancer could come back in the other breast. I am thankful that I was able this time to get to the doctor overseas, who had wisdom to know I needed to get the tumor taken care of as soon as possible. I cannot be certain that I would get to a doctor next time before it spread even further. So having a bilateral mastectomy seemed to be the best route to prevent a reoccurrence that might have more complications and would take us away from overseas service yet again.
That couple that I was talking with last night helped to confirm that decision for me. They were serving overseas when she had her first breast cancer diagnosis. She had been treated with radiation and moved on. Five years later, she was diagnosed again. At that time, she had a bilateral mastectomy. She, as with so many other survivors, has been so encouraging to me, but her husband has also been a great help to prepare Rich for his duties once the surgery occurs. Yes, bilateral mastectomy is the way for me at this time.
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