Hi Charlie,
You poor love, it’s hard to understand, isn’t it? But here we are.
Your question is one that I’ve been inquisitive about, as well. I’m being treated in Finland, which has a good record, I understand, & better ‘statistics’ than the UK (whatever that’s supposed to mean & I’m grateful but not interested in the details). Here, they almost never do chemo before surgery. I’ve asked about this and got a variety of feedback. Scanning and early detection has something to do with it because they would only consider chemo first if the tumour was very, very large with messy margins, which is relatively rare given the health service here. I’m not medically informed so don’t rely on my interpretation of my medical team’s explanation but, as far as I understand, chemotherapy - whatever the cocktail - is most efficient with incipient or ‘baby’ or roving cancer cells (I shouldn’t be going here, I really don’t know what I’m talking about, this is just a ‘gloss’). Finnish medical teams want to get the ‘mature’ growth out as soon as possible. Pre-surgical treatment is state-of-the-art. Mammograms are followed by ultrasound and needle biopsy of the growth. The next step is to inject the growth with radioactive fluid in order to be able to ‘image’ the sentinal lymph nodes - the 1-3 or 4 nodes through which lymph passes directly after contact with the cancer. This is so that the surgeon can find it/them pronto. Wide ranging scans are also administered to eliminate the possibility of established secondaries. These came back negative for me. Just before surgery the tumour is injected again (and wired for easy location) with a blue dye so that all the nodes in the area beyond the sentinels are very easy to find - all being blue. (Mastectomy is rare.) During surgery the tumour is removed along with the sentinels which are sliced & diced by a pathologist on the spot. If any cancer cells are found, ALL axillary lymph nodes are removed - in my case 19, 4 of which also had metastasis (meaning the cancer might be/is on the move). Then they stitch me up - leaving a very slightly depleted right tit & a scar that is covered by a well-chosen swimming costume.
The point of all this blague is that growth is gone and chemo starts. When it is over, a period of radiotherapy follows. And then stuff that I have not yet looked into. If I am right and chemo works best on ‘baby’ cells, then these 5 challenging months are aimed at reducing the possibility of secondary cancer in the various places it is known to crop up. Chemo can - and usually, but not always, does - reduce the size of the original growth whic probably makes surgery easier but as mastectomies seem to be so common in Britain anyway - so what? Finnish medical staff are bewildered and incredulous about the practice of putting chemo first - including my onc nurse who did 16 months at a London hospital. Why? they ask. Get the cancer out fast. Nor do they endorse mastectomy - the figures don’t support it any more. They do thorough excisions, and mastectomies as a last resort (I have a friend who had one but she is very small-breasted and the tumour was large and messy - reconstruction is considered cosmetic and comes much later because it can cause so many complications & ‘health’ is the first priority.)
After the challenging months of chemo - with the surgery scar well on the mend - they come back to the ‘mature cells’ which might have been left behind in the breast area & do the rads. which - so I understand & I’d really welcome correction - work best on mature cancer cells.
From an entirely subjective point of view - I would absolutely HATE to be going through chemo, which has its ups and downs, with a cancerous growth still sitting in one breast. I cannot see any point in it at all and would thorougly recommend surgery first when you are feeling fit. It’s a relatively easy part of treatment that also gives you a month or so of thought time before the chemo starts. Some people sail through chemotherapy, some people are hit hard; there doesn’t seem to be any way to predict how it will take you physically. As a professional anthropologist as well as a fellow sufferer, however, I can assure you that your mental strength will be tested by the experience: from what I have observed since my own diagnosis on Valentine’s Day this year, it feels more ‘positive’ to experience chemo as someone who is ‘cancer-free’ and undergoing whole-body prophylactic treatment, than someone who is going through this shite merely to - possibly - shrink a ‘nasty’ before operation. And then there is the fresh scar to fry with rads.
All silly, I know, but humans are, a bit.
You’ll find the strength, young one. Everyone does.
Keep laughing, M-L xx