Hi
Has anyone experience of hormone therapy to shrink a tumor before surgery?
My oncologist said that my tumour has a good chance of shrinking with chemo. But he says hormones could be an option (I will have to take them anyway at some point) and he thinks chemo may be (in my own words) using a sledge hammer to crack a nut.
My tumor is ductal, ER+ and HER-, 4cm, node sample was clear. The onc is trying to get a grade from the biopsy to help with the decision. However, I do not want to spends months on hormones, only for it not to shrink enough so I need chemo anyway, or if they decide I need chemo after my next operation. I am seeing the oncologist on 14th Sept, and my chemo is booked for the 15th. So I will have to make my decision at the appointment.
Any comments please?
Julie
Hi
Thanks cromercrab/sara, finty and raywitch/rachel for your replies in the similar thread in “targeted therapies”.
breastcancercare.org.uk/forum/viewtopic.php?f=29&t=27633
I thought I carry on here though as it is a more appropriate forum.
I saw my oncolgist today and he is still advising hormones, which I have agreed to. I had my first Zoladex injection today and will start Femara/letrozole tomorrow. He is going review things in 3 months. Although he can’t promise that I will not need chemo at a later stage he said it is highly unlikely.
Although I had already started with some mild menopausal symptoms, blood tests say I’m not quite there yet. Roll on the those menopausal symtoms!
Julie
Hi,
Well, the Femara/Zoladex is working. According to the ultrasound I had a month ago, it has shrunk from 37mm to 21mm. I am still taking the Femara and having Zoladex injections. I have been referred back to the surgeon (although I am also still seeing the onc) and will be seeing the her next week. So hopefully, it will be small enough for a WLE soon.
Since September, I feel like my life has been in limbo whilst still having the tumour and waiting to see if it shrinks. I have hated having it still there. I haven’t been well enough to work, but life has gone on, and I am coping if I pace myself and I have my own routine. Now it’s all going to change again and, although I am keen on getting the surgery done and get rid of it, I feel apprehensive, especially how I will feel physically after the operation and radiotherapy.
Ah well, at least I am getting one step further.
Julie
That’s excellent news - you must be very relieved. Hope it continues like that !!
If it’s working that’s great, but if it were me I would have insisted on chemotherapy to shrink the tumour prior to surgery, for three reasons:
(1) It is important to have surgery as quickly as possible, and unlike endocrine therapy, chemotherapy starts to have an effect almost immediately,
(2) Chemotherapy would also be a good precaution against micro-metastasis in the blood. Remember, even if you’re stage one, and don’t have any Lymph Node involvement, Cancer Cells can still spread un-beknown via the blood, and unlike endocrine therapy, chemo would help destroy these micro mets.
(3) Most people respond to chemo, whereas fewer respond to endocrine therapy.
I have to say that I responded fairly poorly to chemotherapy, despite having it neo-adjuvantly .
I personally know someone whose tumour has almost disappeared using hormonals alone (prior to surgery). Things are not black and white.
Useful as that information is , anecdotal evidence is just that and your oncologist knows best and should gear your treatment to the particular pathology of your tumour.
If you are not sure ask for a second opinion or ask your oncologist for more information.
It sounds like you are having a good response.
Julie x
Because I had shingles on my breast/chest prior to surgery the surgery scheduled for November 2007 was delayed until January 2008. I was scared about the delay but the Femara I took during this period, shrunk the tumour so much, I had far less radical surgery than initially planned. I think it was a blessing in disguise.
AlexG
Hi had been told that I was borderline for neo-adjuvant chemo/hormones /immediate surgery on the basis of u/s Grade 1 tumour( smallish -12mm) but axillary node was confirmed on CT scan. I was left to choose MRI showed 4cm multi focal tumour And.in a fog a year ago I choose to go with chemo .Metal markers put in centre of tumour under u/s and tattooes put on outer skin borders of tumour as it was felt that tumour would shrink so much that surgeon would need a marker to excise tissue. Had MRI after 1st 3 no change on report. Had 3 more different chemos and still no change on next MRI. Was still borderline for surgery or more chemo. Had to choose again but this time Onc and surgeon helped and told me they thought I should have surgery.( what surgeon called extremely generous WLE and ANC) Pathology report showed good response to chemo and much smaller tumour than expected was excised. The surgeon even came to tell me this himself as I had been so clearly upset at no apparent response.I now know that Grade 1 tumours respond less well to chemo and hormones.
It is brill news that you have had a really good response to hormones.Wishing you well with the future treatment.J
Hi
I see this is a few months old but if you have any updates, I’d appreciate them
I was diagnosed end Jan, grade 2, 7cm (yes, 7!) The tests they did showed that chemo wouldn’t help but it reacted very well to hormone therapy, so have been on Tamoxifen and Zoladex since Feb with view to shrinking tumour. Am due to see oncologist week after next and hopefully we will learn more about what surgery I will need.
It’s great to read other people’s stories, nearly everyone seems to have immediate surgery followed by chemo/drugs - I seem to be doing it all arse ways and like you say it’s hard to keep going as normal with tumour still there.
Waiting is the hardest…
Here is my update.
The hormones did sort of work. They seemed to dissolve parts of the tumour, so that it did feel smaller and looked smaller, albeit with fuzzy edges, on the u/s. However, when they did an MRI, it showed that it seemd to dissolve only parts, and so I ended up with a smaller tumour with lots of “satellies” around it.
In the end I needed a mx after all. Because I would now not need radiotherapy, I had an immediate recon.
It wasn’t the outcome I hoped for, but I am still glad I tried the hormones first. I know that Femara/Zoladex work on that particular tumour, so it seems promising that it will also work on stopping a similar new one starting. I gave it my best shot as I wanted to avoid a recon if possible. My LD recon looks quite good and I got to keep my nipple which helps.
Unfortunatly I am having problems with scar tissue on my back (still reduced mobility and uncomfortable after 12 weeks). I am having physio and it is improving. If I had opted for the mx+recon at the start, I am sure I would now be regretting not trying hormones/WLE/radiotherapy. I still feel it was worth trying.
Julie
Hi,
I’ve just come back to reading comments about hormone treatment. I would be so interested to read any more opinions. I have Grade 2 invasive lobular, metastasizing was mentioned, but have been on solely Femara for 4 months. At the last measuring the tumour had increased slightly- but as another lady mentioned, slightly ‘fuzzier’. The plan as has been told to me is to go for surgery at 6 months- whatever the size of the tumour then. I keep asking whether it isn’t better to have chemo prior to surgery (they have said it’s likely post-op). They always change the subject and I end up feeling brushed-off. The stress it’s causing me is tremendous and in my Oncology dept they really don’t seem to get it and don’t like being asked questions. Like others, I don’t want to regret anything later. Has anybody else asked this question and have they had an answer? It would give me the power to insist on one at my next appointment.
ziggy - I don’t have experience of hormone therapy before surgery, but I think you are right to be concerned, and you do seem to be getting the brush off. If the tumour isn’t reducing, I don’t see the logic in waiting another two months for surgery if they say they can do it whatever the tumour size - if there are good reasons for waiting they need to explain them to you. I think you need to go armed with a list of questions and insist on some answers - maybe take an assertive friend with you?
finty xx