Breast Cancer Neoadjuvant Chemotherapy: For Patients

We teach you about the benefits of neoadjuvant chemotherapy. Chemotherapy before surgery, rather than afterwards, may offer distinct advantages in your unique breast cancer situation.
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Questions for your Breast Surgeon and Medical Oncologist:
1. Do you know now, before surgery, if I will need chemotherapy?
2. If “yes,” should we consider “Neoadjuvant Chemo” before surgery?
3. What are the benefits of Neoadjuvant Chemotherapy?
4. Isn’t Neoadjuvant Chemo recommended more now?
5. Do my receptors suggest I will need chemotherapy?
6. Do I have cancer in my axillary nodes?
7. Will you ultrasound my axillary lymph nodes today?
8. What is Neoadjuvant Chemotherapy?
Neoadjuvant chemotherapy is when chemotherapy is given before surgery, not afterwards. Most never require chemotherapy. But if chemotherapy is needed, there can be specific advantages to neoadjuvant chemotherapy. This approach is a “cutting edge” trend in sophisticated breast cancer care.
If your breast biopsy “receptor pattern” suggests you need chemotherapy, it is important for you to inquire about the possible benefits of neoadjuvant chemotherapy with your breast surgeon. If cancer is detected in your lymph nodes before surgery, you may also benefit from neoadjuvant chemotherapy. Learn more about receptors and chemotherapy with our video lesson “My Tumor Receptors” (here).
When is chemotherapy generally needed?
If needed, chemotherapy is most commonly given after surgery (“adjuvant” chemo) for invasive breast cancer. It is a more intense cancer treatment than hormonal therapy. Only a minority of breast cancer patients will ever need chemotherapy. These complex decisions are ones you will make with your medical oncologist and breast surgeon. You will make better treatment choices when you are well informed about chemotherapy before you meet your breast surgeon and medical oncologist.
Would I benefit from “Neoadjuvant Chemo?”
What is often overlooked are the benefits of offering neoadjuvant chemotherapy for appropriate “Early-Stage” breast cancer. The decision to consider neoadjuvant chemotherapy always begins with your breast surgeon. You and your breast surgeon will choose the initial direction of your entire breast cancer treatment plan. You must address this treatment option before surgery to benefit from neoadjuvant chemotherapy. Some breast surgeons do not yet embrace neoadjuvant chemotherapy for early stage cancers. Do not be afraid to ask. This is a very important question.
The Potential Benefits of Neoadjuvant Chemo:
*Begin life-saving chemotherapy earlier
*Reduce the need for a mastectomy
*Improve cosmetic outcomes with a lumpectomy
*Reduce the need for an “Axillary Dissection”
*Allow more time for BRCA genetic testing
*More time to think about “lumpectomy vs. mastectomy”
*Shows your cancer team if the chemo is working
*Can eliminate all cancer cells before surgery in some
*Reduce the need for radiation after a mastectomy
Who may benefit from Neoadjuvant Chemo:
We list below a few of the criteria important in deciding if neoadjuvant chemotherapy is an option for someone who has yet to undergo breast cancer surgery.
Your Breast biopsy “Tumor receptors” reveal
*“HER2-positive” receptors
*“Triple Negative” receptors
*Estrogen receptor negative
OR:
*Cancer is found in the Axillary Nodes before surgery
*A tumor larger than 5 centimeters
*Diagnosis is inflammatory breast cancer
What “Receptor Patterns” suggest Neoadjuvant Chemo?
HER2-Positive Receptor (HER2+) tumors are incredibly responsive to chemotherapy when paired with new breakthrough drugs that target these cancers, such as Herceptin and Perjeta. The same holds true if a HER2-positive tumor is also ER positive.
“Triple Negative” (ER-)(PR-)(HER2-) tumors are also fast growing tumors that are usually treated with a specific chemotherapy regimen. These tumors are not responsive to hormonal therapy, but can be very sensitive to chemotherapy. Visit our “Triple Negative Breast Cancer“ video lesson (here).
Estrogen Receptor Negative (ER-) tumors do not respond to anti-estrogen oral medications that are essential for treating estrogen receptor positive (ER+) tumors. Quite simply, patients with ER negative tumors will benefit from chemotherapy.
Why does “Inflammatory Breast Cancer” mean Neoadjuvant Chemo?
If you have been diagnosed with inflammatory breast cancer, the first step is always neoadjuvant chemotherapy before surgery. This type of cancer has a high likelihood of spreading to the lymph nodes and other parts of the body. Starting chemotherapy as soon as possible is essential to curing this aggressive breast cancer.