Should
triple negative breast cancer be operated on first or should the tumor shrink after chemotherapy? Because the effect of triple negative breast cancer chemotherapy is often very good, so we are faced with this problem, should we operate first or first? Let’s make it clear today. If this is the case, it is recommended that you operate first and then do chemotherapy. When your breast cancer meets two conditions, you can consider surgery first. The first condition is that your tumor is relatively small. It is usually considered that a tumor less than 2cm can be operated first. Because this tumor is relatively small, the probability of metastasis will be a little lower, and the probability of recurrence in the future will be a little lower. Now the necessity of chemotherapy is not so great. Chemotherapy after surgery is enough; The second is to meet at the same time, the tumor is not only relatively small, there is no axillary lymph node metastasis, that is, the doctor did not feel metastasis, or do nuclear magnetic resonance, B-mode ultrasound, molybdenum target, also did not see a clear lymph node metastasis, to do puncture, or even a small sentinel lymph node biopsy also did not find axillary lymph node metastasis, this situation can also be first surgery after chemotherapy. The recurrence rate of triple-negative breast cancer will be a little higher. Can breast-conserving surgery be done? What we want to explain here is that triple-negative breast cancer does have a higher recurrence rate, but it is not local recurrence that threatens everyone’s life, that is to say, it is not terrible to grow around the resected tumor, but to metastasize to the liver, to the lung and so on. This is why we do triple negative breast cancer chemotherapy, immunotherapy or so-called targeted therapy, so triple negative breast cancer can do breast-conserving surgery, and other breast cancer can do breast-conserving surgery indicators or its requirements are basically the same, if it is triple negative breast cancer or to actively discuss the possibility of breast-conserving surgery with your doctor. In addition, should immunotherapy be added to chemotherapy? Before triple-negative breast cancer surgery, if neoadjuvant therapy is used, when the tumor is relatively large, such as more than 2 cm, or when lymph node metastasis occurs, immunotherapy may be added to have a higher pathological complete remission rate, which we usually call PCR rate, so the recurrence rate may be lower. But if I have an operation first, should I add immunotherapy when I prepare for chemotherapy after the operation? So far, all the studies, including the one that just came out in the past few months, have once again denied the role of immunotherapy in this kind of patient, that is, if you operate first, the tumor is removed, and then immunotherapy is added to chemotherapy, it will not reduce the recurrence rate, because immunotherapy needs to find tumor cells before it can stimulate the role of immune cells. If the tumor cells have been cut off by us, it is difficult for immunotherapy to work, so when the tumor is still there, it is better to add immunotherapy to chemotherapy in neoadjuvant therapy before surgery. If triple-negative breast cancer metastasizes or recurs, the effect of immunotherapy is good because there is a tumor at that time. If the tumor is cut and chemotherapy plus immunotherapy is done to prevent recurrence, there is no target for the tumor, which is ineffective at this time. Therefore, for patients with chemotherapy after surgery, no matter whether there is lymph node metastasis or not, no matter how big the tumor is, it is not recommended to add immunotherapy during chemotherapy.
