My surgery was first, also. My son’s surgery came before any other treatment, also, so I assumed this was the norm. I see now that they decide to do chemo first for very specific reasons, for example, If the perceived tumor is sitting on the chest wall to shrink it in hopes of getting a cleaner margin, or, in my son’s type of cancer, if it is wrapped around the spinal cord, making excision very difficult. You’re right, though- many women find a different story in post-op pathology than what scans initially revealed. I see many women here who, undetected by mammo or even MRI, find secondary cancers on post-op path. All my breast scans were negative, every single one. Yet post-op pathology found both LCIS and IDC. Of course we treated to the latter.
Any invasive quality, that’s is, clear evidence that the tumor had ruptured and is now shedding cells into the lymph channels or blood system (vascular invasion) or surrounding tissue means system-wide treatment is warranted...chemo is on the table then, because they do know the horses are out of the gate at this point.
Having said this, while it may be quite evident underneath a microscope, malignancy is not appreciable on scan until it has formed a group of thousands large enough to be picked up by scan...that has to be a pretty significant cluster. With post-op microscopic analysis, seeing what a scan could not possibly, they cautiously assume there are rogue cells taking the lymphatic or vascular highway after they deem it is ‘invasive’, and apply systemic treatment. Even if cancer appears ‘gone’ by surgery, or ‘No Evidence Detected’ on scan.

It’s the elusive single cells that literally fly under the radar that are (in as best effort as possible) swept and mopped away by radiation and chemo. God willing. 🙏💕

((Hug))

My Onc does not use the words "cancer free". I am "in remission". Much like my RA was from about 10 years old until about age 30. RA did not go away, it cannot be cured. It lays silent and then rears its ugly head again.

That is what cancer does. It is always there, waiting. And some of us end up with activity, others go their entire lives without a hint of it showing. They are dormant cells waiting for a spark.

So no, I am not cancer free. They just can't see where it will start the next party. Until then, I live life the way I want to and make the most of every day.

To be honest ladies, I think we are often caught between insurance companies who do not want to pay for routine full body scans without symptoms and "protocol" which medical professionals use fall back on way to often rather than an aggressive all over checking out everything when a cancer is discovered. It is scan, treat and wait. Then repeat. Although I believe I am cancer-free at the moment, and all scans I've had so far support that, the truth is I don't know. They've never looked at my bones, my brain, my lungs, my liver, etc.I was TNBC Stage 1 with no lymph node involvement and it's not protocol. The unfortunate truth is NONE of us can even be 100 percent sure of that today much less considering the future. That is a tough thing to deal with when you've had to go through this and put up an exhausting fight. And you don't have a clue if you've won just a round; not the whole fight. Nonetheless, mindset is everything. You have to believe you can beat this and put up the biggest fight you've got in you.

Jwags, yes, pretty much.
But to fine tune that thought a bit- relapse/ ‘coming back’/ recurrence/ ‘return’ are evidence that frontline treatment was not profound in its eradication. It doesn’t ‘come back’ literally- it’s that it never completely left. We HAVE to have confidence, maybe not so much in the treatment itself, because it is fallable, but in the very real fact that we have each made our absolute best effort in electing our balls-to-the-wall treatment course. Stay solid in that you’ve done your level best and sacrificed much to the cause- there is no ambiguity there, Sister Soldier.
And then we move forward with the intention of living cancer free.

((Another hug))

Well I have hinted at this in my previous posts ... I don't think you are ever technically "cured" of cancer because there are no guarantees for ypur future. Some would say you have to make it 10 years NED before those words are ever spoken. I also have been told that you can't be considered "in remission" until 5 years of NED. I just passed my first clean mammogram since my diagnosis almost one year ago and have had numerous other cancer screenings that have all come back negative so I choose to consider myself NED and cancer free and have been since my surgery as the radiation was just to prevent any local recurrence. Yes, the cancer could be lurking hidden anywhere in my body just waiting. Yes, my status could change tomorrow. But I feel good and I am enjoying my life. I have survived so far and therefore think of myself as a survivor to this point. I will monitor it often and push advocate for my own healthcare ... But continue to live my life. I feel victorious over cancer.