Medical Oncologist
During treatment
My tumour is not shrinking: what happens now?
If your cancer is not shrinking, your team changes the plan, usually by switching to different drugs or moving to surgery sooner. Finding this out partway through is one of the reasons chemotherapy is given before surgery. This page explains the options, why subtype changes how the finding is read, and what to ask next.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed September 2026, next review due September 2027
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On this page
- What happens if the tumour is not shrinking?
- What your team can actually do
- What happens after a poor response is found
- The vocabulary, in plain language
- How much a slow response matters, by subtype
- What this means, and what it does not
- What families conclude at this point
- Common questions about a poor response
The short answer
What happens if the tumour is not shrinking?
Your team changes the plan. That usually means switching to different drugs, or moving to surgery sooner than scheduled. Finding this out partway through is one of the reasons chemotherapy was given before surgery in the first place.
First, check what is actually being said
There is a large difference between not shrinking much, not shrinking at all, and growing. The first is common and often acceptable. The last is uncommon and does prompt immediate action. Ask which of the three applies to you, because the word used matters.
Slow response is not the same as no response
Hormone sensitive, HER2 negative cancers often shrink slowly and may never disappear on chemotherapy. That is the expected behaviour of that subtype rather than a failure, and the long-term work in those cancers is done by hormone tablets over years.
The options
What your team can actually do
There is more than one route, and the choice depends on your subtype and how much treatment you have already had.
Switch to different drugs
Most regimens are built in two parts using different families of drug. A cancer that resists the first part may still respond well to the second, so moving on early is a real option.
Move to surgery now
If the cancer is operable and not responding, removing it is often better than continuing treatment that is not working. The remaining cycles can be given afterwards.
This is a change of plan, not a last resort.Recheck the diagnosis
A repeat biopsy is sometimes taken. Receptor and HER2 results are occasionally different from the original sample, and a different result opens different treatments.
Worth asking
- Should the tissue be retested
- Was the original sample adequate
- Would a second pathologist review it
Consider a clinical trial
Cancers that respond poorly to standard treatment are exactly the group many trials are designed for. Ask what is open, at your centre and elsewhere.
Not sure whether this applies to you?
Ask an oncologistThe process
What happens after a poor response is found
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The finding is confirmed
One measurement is rarely enough. Examination, the scan and the trend over previous cycles are read together, because swelling from treatment can make a shrinking cancer seem unchanged.
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Your case goes back to the tumour board
Medical, surgical and radiation oncologists review it together. A change of plan partway through is exactly the kind of decision that should not rest with one doctor.
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The options are put to you
Switching drugs, operating now, or retesting the tissue. Ask what each would involve, what it would gain, and what your oncologist would choose if it were their own family.
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The new plan starts quickly
Usually within days to a couple of weeks. If nothing has been scheduled and nobody has called you, chase it. A change of plan should not drift.
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Monitoring continues, more closely
Whatever is chosen, the response is watched again. A cancer that resisted one treatment is followed more carefully on the next.
Words you will hear
The vocabulary, in plain language
- Stable disease
- Not clearly smaller, not clearly larger. It prompts a discussion, not an emergency.
- Progression
- The cancer has grown during treatment. This is the finding that leads to a definite change of plan.
- Chemoresistant
- A cancer that does not respond to a particular drug family. It does not mean nothing will work.
- Cross-resistance
- Resistance to one drug making resistance to a related one more likely. It is why the switch is usually to a different family entirely.
- Salvage surgery
- An operation brought forward because treatment is not working. The name sounds alarming; the meaning is simply a change of order.
- Repeat biopsy
- Taking a fresh tissue sample to recheck the receptor and HER2 results.
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Side by side
How much a slow response matters, by subtype
Your subtype
How a limited response is read
Hormone sensitive, HER2 negative
Slow shrinking is expected; rarely a cause for alarm
Triple negative
A poor response is taken seriously and usually changes the plan
HER2 positive
Response is usually good; a poor one prompts retesting HER2
Any subtype, clearly growing
The plan changes promptly, whatever the subtype
Being straight with you
What this means, and what it does not
A cancer that responds poorly to chemotherapy is a harder cancer to treat, and it would be dishonest to pretend otherwise. It is not the end of treatment, and for most women it is not the end of treatment given with the intention of clearing the disease completely.
It is not your fault
Response depends on the biology of the cancer. It is not caused by diet, by stress, by a missed cycle or by anything you did or failed to do. Families search for a reason at this point and often land on something the patient supposedly did wrong. There is no such reason.
What this page cannot tell you
It cannot tell you what your team will recommend, because that depends on your subtype, what you have already had, and how much cancer there is. What it can tell you is that there is almost always a next step, and that you are entitled to hear all of the options.
Questions worth asking now
Is this stable disease or progression. What are my options, including the ones you are not recommending. Should the tissue be retested. Is a trial open to me. When does the new plan start. Write them down and take someone with you.
Commonly believed
What families conclude at this point
Nothing is working, so nothing will.
Chemotherapy regimens are built from different families of drug, and resistance to one does not predict resistance to another. A cancer that ignored the first part of a course often responds to the second. This is why switching is a genuine option rather than a gesture.
We wasted months that should have been spent operating.
The cancer was being treated throughout, including any cells that had already left the breast. The months also produced the information that is now changing your plan. Had surgery come first, the same resistance would exist and nobody would know about it.
She must have done something to cause this.
Response is determined by the biology of the cancer. It is not caused by diet, by stress, by a missed cycle or by anything anyone did. Families search hard for a reason at this point, and the blame almost always lands unfairly on the patient.
We should try something alternative now.
Adding unproven treatments at this stage risks interfering with the treatment that may still work, and some herbal and ayurvedic preparations genuinely do interact with chemotherapy. Tell your oncologist about anything you are taking, and ask about clinical trials instead.
Questions we are asked
Common questions about a poor response
Does this mean the chemotherapy was wasted?
No. It acted on cancer cells throughout the body even where the lump in the breast did not shrink much, and it has told your team something important about this cancer. That knowledge changes what is offered next, which is exactly what this order of treatment was chosen to provide.
Should I change hospital?
A second opinion is reasonable and no good oncologist will object. Changing hospitals mid-treatment usually costs time and continuity. Ask for the opinion first, take your full records, and decide afterwards.
Can they just operate now?
Often yes, and that is one of the standard responses to this situation. It depends on whether the cancer is operable and on how much treatment you have had. Ask directly whether moving to surgery now is an option for you.
Will the remaining cycles still be given?
Usually something is still given, either different drugs before surgery or the remaining treatment afterwards. Stopping systemic treatment altogether is uncommon. Ask what the full plan now looks like from here to the end.
Is a repeat biopsy worth it?
It can be, particularly if the original sample was small or the response is unexpectedly poor for your subtype. Receptor and HER2 results occasionally differ on retesting, and a different result opens different treatments.
Does this change my chances?
A poor response is associated with a higher risk of the cancer returning, and your oncologist should be honest about that. It also now leads to additional treatment after surgery that did not exist a decade ago. Ask what those numbers mean for your specific situation rather than reading general figures.
Should we try something alternative alongside?
Tell your oncologist about anything you are taking, including herbal and ayurvedic preparations, because some interfere with chemotherapy. Adding unproven treatments at this point risks the treatment that might still work. Ask about trials instead.
How quickly should the new plan start?
Days to a couple of weeks in most cases. If your case has gone to a tumour board and you have heard nothing within that window, telephone and ask for a date. A planned short wait is fine; an open-ended one is not.
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Speak to a breast cancer specialist
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Sources
- Cancer Research UK — When chemotherapy does not work
- National Cancer Institute — Breast cancer treatment (PDQ)
- Breast Cancer Now — Chemotherapy before surgery
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.