Lymph Node Involvement

cpanasci

Hello out there;

After an 18-month journey, I was diagnosed with IDC (stage one or two according to the needle biopsy report) on 11/20. I had surgery on Monday, 12/8. I expected lumpectomy alone, but they found sentinal lymph node involvement and took the "fat pad" (can't they come up with a better term?) as well.

As I wait on my pathology report and my mind races, I wonder if anyone has had a similar experience? Does this mean it has spread? I have an appointment 12/18 with my oncologist. Which seems light years away. I am still getting used to saying "the  C word."

Thanks for any help you may offer. - Carol on Cape Cod

KKing

Carol

I am stage II and one node involved.  It does mean it is invasive but is still considered early stage.  I did do chemo and rads as I had a lumpectomy.

If you need other info just ask.  Wishing you all the best.

Karen

cpanasci

Did they take the fat pad from your underarm?How was the chemo?

I am so scared...

roxy42

Hi I'm stage 2 b with one node.I'm 15 months out doing well.It is a early stage.I did 6 months of kemo and rads and tomox,now I'm on arimidex.Wishing you health and happiness.....godbless roxy

shan1171

Carol,

Fat pad?  Not familiar with that.  I had stage III invasive in both breast, had bilateral mast.  They removed about 7 nodes on each side, only one node on the left was involved.  There was no sign that it had spread anywhere else in my body and Lord knows I had every scan known to mankind.  I would definitely think your surgeon would recommend a bone scan and ct scan to alleviate your fears.  Also, the words "negative margins" are what you want to hear from the path report, which means they removed all cancerous tissue.  Because of my age and the node involvement I am undergoing a rigorous chemo regime and then radiation at the recommendation of my bc team (my oncologist, surgeons, and radiologists).  They really urge you in this direction because with node involvement there is always a random possibility that some cells have traveled elsewhere in the body and are hiding out and just waiting for the right opportunity.   I wasn't taking any chances with this beasty. 

It is scary, but you will find reserves of strength you never thought you had and women all around you of all ages and walks of life beating this side by side.

Don't hesitate to grill your dr's that is what they get paid for.  Take a pad and have all your questions ready so you don't forget anything (done that before).  Take some support with you, I took my mom.  Above all, remember, it is a disease that can be treated very effectively!

My thoughts and prayers will be with you.  

Gitane

As I understand it the lymph nodes are surrounded by a padding of fat in the underarm area.  When there are cancer cells found in the sentinel node, the surgeon will sometimes take more than just that node.  That is what happened to me.  My nodes were very small and there were many of them hidden around in the fat pad ( I agree, what a terrible name).  My surgeon just pulled out that part, taking lymph nodes from what she called "level 1".  I think there is a level 2, and a level 3, also.  She took out 9 nodes all together, though she didn't know for sure at the time how many were there.  I think this is done so that the pathologist can decide whether the cells indicate spread of cancer through the nodes, or are just isolated cells that may have become dislodged during the breast surgery.  This information will be helpful in deciding if chemo might help lower your risk. 

If you read through the posts on the chemo thread, you will get a good idea of what the chemotherapy experience is like.  Just keep in mind that different treatments have different side effects, and even knowing that, different people react differently.  There are some aspects of treatment you can anticipate, and others you just have to wait and see.  You may not even need chemo.  As much as you need information right now, be careful not to anticipate the worst case scenario.  Our brains tend to do that. 

I agree, waiting is very, very hard.   

HUGS 

Tamara67646

Carol,

I had a lumpectomy in June with the sentinel node biopsy - when they tested that node - they found micromets (less than 2mm of cancer) in that node so they removed the rest of nodes (ie the "fat pad" though my surgeon didn't use that term). That is the purpose of the sentinel node biopsy - if no cancer in the SN, then no further removal of nodes is necessary.  If they did a SNB and then removed more nodes - something was found in the sentinel node. 

In my case, none of my other nodes showed any cancer.  My onco said with only micromets in the SN - it was a "gray" area whether I am considered lymph node positive but given my age (45), he recommended agressive tx and treated me with the lymph  node positive protocal - 6 tx of TAC chemo regime followed by 6 1/2 weeks of radiation, to be followed by tamoxifin.

I am done with chemo and 1 1/2 into the radiation.  None of it is fun and not how I wanted to spend the last 6 months.  But, it is all very doable and many of the SE are temporary.

I know it is hard not to worry - not having all the information is the most difficult time. Nothing is as stressful as the waiting for results.  I agree with Gitane, don't anticipate the worst case, assume the best case scenario.

Hope your results are in soon and your tx go well.

Tamara

cpanasci

Thank you. I will stay tuned.

Robyn66

I have a question to go along with this thread, I had some found in my sentinel node and there were 10 nodes taken out in all.  Does that mean all I had was 10 lymph nodes?  I see other people talking about having 30 nodes or more?  I am more annoyed with this whole lymphadema risk than anything else.  I like lifting heavy things and not having limits.  Now I am being told I won't be able to do what I want to do and that really irritates me!!!!!  I would post this in the lymphadema forum but I don't like leaving here.  The other forums have a tendency to freak me out!  I know, sounds wierd but then you all should be getting used ot me by now

Robyn

unlimited

I did a lot of research on this when I had my lumpectomy 12/5/2006.  My sentinel node was also positive..... and had to have more nodes removed because of that.  Since my tumor was classified as GRADE 1 ( slow growing, less aggressive ) and the fear of developing LE ( lymphedema)  I wanted to make sure the surgeon would REMOVE only LEVEL 1 .. of my nodes...

Yes their are 3 Levels of nodes -- level 1 and 2 under the armpit... level 3 is in the clavical area.

Now from my research -- I found  that the average number of nodes in Level 1.... is 15 ... however some women can have 7 nodes there - or 20....everyone is different ...... IN MY LEVEL 1 area -- I had 21 NODES  !!! ..  geeez ................   all removed and cancer free.............

But I do have some mild LE to contend with -- but it is very manageable.  But you can imagine the type of " traffic jam" that I have under my armpit -- even though I still have Level 2  nodes there -- MISSING 21  makes it hard for that lymph fluid to filter back out of the arm area.   With Level 2 -- the average # of nodes would be less then 15  and with fewer yet as an average number in the Level 3 - clavical area.

Hugs and Happy Holidays Everyone

cpanasci

Hi Robyn;

As I understand it, there is no "right" number of nodes in the "fat pad." I had 20 in mine. Not to worry; it is, as ever, quality not quantity that counts.

Ditto on the lymphodema nonsense. I would've been back at work by now if not for this damned turkey baster under my arm!

Get Dr. Love's Breast Book. It's the best. 

Binney4

Hi, Robyn and all,

Just bopping in here to suggest a web site for information on lymphedema risk reduction and post-bc exercise (don't worry, Robyn, exercise isn't forbidden -- but a little information and watchfulness can pay off in keeping you "swell-free"!)

http://www.stepup-speakout.org/riskreduction_for_lymphedema.htm

Hope it helps give you the freedom you want and need!

Be well,
Binney

Springtime

I had never heard the term "fat pad" and didn't know there were three levels. I love these boards, always learning something I didn't know...

LindaLou53

I know it helps me to visualize anatomical points so here is a diagram I found that points out the location of the various nodal areas in the chest.

Lymph node areas adjacent to breast area.

A: pectoralis major muscle

B: axillary lymph nodes: levels I

C: axillary lymph nodes: levels II

axillary lymph nodes: levels III

E: supraclavicular lymph nodes

F: internal mammary lymph nodes

Typically in a standard axillary dissection level 1 and 2 nodes are removed. Level 3 nodes are usually not removed unless there is widespread involvement.  The supraclavicular and internal mammary nodes are almost NEVER removed because they pose a much higher surgical risk.

I did have all 3 levels of nodes removed in my case due to having very advanced local spread.  The number of nodes a person actually has is extremely individual.  It is also possible that the surgeon may not have removed all nodes but took as much of a sampling as he thought necessary.

Jordianna

Hi Carol,

During my surgery on July 3rd, my SNB was clear.  However, the final path report showed a micromet in one of the nodes.  I elected to have more nodes removed to see if there was more node involvement.  Fortunately, there was not. 

I finished my chemo on 12/4.  I go for my planning CT for radiation on 12/24.  I then will start 6 weeks of radiation.

My situation sounds similar to Tamara's however I was 47 at diagnosis.  My chemo was dose dense:  4 AC followed by 4 Taxol. My oncologist stopped me after my 3rd Taxol because I had started to develop neuropathy.  She is confident that I had enough chemo to safely stop and not risk the neuropathy worsening. 

Good luck during your treatment whatever it turns out to be.   I can echo the words of many others.  The anticipation for me was almost always worse than the reality. 

What really worked for me was to educate myself to what the possible SE from the treatments I was getting were, but not to assume that I would get all or even any of them.  I was very fortunate to get through chemo with minimal SE.

Best wishes.

Jordie

cpanasci

Would it be too much to ask you to let me know about your side effects? I am really quite concerned having watched my mother go through hell (admittedly in 1992). Also, I am a teacher and wonder what to tell my 7th graders, if anyone has any advice. Thanks in advance, and healthy, happy holidays to all of you courageous, nurturing friends I never have met.

RCL

I had one lymph node (sentinel) positive out of 26 and was diagnosed Stage 2B five years ago.  I absolutely declined chemo (against everyone's advice), but did have a quadrectomy, radiation and took Tamoxifen & Aromasin.    To answer your question, does not mean it has spread.  Go with your gut feeling as to making decisions regarding your treatment down the road (JUST MY OPINION).   Good Luck to you and SMILE. 

pinkhd

Linda-

How are you doing?

I am freaked a little.  My PS said he expected thst my BS would take 4 lymp nodes.  She removed 13 nodes and 3 were positive.  She {BS} said it was good news becasue they were contained and no rad since less than 4.  I has a mastectomy.  I see the ONC tomorrow.  I guess lots more tests will be on the way.   I hate needles.  Thanks for the visual.  I'll ask what was removed.  The area the supraclavicular feels sandy.

Diana