Micrometastasis

Renia

Guys, I was wondering if anyone knows the significance of micromets. My mom has been diagnosed with Stage 2, grade 1 IDC, measuring 2.4cm ( which pushes her into stage 2). her sentinel node biopsy was negative, but out of 5 nodes taken out 1 had micromets measuring 0.6mm in greatest dimension. She is ER/PR positive for both. Her2neu negative, and she is post-menopausal. She had a lumpectomy with clean margins three week ago. We are waiting for Oncotype to help us determine what else besides radiation she will have. Chemo or hormonal therapy. I was told by the surgeon, the oncologist as well as radiation oncologist that she does not need axillary nodes dissection, in spite of the fact that there was one node with micro-mets. I am worried though. Anyone with similar experience? I am just paranoid ( normal part of the process I guess) that we are missing something. Please let me know what do you know about this. Renata.

wendy57

From the 2008 San Antonio Breast Cancer Symposium: (although referring to Sentinel lymph node micrometastasis - my guess is it would hold true to non-sentinel node micromets)

SAN ANTONIO, Dec. 16 -- The presence of micrometastases or isolated tumor cells in sentinel lymph nodes significantly increased the risk of breast cancer recurrence and needs systemic therapy, according to an analysis of a large Dutch database.

Micrometastases or isolated tumor cells were associated with a 9% absolute reduction in disease-free survival compared with negative nodes, Maaike de Boer, M.D., of University Medical Center in Maastricht, reported at the San Antonio Breast Cancer Symposium here.  

Among patients with micrometastases and isolated tumor cells, adjuvant chemotherapy eliminated the recurrence hazard, making disease-free survival the same as in patients with clear nodes.

"In the group of patients not receiving systemic therapy, isolated tumor cells and micrometastases both were prognostic factors for disease-free survival," said Dr. de Boer. "More remarkable, the prognostic impact of isolated tumor cells was as large as that of micrometastases. Our data show that patients with isolated tumor cells and micrometastases benefit from adjuvant systemic therapy."

 The prognostic significance of micrometastases (>0.2 mm to 2 mm) and isolated tumor cells (≤0.2 mm) has remained controversial, as studies yield conflicting data. In the absence of definitive evidence, no consensus exists about the role of adjuvant chemotherapy in patients with residual micrometastases or isolated tumor cells

idaho

From what I understand she does not need axillary node biopsy because they are probably going to treat her with chemo anyway, and that will kill all the cancer in her body, she will also probably have radiation which will concentrate on her breast and under her arm so it will make sure all the cancer cells are killed in that area.  So even if there are more nodes involved it will be taken care of.  I wouldn't want to go through another surgery to see if there are more nodes positive, because they will just do the same thing anyway.  The docs won't miss anything.  Just my opinion- Good luck to you and your MOm, Tami

Renia

Thank you for responding. I did my own research as well, and even though the data seems to be confusing, the current suggestion is that ALND is not necessary in these patients. The significance of micromets in long term survival remains to be seen. Thank you once again, good luck to you Tami as well. Do not know what I would do without this board.

sarabhealed

I just wanted to add that I had a micromet in one node and did not have more nodes removed--lymphedema is a big concern and I agree with idaho and the docs to pass on more surgery. I also had a low oncotype DX score and passed on chemo as well with my doctors blessing. For some cancers hormonal therapy is far more effective than chemo and obviously chemo should be avoided if you don't need it--better to improve your immune system than destroy it. I would see what the test results and your doctors say--it may become clear that your mom does need chemo, but maybe not--more toxic treatment does not automatically mean a better outcome--and chemo doesn't equal cure

Renia

Sara,

Thank you for your words, it means a lot. We just got my mom's oncotype DX score, and it was low as well, so as we do not have to go through chemo but radiation and hormonal. I know that cancer is like give and take game, not all treatments equall cure, rather it is a fighting by trying to use the most efective weapons. Appreciate once again, sounds like we are in a simmilar situation.

I have another concern though, perhaps some of you can shed some light on it. My mom's surgery was on March 16th, which is a month go. We had an appoitment with an oncologist last week, and with radiation oncologist as well. Now we got the results of the oncotype, which means starting radiation next. I called to make the appoitment for simulation ( the first one) and the Dr. is on vacation next week, so the first one I got is on the 30th. Then it takes about 10 days for the department to get everything ready, and she will start her radiotherapy in mid May, or so. I am concerned that it is taking too long from the surgery to additional therapy. Does it matter how long you wait? I would imagine waiting to long is an issue, but how long is to long? A month or two? Please let me know your thoughts.

Renata

Nthrutheoutdoor

I know this is an old post, but just wanted to add this in case someone came across it. I met with my RO last week and he said radiation treatments should start no more than 14 weeks after surgery. I had my surgery in early March and am now hoping to start radiation in early to mid May, putting me at somewhere around the 8-9 week range

Hop3ful

hi...i just signed up here nd saw your post...hiw is your mom doing right now? It has been 8 years already...i hope all is well