Risk after SNB/ Lillie Shockney gets it wrong

kira66715

We have gotten quite off topic here--there was/is a thread about developing LE after SNB, and really, that is where this belongs, and this thread was to discuss the expert advice our breast cancer coach and self proclaimed expert, Lillie Shockney was writing on the Johns Hopkins site.

Lunakin, I had a very similar situation to you--seroma, axillary web and development of hand LE after insect bites--occured prior to rads, which didn't help the situation.

Current research on LE is looking at inherent risk:  genetic, inflammatory and inherent lymphatic pump disorders.

That said, some of us may be predisposed, but I'll always wonder if my seroma had been aspirated in a timely manner, if I had been informed about LE risk reduction (avoid heat, insect bites) if I could have dodged this bullet, and not be living with a chronic condition.

Those who think that sentinel node biopsy involves just the initial node, are incorrect--the procedure is to identify the draining nodes and usually at least 2 light up, and I've definitely seen mets in the second node. SNB does have a false negative rate of about 5%. I've also seen initial negative SNB, and the final path shows disease.

The NCCN guidelines are wriiten every year and reflect the latest concensus beliefs of the national experts.

I went to school--Pitt-- where Bernie Fischer pioneered the lumpectomy and while I've read the articles from the National Bowel and Breast Study, I've never seen anything from Fischer ) about the lack of benefit from node sampling for staging . If it's out there, I'd appreciate the reference.

Wasn't sure if Fischer was still alive, and found an article from Pitt that the former head oncologist from Johns Hopkins, Nancy Davidson, gave the lecture last year on his 90th birthday. Ironic, because we were going to appeal to her to deal with Lillie, and the level of misinformation on the ask an expert site.

http://www.upmc.com/MediaRelations/NewsReleases/2009/Pages/fisher-lecture-2009.aspx

I did read an editiorial in an oncology journal where they hoped that axillary sampling would some day be unecessary, but it's the current standard--to stage, and then to determine therapy--chemo and radiation.

The latest study from ASCO--and they tend to present abstracts, not the full studies--implied that full ALND after positive SNB did not translate to a survival benefit--but I haven't read the study, and don't know if they then recommended radiation to the nodes and/or chemo. From what Lunakiin posted, the study was under-powered, too few patients. Who knows what other method issues are in the full study, until it's available for Otter's expert review.

One thing that has come from the National Surgical Adjuvent Bowel and Breast Project is the oncotype dx, and my oncologist puts great stock in the predictive value of the test in determining therapy.

I'd love to move this to the LE after SNB thread, and lymphtherapist--many people don't take nodes in DCIS. But, sometimes the final path shows invasive disease, and then a node sampling is recommended.

SNB is almost never one node, the average is 3 nodes, and the surgeons around here tend to average closer to 6.

I am not an oncologist--I work in radiation oncology, but am board certified in primary care, but, my oncologist at Dana Farber loves the practice model that I'm in and the collaborative nature of my work and I have learned a lot about oncology by caring for oncology patients.

And Otter is so right: I am still very, very ticked off about developing LE after SNB, especially after my surgeon asked me how to manage my seroma, and I made the wrong choice--to leave it alone--and then told me she had no responsibility to help me manage my LE.

 She told me LE is chronic, and not her problem. My surgeon was all about cosmesis--wanted to do a mastectomy for cosmesis ("You didn't give me much to work with here."), rather than a lumpectomy (and I invoked Bernie Fischer to argue against that), and when I developed extensive post op bruising, she said "it wasn't a simple lumpectomy, I worked on you for three hours and pulled all the breast tissue out of your axillary area to make a better cosmetic result." Well, it does look good. Too bad I have a swollen hand, and my wedding ring hasn't been on since my surgery.

Let me bump up the SNB thread, and we'll keep this one for issues with Lillie.

Kira

Janeluvsdogs

Note: lymph node-dissected patients had more distant recurrences. 

excerpt from:

http://www.medscape.com/viewarticle/465484_2

A turning point in this story began in 1960 when Bernard Fisher, then the director of the National Surgical Adjuvant Breast and Bowel Program, began an ambitious study that was to be the first randomized controlled trial (RCT) investigating the value of the ELND in breast cancer patients.^[15] To the surprise of most, Fisher's study of 1700 patients failed to reveal any statistically significant survival advantage for patients undergoing ELND. Although the lymph node dissection group experienced fewer recurrences in the treated lymph node basin, this improvement in local control did not translate to a benefit in overall survival. In fact, when these patients did have recurrences, these were more likely to be distant disease. Since Fisher's landmark study, five RCTs evaluating ELND in breast cancer patients have failed to reveal a statistically significant survival advantage for patients treated with ELND.^[16] The lack of evidence supporting the value of ELND for breast cancer patients in these five trials raised significant questions regarding the dogmatic but unproven traditional approach to surgical management in patients with cancer.

Member_of_the_Club

Wouldn't patients with the full dissection have more advanced cancers and therefore be more likely to have distant recurrences?  Am I missing something here?

 OK, this is anecdotal but  . . . I had one out of three sentinel nodes positive, and therefore the full dissection, 17 nodes, although ultimately I still only had the one positive node.  Recently I went through the very wrenching process of deciding whether or not to have my ovaries removed (I finished 5 years of tamoxifen and was put into chemical menopause via zoladex).  My oncologist thought it very significant that I had a sizeable tumor that only got into one node, that this was important information about the behavior of my particular cancer and that it hadn't behaved aggressively.  As result, he wasn't pushing the oophorectomy and I chose not to have it.  What this meant to me was that the dissection wasn't just a matter of treatment but also of information gathering that was important for treatment.  We may be at the point, or fast approaching it, when this won't be necessary but i was very glad to have this information when I made this important decision. 

LindaLou53

 "They have known for years that removing nodes in breast cancer patients --even if they are cancerous--does not extend survival. So removing nodes has no therapeutic value and obsolete staging value."

I had a SNB with my first BC dx 10 years ago in which 6 nodes were removed, none of which showed up as positive at the quick pathology check during the procedure.  However, a week later after the immunohistochemistry they found micrometastasis to 2 of the 6 nodes.  My surgeon wanted to schedule me for a full ALND.  My oncologist agreed with me, however, that since I would be getting both chemo and radiation due to the micromets there was no need to do further staging or removal of more nodes.  The treatment plan would not be changed based on an ALND. The SNB had done its job in providing proper staging of my cancer.  That was a decision I have been very happy I made.

My BC history has unfortunately allowed me to see the coin from both sides and I would never go so far as to say that removing cancerous nodes does not have any therapeutic value.  With my second BC dx 5 years later (a new primary in the other breast) all the signs were ominous for nodal involvement.  Both breast MRI and PET/CT scans indicated high activity in the axillary area.  I still instructed my surgeon to start with the SNB procedure in the hope that she would not have to go any further.

As it turned out every single one of the 23 nodes she ultimately had to remove were fully involved with cancer, to the extent that several had already ruptured (extracapsular extension) and many designated as having tumor loads greater than 5mm. As dismaying as it was to be told all my nodes were positive, I was very glad they were surgically removed.  As far as I was concerned they were 23 tumors requiring removal just as much as the primary tumor in my breast.

I will never know what the outcomes might have been had I not had a total ALND.  I realize there is no way I can predict what the future holds either, but I feel very strongly that removing those cancerous nodes has played a role in why I am still here today.  Yes, I have lymphedema as a result, but in my book that is a price worth paying to be NED 5 years later with such a locally advanced cancer.

I recognize that there are many varied presentations of BC and agree that there are certainly cases where ALND is not necessary or recommended.  But I do not believe that with our current treatment capabilities we can say nodal removal is never of any value. 

Janeluvsdogs

Lindalou, you're presenting your belief which you are heavily invested in because of your history.

I'm just presenting years of evidence. Statistically, node removal has never shown any value in delaying disease progression or survival. The evidence shows you would have done just as well without node removal.

 If you read the article, you will see that the premise of how the nodes function must be questioned if removing them provides no survival advantage. Clearly, evidence of cancer in the nodes, which are an entirely different functioning organ, is different than cancer tumors in the breast.

If it seems counterintuitive to leave cancer cells trapped in the nodes, then the premise that nodal cancer leads to spread is wrong. As the evidence clearly shows.

Best continued good health.

LindaLou53

Janeluvsdogs, all any of us can ever present is our belief.  You either accept a published research as evidence or you don't.  Given the wide variance between research models, scientific process and interpretation of statistical data there is good reason NOT to believe everything you read.

I did read the article and I stand by what I said.  The article makes a distinction between Therapeutic Lymph Node Dissection (TLND) and Elective Lymph Node Dissection (ELND) of the Regional Lymph Nodes (RLNs).  They do not negate the value of TLND in the presence of active nodal tumor growth. They state in their conclusions that:

"What then are the consequences of tumour metastases developing in the RLNs? When the volume of metastasis is small, the immunological effect generated against the primary tumour can be sufficient to control potentially lethal cells in a dormant state for a long period of time^[60,61] and occasionally may result in cell death without further growth or dissemination.^[38] Removal of these clinically irrelevant cells would be unnecessary and might even be harmful from an immunological standpoint. Yet, as the tumour grows, eventual immunosuppression is likely to develop through a variety of tumour-induced mechanisms.^[62] Eventually, the normal lymph node architecture is destroyed rendering the lymph node immunologically ineffective and a possible source for further tumour dissemination. At this point, once the tumour has become biologically active and has obliterated the normal structure and function of the node, removal would serve to decrease tumour burden and potentially decrease further tumour-based immunosuppression.^[38,63-65] "

They also state:

"When no effective adjuvant therapy exists for metastatic disease, close clinical follow-up and TLND at disease recurrence is an acceptable approach in patient management. TLND in this case allows for improved local control and may on occasion even salvage a small number of patients." 

In reference to their concern about ELND they state that:

"we have demonstrated that no scientific evidence exists to support the routine elective removal of clinically uninvolved lymph nodes in any cancer in an attempt to prolong survival."

Seems like a pretty obvious statement to me and I have no problem with it.  I agree that the routine removal of healthy uninvolved lymph nodes seems totally unnecessary and harmful. 

Regarding the use of SLNB they state:

"in patients who desire more prognostic information SLNB may be a more appropriate intervention. When proven effective adjuvant therapy exists for patients with cancer, SLNB can be used as a staging tool to determine those patients eligible for adjuvant treatment."

They state:

We believe that the reason ELND does not benefit patients with cancer is because the RLNs are not mechanical filters or dams preventing the spread of tumour to the systemic circulation but are instead indicators of the presence of systemic metastasis.

For all I know they might be right, but I do not see where there is any evidence that "clearly shows" this is the case.  Even if it is true there is nothing in their article to indicate they would not fully support the removal of nodes which were involved with cancer to the point of architectural destruction as mine were. 

I am sure the medical community's understanding of the lymphatic system and the full role it plays is far from being either totally accurate or comprehensive. I would never presume that anyone has a corner on understanding all the complexities of the human body.  Hopefully our knowledge will continue to improve and treatments will become more effective and less damaging.

 I stand by my earlier statements: 

"I would never go so far as to say that removing cancerous nodes does not have any therapeutic value."

"I do not believe that with our current treatment capabilities we can say nodal removal is never of any value." 

Janeluvsdog I appreciate your point of view and your right to express it.  The only reason I felt the need to post was your statement  "So removing nodes has no therapeutic value and obsolete staging value."    After reading the research article you posted I just don't see how you can make that statement.

Member_of_the_Club

I would add that there used to be a belief that if bc is diagnosed as metastatic from the get-go, that there is no reason to remove the primary.  Lately there has been movement in the opposite direction, with the idea that lowering the tumor load by removing the primary does have benefit for patients with mets.  Granted, distant metastasis occurs through the bloodstream, so removing nodes isn't "blocking" that but if there is a heavy tumor load in the nodes, as LindaLou says, removing the nodes decreases the work that the adjuvant therapy has to do.  I think these new studies apply to folks like me who have minimal nodal involvement.  But as I pointed out iin my earlier post, reenforced by LindaLou's post, there is an information gathering element to this as well, not just an impact on survival element.  For me this has been extremely important.  I can imagine it wouldn't be so for others.

I know these new studies are important and that practices change but we should be careful about definitive statements here because there are nuances and everything is in flux. 

kira66715

Not sure I want to wade into this, but lets look at some published medical articles:

MOTC: I read a NEJM case report about a woman with a single met, and they didn't resect her primary and her disease progressed, and the discussion said that the thinking has changed, to treat the primary, even in stage IV at diagnosis:

Eur J Surg Oncol. 2009 Nov;35(11):1146-51. Epub 2009 Apr 26.
Surgical resection of the primary tumour is associated with improved survival in patients with distant metastatic breast cancer at diagnosis.

Ruiterkamp J, Ernst MF, van de Poll-Franse LV, Bosscha K, Tjan-Heijnen VC, Voogd AC.

Department of Surgery, Jeroen Bosch Hospital, PO Box 90153, 5200 ME 's-Hertogenbosch, The Netherlands. j.ruiterkamp@jbz.nl
Abstract

OBJECTIVE: Recent studies indicate that removal of the primary tumour may have a beneficial effect on mortality risk of patients with primary distant metastatic breast cancer (stage IV), although most of them did not rule out confounding by the presence of co-morbidity. In this retrospective study the impact of surgical resection of the primary tumour on the survival of patients with primary distant metastatic disease is investigated, taking into account the presence of co-morbidity and other potential confounders.

METHODS: Between 1993 and 2004, 15 769 patients with breast cancer were diagnosed in the south of the Netherlands. This study included the 728 patients with distant metastatic disease at initial presentation, which was 5% of all patients. Of them, 40% had surgery of the primary tumour. Follow-up was carried out until 1 July 2006.

RESULTS: Median survival of the patients who had surgery of their primary tumour was significantly longer than for the patients who did not have surgery (31 vs. 14 months). The 5-year survival rates were 24.5% and 13.1%, respectively (p < 0.0001). In a multivariable Cox regression analysis, adjusting for age, period of diagnosis, T-classification, number of metastatic sites, co-morbidity, use of loco-regional radiotherapy and use of systemic therapy, surgery appeared to be an independent prognostic factor for overall survival (HR = 0.62; 95% CI 0.51-0.76).

CONCLUSION: Removal of the primary tumour in patients with primary distant metastatic disease was associated with a reduction of the mortality risk of around 40%. The association was independent of age, presence of co-morbidity and other potential confounders, but a randomized controlled trial will be needed to rule out residual confounding.

Now, I haven't really researched the controversy about ALND vs. SNB, but here's a quick pub med search result

http://www.ncbi.nlm.nih.gov/pubmed/19108002

Br J Surg. 2009 Jan;96(1):40-6.

Impact on regional recurrence and survival of axillary surgery in women with node-negative primary breast cancer.

Axelsson CK, Düring M, Christiansen PM, Wamberg PA, Søe KL, Møller S; Danish Breast Cancer Cooperative Group Surgical Study Group.

Collaborators (16)

Axelsson CK, Düring M, Møller S, Møller NG, Ravnsbaek JD, Sørensen J, Adlouni W, Christiansen PM, Wamberg PA, Kryh D, Rasmusen NR, Søe K, Holtveg HM, Pedersen AE, Friis E, Nielsen BP.

Department F of Breast Surgery, Herlev University Hospital, Copenhagen, Denmark. cax@dadlnet.dk

Abstract

BACKGROUND: This study examined whether axillary lymph node dissection (ALND) with removal of many normal lymph nodes resulted in a reduced rate of axillary recurrence and better survival, as reported in recent studies.

METHODS: The follow-up analyses were based on 8657 patients with node-negative primary breast cancer treated solely by surgery. Median follow-up was 9 years.

RESULTS: The number of lymph nodes removed correlated with a reduction in the rate of subsequent axillary recurrence (from 2.1 to 0.4 per cent; P = 0.037), local recurrence (from 7.4 to 3.8 per cent; P < 0.001) distant metastases (from 15.0 to 10.3 per cent; P < 0.001) and death as first event (from 7.5 to 5.5 per cent; P = 0.012).

CONCLUSION: When ALND is indicated, at least ten axillary lymph nodes should be retrieved. The role of ALND as primary treatment has decreased significantly during the past decade. The findings leave the concept of the sentinel node biopsy intact, as a highly specific procedure compared to ALND. Copyright (c) 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

So, this is in node negative women.

I am going to start a new thread, so we don't dilute the Lillie Thread.

One last article, about the controversy if the SNB is positive:

J Clin Oncol. 2009 Jun 20;27(18):2946-53. Epub 2009 Apr 13.
Comparison of sentinel lymph node biopsy alone and completion axillary lymph node dissection for node-positive breast cancer.

Bilimoria KY, Bentrem DJ, Hansen NM, Bethke KP, Rademaker AW, Ko CY, Winchester DP, Winchester DJ.

Cancer Programs, American College of Surgeons, Chicago, IL 60611, USA.
Abstract

PURPOSE: For women with breast cancer, the role of completion axillary lymph node dissection (ALND) after identification of nodal metastases by sentinel lymph node biopsy (SLNB) has been questioned. Our objectives were to assess national nodal evaluation practice patterns and to examine differences in recurrence and survival for SLNB alone versus SLNB with completion ALND. PATIENTS AND METHODS: From the National Cancer Data Base (1998 to 2005), women with clinically node-negative breast cancer who underwent SLNB and who had nodal metastases were identified. Practice patterns and outcomes were examined for patients who underwent SLNB alone versus SLNB with completion ALND (median follow-up, 63 months). RESULTS: Of 97,314 patients, 20.8% underwent SLNB alone, and 79.2% underwent SLNB with completion ALND. In 2004 to 2005, patients were significantly more likely to undergo SLNB alone if they were older, had smaller tumors, or were treated at non-National Cancer Institute-designated cancer centers. In patients with macroscopic nodal metastases (n = 20,075 during 1998 to 2000), there was a nonsignificant trend toward better outcomes for completion ALND (v SLNB alone) after analysis was adjusted for differences between the two groups: axillary recurrence (hazard ratio [HR], 0.58; 95% CI, 0.32 to 1.06) and overall survival (HR, 0.89; 95% CI, 0.76 to 1.04). In patients with microscopic nodal metastases (n = 2,203 during 1998 to 2000), there were no significant differences in axillary recurrence or survival for patients who underwent SLNB alone versus completion ALND.

CONCLUSION: Compared with SLNB alone, completion ALND does not appear to improve outcomes for breast cancer patients with microscopic nodal metastases; however, there was a nonsignificant trend toward better outcomes with completion ALND for those with macroscopic disease.

I'll do more research on it, but I suport LindaLou's approach to removing all the macroscopically involved nodes, and I know when we read path reports and see extracapsular extension, it's considered a very negative sign.

Kira

lymphtherapist

regarding seroma.  As a lymphedema therapist, it is contraindicated to treat a seroma with manual lymph drainage.  The treatment of choice is compression only.  The idea is to apply pressure to increase fluid drainage into the lymphatic vessels and would encourage flap adherence to the chest wall, thereby allowing swifter resolution of seroma.  I don't usually see a correlation of seroma and lymphedema.  The person may have both conditions simultaneously, but one doesn't usually cause the other. 

kira66715

The treatment of seroma is to drain it, and there is an established correlation between seroma and lymphedema--it's documented in the International Best Practices for Lymphedema Concensus document which is linked on our home page:

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

Here is the document, and as a LANA certified therapist, I hope you've seen it already

http://www.activahealthcare.co.uk/lymph/pdfs/lf_best_practice.pdf

Page 3: risk factors for UE LE

Upper limb/trunk lymphoedema
■ Surgery with axillary lymph node dissection,
particularly if extensive breast or lymph node
surgery
■ Scar formation, fibrosis and radiodermatitis
from postoperative axillary radiotherapy
■ Radiotherapy to the breast, or to the axillary,
internal mammary or subclavicular lymph
nodes
■ Drain/wound complications or infection
■ Cording (axillary web syndrome)
■ Seroma formation
■ Advanced cancer
■ Obesity
■ Congenital predisposition
■ Trauma in an 'at risk' arm (venepuncture,
blood pressure measurement, injection)
■ Chronic skin disorders and inflammation
■ Hypertension
■ Taxane chemotherapy
■ Insertion of pacemaker
■ Arteriovenous shunt for dialysis
■ Air travel
■ Living in or visiting a lymphatic
filariasis endemic area 

I had a seroma that caused me to have extensive axillary webbing--over a dozen cords--and in the midst of this impaired situation, I sustained insect bites on a hot day and that triggered my lymphedema.

I was getting MLD, from reputable therapists, and none tried to treat my seroma--it was ultimately aspirated months later, and a large volume of pure, serous, lymphatic fluid was drained, Afterward it waxed and waned for a while and finally resolved, but the damage was done.

Kira

MRDRN

Thanks for this very informative thread !

kira66715

Thanks for reminding us that the LE information on bc.org is still unchanged. I got the course info for the Survivorship Conference at Dana Farber for this year, and there's a lecture on "Rehabilitation of the arm after breast cancer treatment"--no mention of LE, but last year they denied it existed. And the mission of the Lance Armstrong Survivorship Clinic is to treat LE--it's mentioned right in the mission statement.

 And, I always knew they sold LE products on the 9th floor, but only while searching for a price for a garment, did I discover that they had a fitter and a perometer. There is absolutely no information given out about that service. Because, like Johns Hopkins, none of their patients get LE...

Kira

Binney4

Well, okay, so I'm just dropping by this evening to read posts, and who should I find pictured at the top of every page on the LE forum, but Lillie, being touted as My Breast Cancer Coach. (Not!) So it occured to me once again that we have yet to see any of the much-needed changes to the lymphedema information pages here at bc.org, or even any indication of whom they might be consulting to review and improve the LE information. This site is otherwise so excellent as a reliable resource that I really want to see it become a trusted source for women dealing with this crummy condition.

Mods? What news?

Thanks!
Binney

Member_of_the_Club

I'm not sure they read the threads.  We probably should PM them.

kira66715

EEK--she just popped up as my coach. This is too much. I think we need to ask the moderators what is the timeline for updating the LE pages.

Kira

missrwe

bump.

Suzybelle

I just PM'd the moderators.  I am totally frustrated that this hasn't been done yet.

Geez.

kira66715

Binney has pointed out that bc.org has pursued the Lillie ads as some sort of fundraising, so there was never any way they were going to discredit her.

BUT--they still should have decent LE information on the site.

I pm'ed the moderators too, no response. I think Binney has some plans. 

It's unthinkable that they don't address this: I realize finanaces are tight, but my goodness, there are women on this forum who could re-write the information easily.

Thanks Suzy.

Kira

Suzybelle

Kira,

I haven't gotten a response to my PM...I'm extremely disappointed.

I am prepared to deal with ignorance and apathy about LE in other places, but it's hard to understand when it's here...and as you say, there are some incredibly knowledgeable women in our forum who would take it on and be happy to rewrite it if they don't have the time or inclination.

cs7777

One thought -

There's a pinned thread at the top of the LE after Surgery forum that is the links to the LE pages on BCO.  And as you all note, the info on those pages is incomplete and out of date.  I suspect a lot of women on BCO looking for LE info do what I did - come to this LE after Surgery forum, see that nicely pinned thread, read it, and jump over to the BCO LE info pages.  Then we take that info  as the latest/greatest since BCO is recommending we read it. Perhaps you could request to unpin that thread so its no longer so prominent until they update the LE pages, since it's sending newbies to out-of-date info.  Or request to modify the post to include a link to the LE step-up speak-out website (or other uptodate LE info) as well.  It was started by someone named Melissa.  Is that a moderator?  You could provide the exact language for the post so it would be easy to make the modification if they're willing.  I'd do this myself but I'm much less informed about LE than many of you on this thread are and am not as able to make the case as you would be.

kira66715

Great idea: I'll pm Melissa the moderator right now.

Kira

Suzybelle

I got a pm from Melissa saying that they are almost ready to launch the new info.  She will let us know the exact date soon.

faithandfifty

Really great to hear there is progress in the wings.

Anonymous

Thank you for pursuing the updating of this info. You guys are the best!

missrwe

bump.

hollyann

I have mild LE in my left arm and I was wondering how to gt rid of the achy feeling I have all the time.......It feels heavy and aches all the way down to my wrist and thumb.......Self-massage isn't working anymore............Love this thread!......

MRDRN

I had my arms and hand strength throughly measured pre op in the PT dept at Mercy....I was definately weaker on the left.  This is a very good thread !  VERY INFORMATIVE ))  It seems like the achy feeling can last for months after surgery.  Now that I am 2 months post op and exercising I notice a big difference but still do have the achy feeling and can always go back to the PT to see if measurements changed.  I was diagnosed at Hopkins (they couldn't do an immediate DIEP with the Bi Lat Mx) so I went to Mercy with Doc's who used to work at Hopkins. I have had an awesome experince there and feel blessed that I was referred to Mercy ! )) 

Binney4

Just kinda wondering how the BreastCancer.Org revisions are coming along.

Melissa? Anyone?

We REALLY need that information updated and corrected to reflect our reality and offer all of us the kind of guidance we've all come to depend on here when it comes to BC treatment. Please!

Thanks!
Binney

Member_of_the_Club

Bump

lago

My BS said that even removing the breast can cause lymphoma. I had sentinel on the left (4 nodes). Although the risk is lower with just a sentinel I find the hospital is very diligent about not sticking me or blood pressure on that arm.

On the right I had 10 nodes removed. All clear. The reason the BS did this is to make sure there was no micro-invasion. My tumor was large, aggressive grade3/HER2+. The chances of a micro invasion was like 80%. Having this knowledge allowed for proper staging and treatment. Had they not done this I bet I would have had to go through at least 8 rounds of chemo instead of 6and maybe rads too. I think I rather lose 10 nodes then have more chemo and rads. Chemo/rads have more serious SE.