Node that won't shrink with chemo

Babs37

I am 37. I' ve been diagnosed with TNBC in august and I'm now going through neoadjuvant chemo since september (4DD AC + 12 weekly Taxol ending the 20th of January) I have 3 different masses in my right breast, 1x 4.5cm, 1x 1.5cm and a smaller sattelite mass). My Pet scan showed 3 positive nodes. No mets anywhere. After my 3rd AC chemo my 3 masses in my breast disappeared and my node shrunk from 2cm to 1.5cm and has not shrunk till then. I have 4 Taxol to go. My question is: Did anyone go through that situation? And if the lymphnode is still there after the chemo is finished, did anyone had to have other chemo after their breast surgery?

Thanks. 

Meggy

I had a somewhat similar situation.  just 2 doses of AC flattened my breast tumor but my node took much longer to go down.  It did go down on the 4th dose...but I wish I had done a 5th and maybe 6th dose of AC before starting taxol.  At the time I did not know you could do that.  If you read my signature, I did take 2 more AC after surgery but who knows if it worked using the same drug with that interuption for surgery. 

After my surgery (bilat) plus full disection of the axillary which I would guess they would recommend with that stubborn node...

 Upon surgery I was lucky to have only one tiny bit of cancer left in one node (not a sentinal node...so I was glad I had the disection.)  I then went onto a platinum based drug (carboplatin plus taxotere).  Then I did rads.   I feel very very good about having done the extra chemo.  I this mother takes me down...no one can say I didn't put up one hell of a fight.  I have no regrets except wish I had done more AC at the time it was so clearly working.  I acutally was going to do more AC after the Taxol but before surgery and my surgeon spooked me (wrongly).  He told me my node was back.  he was wrong but I rushed to surgery.  I think more AC for me before suregery would have had more power.  Just my thought.  AC was clearly my cure...wish I had known you can take more while I was taking it. 

My doctor wasn't seeing me at all of my appintments at the time.  That was a shame.

I am nearing my 3 year anniversary since starting chemo.  I've done a  lot of stressing but lately I've been feeling cured again.

Bless you sister.  May God watch over us all.

Meg

Suze35

I'm in a similar situation.  After 4 weeks on Carbo/Taxol, my tumors are no longer palpable, but 2 of my lymph nodes are.  My doctor said that nodes can build up scar tissue and dead cancer cells, so they can take longer to react.  She even had a name for it, but I'm blanking right now...I still have 8 more weeks of the C/T, so I feel pretty good, but we'll see when I have surgery.

ETA - I did 4 rounds of AC and only had a 50% response overall, which is why I'm doing the Carbo/Taxol.

Also wanted to add I found this study about scarring (it is a little old):

"Axillary lymph node scarring and the association with tumour response following neoadjuvant chemoendocrine therapy for breast cancer



References and further reading may be available for this article. To view references and further reading you must purchase this article.

J. Donnelly^f1, D. M. Parham, T. Hickish, H. Y. Chan and A. I. Skene

Royal Bournemouth Hospital Breast Unit, Bournemouth, UK

Available online 12 March 2002.

Abstract

We observed that the axillary lymph nodes of some of our breast cancer patients who received neoadjuvant chemoendocrine therapy (NCT) showed evidence of scarring. The purpose of this study is to determine whether such scarring exists and, if so, whether it is confined to neoadjuvant patients and may be related to response to therapy of the primary tumour. We examined the axillary lymph nodes of a consecutive series of 255 breast cancer patients, all of whom had undergone radical axillary dissection. Fifty-three had received NCT; the remainder formed the control group. A scar was defined as an area of cellular fibrous tissue>0.25 mm in diameter and for each patient scar count, median size and score were recorded. Nodes with scars were stained immunohistochemically (IHC) with 2 epithelial markers for the presence of occult micrometastases. The nodes of 20.7% of patients who had received NCT contained scars compared with 13.4% of controls. The median scar size was significantly greater in neoadjuvant patients (P<0.001) and within this group scar count and score were significantly higher (P=0.026 and 0.020) in those with no or minimal evidence of residual primary tumour. Scars which were IHC-positive for micrometastases were almost exclusively confined to neoadjuvant patients. Our results suggest that axillary lymph node scarring does exist, but is not a common phenomenon. It is more significant in neoadjuvant patients and within this group is most marked in those with the greatest primary tumour response to therapy. We believe that scarring is likely to represent downstaging of axillary disease. A prospective study involving a larger group of patients receiving NCT is indicated, to confirm these preliminary findings and establish whether scarring has prognostic or predictive potential."

^f1 Address correspondence to: J. Donnelly, 129 Walkley Bank Road, Sheffield S6 5AN, UK. Tel.:+44114234 6095 (home); +441226 730000 (work); E-mail: jill.donnelly@binternet.com

It makes an interesting case that the better your response to neo-adjuvant therapy, the more scarring that occured.

TammyLou

You will really, really not know until the node is surgically removed.

A piece of the formula is that the way that the cancer "dies" could leave an unresolved mass...and that would show up on CAT, etc.

The body may have a lot of dead tissue to absorb, etc.

tl 

Babs37

Thank you girls for your responses. It makes me a little less nervous about the situation knowing it could be dead tissue or scarring. I go see my doctor next wednesday so I'll know then if there' s a change in my node since the 3 last Taxol treatment. I'll keep you posted.

Babs37

bonsi77

My mom had a some what similar situation. She was DX Stage 2b/3a TNBC in July. Her tumor was 4.5cm and she had 3 nodes involved at time of DX. Her tumor shrunk by half after the first round of AC. The nodes shrunk a little on the AC but the Taxol was what took down the rest of her tumor and the nodes. She had a petscan before her BMX and everything was clean, no more nodes or tumor lighting up. We thought it was all dead. However when we got the path report back after her surgery there was some residual cancer left in the 3 nodes. The tumor was all gone but the chemo didn't get everything in the nodes. We just met with her Onc and she is going to do some additional chemo now as a precautionary measure since there was residual cancer in 3 of her nodes. Seems like she'll be doing carbo/gem 12 rounds. It's 3 weeks on and 1 week off. Even though her petscan was clear the fact that there was residual cancer left in the nodes after the neo-adjuvent increases her chance for recurrence. 

 Don't worry too much yet as the Taxol really worked well for my mom. Unfortunately it didn't get it all but at the time of her dx the nodes measure 2.5cm and prior to surgery they were no longer enlarged at all. Good luck and hoping you get complete response. 

Diane 

Babs37

Diane: thank-you for the info. At my last doctor's appointment my node didn't shrink. It was still 1.5cm. I just have 2 taxol to go so I don't think it will have time to shrink. I talked to my dr. about doing more chemo after my surgery if the node (s) have still active cancer in it. We will see. But it sure would feel "safer" for me to do more chemo after if I did not have a complete response.

I hope the best for your mom. I know that she must not be thrilled to do more chemo but if it lowers the chance of recurrrence, it's better that way. Good luck.

Isabelle 

bonsi77

Thanks Isabelle. Hope that the last of your 2 taxol's kick some cancer butt. If not definitely discuss the option of add'l chemo with your Onc. My mom's not thrilled but figures it's better than having this thing come back. She did well on ACT so hoping that she handles the new chemo just as well.

Best!

Diane 

inmate04232010

Hello all.  I am a newbie to the board.  I was diagnosed in April with TNBC stage IIa grade 3.  I recently finished chemo (Dec 3rd) and started radiation on Thursday.  I had a lumpectomy of my left breast with 14 nodes taken, 3 positive. Chemo followed surgery with 4 rounds of DD AC and 12 rounds of Taxol.  A scan taken after surgery, before chemo, showed the cancer had spread to lymph nodes in my chest.  It was thought that the chemo would take care of the two nodes in my chest.  Well, it didn't and now I get extra radiation to eliminate the "glow" in my chest.  Problem with being a "lefty" is my heart gets in the way of the radiation.  My fear us that the cancer is showing it's stubborn side and won't leave me alone, instead, coming back with a vengeance to another part of my body.

Has anyone had stubborn nodes eliminated with radiation?  

bonsi77

inmate04232010:

 Are the nodes internal mammary nodes?  Was there no talk of doing additional chemo? Carbo/Gem combo seems to be working really well on TNBC and also with Parpi. You may want to look into getting into a clinical trial. I don't know that you want to trust that the radiation will knock out the nodes. And especially that it is your left side it is very hard for them to radiate the internal mammary nodes b/c of the heart. I'd ask about doing more chemo especially carbo/gem/parpi.

Good luck.

Diane