DCIS and checking nodes??

bluewillowskys

I recently had a lumpectomy due to DCIS. I am wondering if its normal to NOT check any nodes with a diagnosis of DCIS ? I have seen so many ladies posting about having nodes checked or removed , now I am concerned that maybe mine should have been checked ? I know that DCIS means nothing has become invasive. But does that mean there is NO possibility of having cancer in the nodes ? Or can you have DCIS AND have cancer in nodes too?

AnneWisc

Hi, bluewillow.  No one said anything to me about checking my nodes, either.  I'll watch this thread to see what we can find out.  

julianna51

Hi Ladies,

 I have DCIS and just had a BMX w/reconstruction and had a SNB at the time of surgery.   It may be that it was done because I was doing the MX and a SNB after that would not be possible.  I also think maybe because a biopsy can tell you about the sample biopsied but until you do a lumpectomy or MX you wouldn't know if the DCIS had become more or not.  In that case you would want the nodes biopsied.   While I was not happy to have the SNB, I knew it was necessary.  They only ended up taking 2 nodes which is great.   I do not have my pathology report yet though.

I'm sure you'll get many more responses.   Best wishes to you on your journey.  This site is wonderful to learn so much from many wonderful women.

Juls

kathleen1966

Sometimes there can be a micro-fragment of invasive cancer.  But I'm not sure if this would be near the tissue or in a node.  DCIS is non-invasive, meaning it has not left the ducts yet . So if it hasn't left the ducts, there is no way it could be in a lymph node...unless there was undiagnosed or missed invasive cancer in the breast as well. I am a bit confused though. I believe a sentinal node biopsy can only be done once. Dye is injected in the tumor (but there is no tumor with DCIS) to see what lymph node the cancer would go to first.  This node or nodes is then removed (I had five, another woman on here had 7!). They always remove these nodes to test for cancer.  So once they are gone, they are gone regardless of being positive or negative for cancer. Now they are saying that removing these nodes and radiating these nodes may have the same outcome in terms of getting rid of cancer in them (unless you have numerous positive nodes, then they are still saying take them all out). Why would they test nodes in a non-invasive DCIS cancer, unless there was a misplaced micro-fragment of cancer, or evidence that there was more than DCIS. I think it would be better to leave these nodes in there to "catch" a potential future invasive cancer.  I have always wondered, now that all of my nodes are gone on my mastectomy side, what is there to catch a local recurrence if I were to have one, in the chest wall or scar tissue.  Maybe this is why they say a local recurrence is bad once you have a mastectomy and usually means there will be a distant recurrence. Keep the nodes if you can! Most of my cancer was DCIS (7cm of non-invasive cancer that obviously became invasive).  I had no idea you could have more than one type of cancer. Good luck!

Jelson

bluewillowskys-

It is normal NOT to do a sentinal node biopsy when having a lumpectomy for DCIS. If your pathology came back with invasive BC, then that decision might change.  Many of the women with DCIS who have had sentinal node biopsies have had mastectomies. I believe a sentinal node biopsy can't be done or is difficult to do after a mastectomy has already been done.

AnneWisc -

try the search function at the top of the discussion board page using the words snb dcis lumpectomy

hugs ladies

Julie E

jyg

When undergoing a mastectomy, the nipples are gone and so is the chance to ever do a SNB since all the ducts come from the nipples. Thus, if one is having a mastectomy a SNB will be/should be done as the chance for metastastic disease to the lymph nodes is possible (likelilhood depends on many factors). Remember that the core biopsy is only preliminary - the lumpectomy/simple mastectomy or mastectomy will give the final pathology report on the cancer stage.

sweatyspice

I had a lumpectomy and did not have any nodes checked. 

My surgeon and I decided not to do an SNB and take the (small) risk of developing lymphedema, but if my pathology from the lumpectomy came back showing any invasion at all, we'd do the nodes as a second surgery. 

Luckily, the pathology report showed no evidence of any invasion, so I did not do node surgery.  I'm OK with my decision.  

If you are having a mastectomy then SNB is routinely done at the same time, because it cannot be done post-mastectomy. 

agada

Hello

Don't forget that you can be pn0(i+) for cells in the lymph nodes.  I had this.  One explanation is that the cells were pushed out of the ducts and into the nodes during surgery.  The jury is still out on this.  Pn0(i+) is still considered negative but I am seeing some papers where some researchers are calling it nanometastasis.  Sorry for the spelling errors again.

Agada

shannonW

My radiologist told me to make sure my surgeon does a SNB with my BMX(which he did). My DCIS was diffuse thruout my breast, not concentrated in one area. I would think if only a lumpectomy is needed and margins are clear and typically since DCIS isn't invasive then a SNB isn't needed with a lumpectomy. I will tell u they only took 2 of my nodes but I still have occas pulling feeling, pain and soreness in that arm from the SNB side(SE-side effects). I pray that goes away but it may never. I feel for those that are experiencing LE from many node removals. When I met with the onco postop and they told me I didn't need any further treatment at first I was like, "Maybe a little tamoxifen will be an insurance that cancer will not return anywhere." But like a co-worker told me, the doctors do this enough and see this enough to know the correct treatment course for the disease. This put things in perspective b/c there are SE's with tamoxifen and why do things if I don't need it.

mommyrnx2

I recently had BMX with TE's and Sentinal Node Biopsies on both sides.  My surgeon felt since there were areas of suspicision on the non-cancer side, I could do more biopsies or do the SNB's at the time of Mastectomies.  He felt this was important because if the final path report came back with invasive cancer on the opposite side, then I would have to go back for a more radical surgery to get the lymph nodes and he and I didn't want to do that.  My SNB's injections were not in the tumor....I think many places must do this differently. I am not sure with a lumpectomy.  I've heard people that have had it and some who didn't.  I think a lot of it is about the big picture of mammogram, biopsies, ultrasounds, and MRI's and what they see.  I had multiple areas in both breast on my tests, so it made sense for me.  I'm sure your docs know what they are doing, so feel assured.  We are all so different, even though we may be classified as DCIS. 

momma_of_3

Don't know if this helps but my bs told me a similar reason... Said if we did bmx and it came back DCIS w micro mets that they would have to do an axillary node disection. She said she hoped to get the SN but that if nothing "lit up" she would not remove anything. Some people have the radioactive part the day before- mine was a couple hours prior to surgery. And by "lit up" she meant she could find it.

helenap

i had my lump done a year ago.. they took two nodes and insisted on doing it. told me it was standard... the node removal caused me more pain and irritation than the surgery itself.. and the chance of water swelling isnt a good thing either..

i had a small area of cancer ,35 and high grade but cancerous cells that were comedo.. which is why i think they felt it was prudent to do it. women still get advanced cancer and none of the their nodes were postiive,. so who knows.

alliesmom15

I just had a BMX after being DX with DCIS with microinvasion, last friday.  They tested my lymph nodes and they were clear. I had reconstruction at the same time and just got the drain tube out today.  I am pretty happy with the way things are going and think my Foobs look pretty good.  I got one nipple saved but the other one was too close to the cancer so they couldnt save it.  The plastic surgeon said he would reconstruct a nipple in a couple of weeks when the sutures come out.  They tattoo right in the office also. 

AnewBeginning

I also have DCIS and lymph or Sentinal nodes were not biopsied.  Of course I know the biopsies on node can bring on more problems so I was happy with the decision my doctor made.  After my final biopsy on the DCIS came back it was said I had micro invasion so now Im scared of mets after reading posts with similar dx as mine.  I guess I will just live with worry now.

hugs to ya!

AJ

AnneWisc

No No No, AJ, don't live with worry.

Talk to your doctor about it.  Sentinel node biopsy can still be done, unless you had mastectomy - your profile doesn't say.  But whatever you do, don't live with worry.  

snowflower

When I had DCIS and had a mastectomy they did not check the nodes.

Kim