Chemo or not? Metastatic to 1 intramammary lymph node

Mariebee

There was a similiar thread, but it was from 2009 (if I remember correctly) and didn't answer all my questions, so I thought best to start new thread.

I had a partial mastectomy and sentinel node removed.  Pathology report reveals negative SLN (sentinel).  However, adjacent to the IDC tumor, was one intramammary lymph node with DCIS.

Are positive lymph nodes (any nodes) considered "positive" regardless if IDC or DCIS?

I'm awaiting oncotype test results now to help determine if I go the chemo route or not.  Has anyone had similar diagnosis, and would you share your treatment selection? 

From my surgeon I got the impression that radiation would be enough to deal with the intramammary node (and tamoxifin), but he did defer to oncologist.  The oncologist (who admitteded he looked it up right before our meeting) stated that recent thinking is the treat positive intramammary the same as positive SLN.  So he is recommending chemo, but he deferred finalize recommendation until after oncotype test result.  Well I have many friends that had one positive sentinel node and they didn't do chemo (or an oncotype test).  And it seems odd to me to recommend chemo when the positive node was DCIS.

Anyone have experiences, thoughts or opinions to share- I've just really begun my research, and not finding a lot with (non axillary) intramammary nodes.  Thank you. 

Oh and as a point of curiosity, none of this can be seen on mammogram- found lump/tumor myself- does show on ultrasound and MRI. 

sweetbean

Sorry to hear you are dealing with this!  Positive is positive - I don't think they classify nodes as IDC or DCIS.  If it has traveled to a lymph node, it's invasive.  Also, an intramammary node is not a sentinel node - it's very serious, because it can't be removed the way a sentinel node can. 

hrf

I agree with sweetbean. It's not DCIS if it's in a node - it is invasive!!!! That means there could more floating around that are too small to be seen with our current diagnostic tools. It's the medical oncologist who knows these things ... not surgeons.

Mariebee

Thanks so much for the fast reply. Excellent info for me while I'm getting myself educated.

I have my follow up w/ the surgeon tomorrow so I can validate this.., but the way the pathology report reads, and what I understood it, the intramammary node was removed during the partial mastectomy.

Jeannie57

Hi, Mariebee,

I'm sorry you have to go through this.  I was diagnosed on January 29th. Good for you for starting to research and ask questions!  There is so much information. What I have found so far in my short journey is that it's best not to compare my cancer with somebody else's.  There are so many factors that go into it, including menopausal status and age, all the descriptions in pathology reports, sizes of tumors and cancer in nodes, characteristics of tumors and nodes.  My cousin had much more extensive ILC than I, had a bilateral MX like I am about to have, had a good number of cancerous nodes and yet she didn't have chemotherapy, based, I guess, on the Oncotype. She is also in another state. I have already been told I will have chemotherapy because the one sentinel node had a good size tumor in it and my grade of the original tumor went from Grade 1 initially to Grade 2. We'll have to see after surgery if there is more node involvement.  While I dread chemotherapy and hope it doesn't kill me(!), I do want all those stray buggers eliminated.  Keep asking questions and be sure you have doctors whom you trust.  They want the best outcome for you and we all do, too!

Mariebee

Again, thank you for the responses and support.  Wishes, luck and prayers to you all. I will pass on the graciousness to others as I enter into discussions on this site. Thank you for the inspiration.

I did confirm (with my surgeon) that the positive intramammary lymph node was removed. I confirmed that per the pathology report that that node was DCIS- which is fairly common in any positive lymph node (for it to be DCIS (precancerous) and not IDC).

I should also note (as a point of interest) that 10 days after my partial mastectomy, I had a breast reduction.  So even more of my breast was removed, and there was no other cancer found in the further tissue removed. 

Oncotype doesn't seem to be a commonly ordered test.  It seems to be common with "cases" where there is a possibility of not proceeding with chemotherapy.  It's just another indicator to help with the decision.

Two appointments with different oncologists the week of Mar 19- so that's when I'll be making my chemo or no chemo decision. 

jacee

Mariebee- I think sweetbean was talking about an "internal mammary node", rather than an "intramammary node". You will find on these threads that many women get them confused and use the terms interchangeably in some cases. Internal mammary nodes are on both sides of the breastbone in between the intercostal area of the ribs. They are rarely removed. I did have one as my sentinel node strangely enough...and my surgeon was able to remove it....lo and behold it was positive. She said it's the first one she's ever removed in 10 yrs of surgeries. 

So, not at all that odd that your intramammary node was removed. So glad to hear no more cancer was found with your reduction. Hoping you don't have to do chemo, but if so, it's doable. So much good info on the chemo threads. Hugs to you....Joni

Beth-In-Tenn

Hi Mariebee,

I'd love to hear what treatment you decided on and what your Oncotype score was.

My pathology report also showed that I had an intramammary lymph node (IMLN) that was "involved by metastatic mammary carcinoma" - and was 4 mm in size.  That was in addition to two other IDC tumors they found, none they knew about prior to my mastectomy (and none that showed up on the mammogram, including the 3 cm primary tumor).

I'd never heard of an IMLN prior to my report and my research hasn't turned up much info... I think there's still a lot they aren't sure about.  These findings did cause my MO to change the planned chemo drugs and increase my sessions from 4 to 6.  We were already planning chemo since I scored a 40 on the Oncotype test, and also in the high risk category on the MammaPrint test which evaluates 70 different genes.

Let me know what you ended up doing.

Mariebee

@ Beth-In-Tenn

My oncotype was 25.  Primary tumor (not seen on mammogram) was 2.5cm (25mm) and the surgery revealed (removed) an intramammary node that was 2.5mm.

I went into a clinical trial and was randomized to no chemo. I am also on lupron and arimidex.  (Not tamoxifen because I have history of blood clots)

Here's info on the trial http://www.clinicaltrials.gov/ct2/show/NCT01272037?term=s1007&rank=1

Clinical trial S1007. A Phase III, Randomized Clinical Trial of Standard Adjuvant Endocrine Therapy +/- Chemotherapy in Patients With 1-3 Positive Nodes, Hormone Receptor-Positive and Her2-Negative Breast Cancer With Recurrence Score (RS) of 25 or Less

According to my oncologist the latest "thinking" is to count an intramammary node as a postive lymph node.  He did admit there is controversey around intramammary nodes, and he did research on the topic for our initial meeting.

Lee7

Mariebee,

I see you are in the RxPonder trial. I wanted to take part in it but I had already started treatment when I found out about it.  My oncoscore was a 20, I had 1 positive node, and I did not do chemo. I had rads and am on Arimidex now. 

There are threads about Arimidex and the SE's with lots of good info. 

Mariebee

@Lee7

Yes, I'm in the RxPonder trial.  My oncologist brought this option to me.

Sorry you missed the opportunity to be in trial.   As I've said in other posts, I was a constant flip flopper about the chemo decision, and decided the randomization of the trial was just as good of a decision making process as any, given that no one could tell me the "right" path of treatment for me.

So far so good with lupron and arimidex (4+ months into that treatment plan), the SE's haven't been bad for me (or haven't been on them long enough).  And yes, lots of good info in other threads on this topic.

Thanks for sharing, and I find it empowering when I hear more and more people that chose not to do the chemo route. 

cookiegal

Mariebee Good for you for doing the trial.

I had one node, oncotype of 22, and declined chemo, but believe it or not it was a different world back in 2009. I was going to do chemo, until Oncotype put out a press release that there was no significant benefit for intermediates with positive nodes.

That kind of did it for me.

Good luck!

cookiegal

Mariebee Good for you for doing the trial.

I had one node, oncotype of 22, and declined chemo, but believe it or not it was a different world back in 2009. I was going to do chemo, until Oncotype put out a press release that there was no significant benefit for intermediates with positive nodes.

That kind of did it for me.

Good luck!

Rubybleu

Hi Ladies,



Not sure if anyone is watching this thread anymore, but here goes. I had a bmx on 11/20 and although my sln was negative, they found (by accident) a positive intramammary node (1.1 mm). I know some of you had this experience. Any feedback? So strange there is so little info on this. I am staged at 1b. I am very confused and worried about this little explained node status.



Thanks,



Ruby