Axillary dissection (no sentinel) reason: chemo before surgery

sophiafred78

Hi, I'm new here. I was dx with IDC, grade2, HER+, ER+. I have a large area of DCIS and a few small tumors, so mastectomy is inevitable. I was also expecting chemo after surgery, but doctor wants chemo before surgery to (chemo - surgery - chemo again). I agreed because I'm 34 years old and want to minimize my chances of recurrence. Here's my problem: he says he's going to perform total axillary dissection (without sentinel test) because I'm having chemo before. Nothing so far indicates there's cancer in the lymph nodes (not on mammo, not on MRI, there's no swelling). I'm having a hard time accepting this without even the sentinel lymph node test, he can be making a total dissection of negative nodes. He says it's because once you had chemo you can't tell if there was somthing on the lymph nodes before chemo. Anyone else thinks this is to radical??  

rozem

sophia - I had chemo before surgery and only had a SNB - I did not show any positive nodes during pre-chemo imaging either and i did not have a snb prior to starting chemo.  I was told if the snb after chemo was just as accurate as before.  I really think they want to do a full axillary dissection on you because you have more than one tumor.  When you have more then one tumor they cannot be completely sure which is draining to what sentinal node.  I believe this is standard for multi-focal, i would certainly ask for clarification from your BS

Lou10

Sorry you're here. 

I'd probably question the purpose of the ALND surgery. If the main purpose is staging, and you're having aggressive systemic treatment any way, then what is the benefit? 

Is the reason for the chemo before surgery to shrink the size of the tumour and therefore get better margins? What about having the SNB first? I know it means two surgeries but it may mean fewer long-term complications.

Even if you are found to have some lymph node involvement, you may not need ALND surgery. You may be a good candidate for radiation to the lymph nodes instead.

 Just some thoughts. Good luck.

sheila888

Sophia Welcome....

We have a Thread which might help you as a Triple+ DX.....Hugs

http://community.breastcancer.org/forum/80/topic/764183?page=419#post_3296117

sophiafred78

Thank you so much for all your answers!

@rozen: I've heard of people with more than one tumor having the sentinel node test, but I'll ask him if that's a reason, he just said that he wanted an agressive approach due to my young age, hence the 2 chemos.

@Lou10: I definately think that a small surgery just for the sentinel node is a GREAT idea, before starting chemo. I'm gonna ask if that is a possibility.

@sheila888: thank you, I'm gonna check that link for more information. So glad I found this forum!

sophiafred78

Just wanted to give you guys an update: so I put my foot down and said that I wanted more tests before starting chemo (since once I started chemo, that meant full axillary dissection, in doctor's opinion). He was very sensitive to my request and send me on a race of all kinds of tests, which I can't translate because I don't know how they are called in the US, but one of them was a bone scintigraphy, a CAT scan, a full check up of my ovaries, something called a PET scan, etc., etc. The results came back negative. So far it looks like there's nothing cancerous in my body beside my left boob. Facing these results he changed his mind and I'm going for a mastectomy next thursday, the 29th. I will be having the sentinel node test, so I am happy because I have a chance of keeping my axillary nodes (or at least part of them). Thank you guys for your help, this forum is an amazing source of information and emotional confort! Hugs )

curveball

@sofiafred78, now that you have your surgery scheduled you might also want to ask your doctor about the Oncotype DX test, especially if your SNB comes back clear. In some cases, it's possible for the detriment of chemotherapy to be greater than the benefit. The Oncotype can throw some light on whether you will probably  benefit from chemo or if in your case it is more likely to do harm than good.

sophiafred78

@curveball, thank you so much for your advice, I'll ask my doctor but I think that they don't do this Oncotype test where I live, I'm from europe. I know it's expensive and I have no insurance, but I do have savings and so do my parents so money wouldn't be much of an issue. In my country there's a national medical service that's meant to be free of charges, but in fact it means waiting lists for surgeries, less exams, more waiting for results, etc. So I've been showing the €€€ to get my diagnose and treatment as soon as possible.

curveball

@sophiafred7, there are similar  genomic tests available in Europe, with links also in the main breastcancer.org site. I hope you can get the info to help you decide about your treatment plan.

The other thing I notice is you are also HER2+. I don't know much about that type of cancer but ISTM I've read on the site somewhere that Herceptin unaccompanied by chemo is still being studied to see if it is effective that way. It may be your doctor is advising chemo because you will be getting Herceptin. Also, your age may be a factor in prompting your doctor to suggest aggressive treatment.

sophiafred78

@curveball, I've checked and I think I can get the Oncotype, at least order it from Spain. But I highly doubt he will let me off chemo, since his first approach was "chemo - surgery with full axillary dissection - chemo again". I'm so glad that I convinced him to at least give me a chance to keep some of my axillary nodes that I'm concentrating on that. Surgery is this thursday, I'm gonna "check in" tomorrow at the hospital. Later I'll discuss again with him if he thinks I can get that test done. One battle at a time! ) But definitely my age is a factor, he said it himself. Thank you so much for your suggestions! Hugs ) (the last one with 2 boobies LOL)

sophiafred78

Hi guys, quick update. Surgery was on November 29th, as soon as I woke up I asked for my arm (I meant my axillary nodes) and they were all gone   The sentinel node test came back positive, so Dr. did full axillary dissection. Well, at least surgery is done and my cancer is in some lab right now and not on me! Thanks for your support, I'll be around for updates on this journey to recovery.