Can I have masectomy without removal of nodes?

jojo68

Thanks for the info!  I am applying to Dr. Gonzalez tomorrow in NYC, if accepted, I will be anxious to hear his thoughts...

LindaLou53

Joellelee, Beesie has given you excellent information regarding radiation which is well worth your review.  I am glad to hear you are considering allowing further node removal to gain better insight into your status.  I hope you will keep your options open even after speaking with Dr. Gonzalez until you can determine the full degree of your cancer involvement. 

I did want to make a clarification though to something you said referencing my earlier post.  I have not had a recurrence of the same breast cancer.  I have had two different primary breast cancers, each a different cancer type in different breasts. Approximately 5% of women with an original hormone positive breast cancer dx will have a second primary dx, which is not a recurrence of the original cancer.  One is not related to the other. The incidence of second primary breast cancers is higher in women with an original triple negative breast cancer.

http://ww5.komen.org/BreastCancer/PersonalHistoryofBreastCancer.html

"Breast cancer survivors have an increased risk of getting a new breast cancer compared to those who have never had breast cancer [74-76]. A new cancer is called a second primary breast cancer. Unlike a recurrence, which is the return of the first breast cancer, a second primary tumor is a new cancer unrelated to the first. Women treated with a lumpectomy (also called breast conserving surgery) for their first breast cancer can get a second primary cancer in either breast. Women treated with mastectomy for their first breast cancer can only get a new cancer in the other breast (except in rare cases). After either type of treatment, the risk of a second breast cancer increases over time. Close to five percent of women get a second breast cancer eight years after their initial diagnoses and about eight to 12 percent 20 to 25 years later."

After my bilateral mastectomy in 2005, the pathology report on my right breast showed absolutely no remaining signs of cancer (the site of my original IDC cancer in 2000).  That cancer was completely irradicated by my treatment plan.  It has been 12 years since the IDC dx and 7 years since the ILC dx and so far I remain NED. 

Cancer can spread outside the breast once it reaches either the lymphatic or circulatory systems.  Your cancer has already entered your lymphatic system since it has been confirmed in 2 nodes.  Once cancer has spread to those systems, surgery alone can not contain the spread.  Radiation, like surgery is a local therapy, however as Beesie mentions above, new research shows additional systemic benefit to radiation also.  It is imperative that a systemic method of treatment be utilized once cancer is in the nodes.  Chemotherapy and Hormonal therapy are the traditional systemic treatments used to destroy cancer cells circulating in the body.

Joellelee, I think you can tell by the many responses you have gotten here, that we are all just trying to help support you the best we can during this time of choosing your treatment plan.  This time period can be one of the most confusing, but also most critical in impacting your ultimate outcomes. I hope you continue to come here and discuss your thoughts and future plans because we really do care.

I don't think there is a single one of us who did not fear our cancer treatments.  It is indeed a scary time and each of us prays and hopes not only for a cure but a healthy body and quality life after our treatment is complete.  Fortunately, most of us discovered our treatment turned out not to be nearly as bad as we had feared it would be.  Plus, most of us who are years out from treatment have been able to return to a healthy and active lifestyle that doesn't involve thinking about cancer every moment of the day. I wholeheartedly wish the same outcome for you.

Linda-Ranching-in-the-mTns

The radiation oncologist I spoke with was conversant with newest studies -- and still wanted to radiate me -- including all level 1-2-3 nodes (which renders them useless). 

I realized that his extensive training was deeply ingrained -- and that he absolutely believed that radiation was the best option for me.

However, my medical oncologist had read the same studies, and agreed with me that "it wasn't crazy" of me to choose no rad/chemo, considering all my specific factors. 

To be fair -- my father (for whom I was care-taker in 2010-2011) did really well during his radiation (spot-radiation to an area about the size of a nickel, at the base of his esophogus). He also did really well with his chemo (only 2 doses, early on and then late in his 6-weeks of radiation).

But the radiation oncologist I spoke to was going to radiate the entire chest (chest wall where breasts were removed) and I have large breasts -- so that was a whole lot of area to radiate. And he was going to radiate armpit nodes and collar-bone nodes. If I radiated as he reccommended: He told me of the risk of permanent damage to my ribs, lungs, liver, pancreas, and heart. 

If I had a more agressive type of cancer, or if I was young and had BRCA, or if my cancer was more advanced, or my tumors larger (largest was 1cm, 5 others tiny and some DCIS)... I may well have made a different decision, and as Paula said "throw everything at this Beast". 

With with tiny tumors, only one node affected, and oncotype of 13 - along with his opinion that I had had the cancer in me for more than 10 years already... and my being 57, meaning I have fewer years left to protect... I am convinced that I made the right choice for me.

But another woman my same age and statistics could (I am sure) think my decision to err on the side of conservative medical measures to be fool-hardy. 

Reaserch and personal reflection are our best tools. There are no easy one-size-fits-all answers with cancer.

The one thing that I do wish is that some institution would collect the data about we who do choose less-invasive actions ... in some organized way, so that (if we who choose less are proved 'right') -- the Standard of Care could be more quickly adjusted. Or -- if the data proved us foolish (for choosing less agressive measures) there would at least be some data for future cancer patients to consider, so they wouldn't be tempted to take the same risks.

Good luck to you all -- and Joellelee -- I know you will make the decision that is best for you

Linda

jojo68

thanks again!  I do have ILC, estrogen positive and tumor is 6cm atleast...so, i am sure many feel I should throw everything at this beast!  LOL  I am doing the surgery and probably the nodes...Hopefully, I can get in with Dr. gonzalez to see what he thinks beyond that.  If I had to do chemo, i would ONLY do IPT chemo which is 5-10% of the regular strength chemo and much more effective!!!

Alyad

Let us know if you do IPT- I am considering this treatment as well. My two cents- I had a mx with immediate TRAM recon- SNB only, which turned out to be a false negative during surgery, I had a .254 cm cancer in that node. Officially I was "supposed" to then have a full dissection, but I refused mostly because I was told my chances of getting LE were high because the blood supply for my TRAM breast is a vein over in my armpit and I already had significant scar tissue- any dissection I had done was going to have to involve my plastic surgeon to make sure the blood supply wasn't compromised. BTW, I do have mild LE, mostly triggered by fluid retention with my monthly cycle. I wear camis instead of bras now and that helps immensely, my LE is more truncal than in my arm, tho the arm does swell some too.

I had planned to refuse chemo and had chose the mx over lx due to central tumor location and wanted to avoid radiation. i just wanted to have the surgery and be done with it all. But the positive node made me scared and I did chemo. I did more research and found out inner quadrant tumors like mine are more likely to spread to the intra mammary node chain, (up the side of sternum). This is not routinely investigated and inner quadrant tumors have a poorer prognosis mostly likely due to undetected spread. So I never had those dissected and the PET scans I had before and after chemo- any positive nodes there would have been masked by the uptake caused by massive healing still trying to occur in my reconstructed breast.

I had radiation, including both node chains. 3 years after surgery, I was found to have bone, liver, lung and brain mets. PET scan showed activity in my intramammary node chain, so i feel like there is a good chance that was where it spread from. So I did more chemo for 5 months and have had signficant regression everywhere but bones. I was SO beaten down by chemo, was hospitalied with a lung infection once in the middle of that. I've been on AI and Zometa only for last 3 months and have continued to have regression, except for bones. I am strongly looking at going away to a clinic for intensive natural treatment and IPT.

jojo68

I have heard wonderful amazing things about Euromed in Arizona...also Vincent Gamilll has a clinic...don't know the name but can google him...keep us posted!

jojo68

Alyed...I am so sorry!  So, the chemo didn't do much to prevent the mets?  Will my pathology report tell me if I have an inner qudrant tumor?

pupmom

This is just my opinion, but low grade (1 and 2) tumors divide very slowly. Chemo can only kill a cell that is dividing, so it is most effective for grade 3. So for ER+ cancers, the best defense is hormonal therapy. Chemo may kill some of the buggers, but the hormonals are needed to starve the rest of them.