Positive lymph nodes (still) after neoadjuvant chemo?

Nikkig

Hi....I was just wondering if anyone had positive axillary lymph nodes after neoadjuvant chemo. I had 4 treatments of AC and 12 treatments of taxol for a 4 cm tumor. The tumor shrunk substantially to less than 2 mm from the chemo....but I still have positive lymph nodes. If this happened to you what did they do next? I am having a double mastectomy next week. Thanks!!

layla0630

I had 2 positive nodes after chemo and before surgery.  They took out 17 lymph nodes but only the two had cancer.  They then recommended that I do 5 weeks of radiation (which I did).  I believe in Europe some radiologists are recommending only radiation and not lymph node removal too for positive lymph nodes.  This is relatively new so you would need to ask your Dr. about it. I believe having the radiation only also lessens the chance of developing lymphedema.  Hope this helps.

Kicks

I still had positive nodes after neoadjuvant A/C (19/19). This was expected as in my case the plan was to do neoadjuvant to gef the IBC to form a 'lump', get margins and shrink so surgery would be possible. (IBC forms in 'nests' or 'bands' without defined margins.). Complete response was never expected. Then 3 weeks after UMX I started 12 weekly Taxol. Then rads and Femara/letrozole. That was over 5+ yrs ago and I am still 'here' and still NED.

I don't know what would be the plan if 2 Chemos (A/C and Taxol) were both done neoadjuvant instead of divided to neoadjuvant and adjuvant. I

Nikkig

Thanks Layla...looks like I am getting proton radiation next....and also anastrazole. I am so scared right now....more than since the initial diagnosis.

Nikkig

Hello Kicks, thanks for your reply to my questions. The rationale behind your specific treatment plan made a lot of sense. Mine is odd because the 4 cm breast tumor shrunk significantly but not in the lymph nodes. After the BMXes last week they started me on anastrazole and I will also undergo proton radiation. They might even put me on another chemo. Thanks again for your input..appreciate it.

Valentine99

I also still had active cells when I had my surgery, which caused me to need radiation. I was pretty ticked off about needing radiation, but I'm halfway through now and looking forward to being done. My tumor shrunk significantly, but there were still active cells in the breast and lymph node.

Traveltext

Like Kicks and others I still had live cancer in my nodes (and breast) after neoadjuvant treatment. Surgery to the breast and a clearance of all the nodes followed. Then rads and now Tamoxifen. Never felt better and am confident that I will remain NED.

CarolynAnne

Hi Everyone,

I am new to this board.

Nikkig - I hope your surgery went well. I also hope you got all of your questions answered before surgery. What they will do with my nodes during surgery is a worry.

It looks like I am about 2 months behind you in treatment.

I have questions for everyone who has posted about positive nodes after chemo. I had A/C x4 and am now having 12 weekly Taxol (#6 today). After the A/C I had imaging done and it showed almost complete reduction of IDC tumor in breast and of the 2 swollen axillary LN.

I am wondering how you knew that your nodes were still positive after neo-chemo? Did they biopsy or was it based on imaging? My understanding is that my SO, will be doing doing a SNLB during mastectomy (end of August) . If those nodes come back neg during surgery, then no more will be removed and RT will be done post-surgery. If they come back pos, then she will do the ALND. Does that sound right?

Healing thoughts to all,

Carolynanne

Traveltext

Carolynanne. My initial needle biopsy showed IDC and cancer and in two lymph nodes. Chemo started straight away and the ductile tumor, as with you, shrunk after the first couple of treatments. At the end of treatment my surgeon did an mx and axillary clearance. It is not possible to have an SNLB during surgery which occurs after chemo. In my case, the material removed, including all 23 nodes, was examined in the lab and it was found that the ductile material and the two original nodes were still cancerous.

Note, since you are having chemo first, it is not possible to have an SNLB during surgery to determine the status of your nodes.

So, to answer your question, post surgery is when they determine for sure what the situation is.

jojo2373

I had 1 pos node after neo chemo. My pet scan before chemo showed 2 pos so resolved one. I had a lumpectomy followed by 33 rads. Now on arimidex after 2 years of tamoxifen. I did read any amount of remaining cancer in nodes after neo increases recurrence rate, but not significantly.

MJS1266

CarolynAnne,

I had a 1.6cm tumor and two positive nodes to start. I had neoadjuvant chemo, 4 AC and 12 Taxol. My tumor shrunk significantly on AC then Taxol knocked it out. Around Taxol 9, I had a mammogram and ultrasound for pre-surgery. The radiologist reported that she could find no evidence of cancer at the tumor site nor the lymph nodes. Of course, you can't be sure without the pathology. They will do a SNB during surgery and if the node is negative they will not take anymore out. The current protocol for those who have positive nodes after neoadjuvant is a full ALND. There is currently a phase 3 study if you still have positive nodes at the time of surgery where they are randomizing SNLB and ALND. I had agreed to this study. However, I had a PCR and with the negative nodes they did not do an ALND and I was knocked out of the study. I am doing radiation though as I had a lumpectomy. T^{here is another study for radiation where you are randomized for radiation to the clavicle area or no-radiation. I was a bit cautious here because I had grade 3 tumor so I decided to go for the full radiation. The RO said not many are electing to participate in this study. If I had had a lower grade cancer I probably would have done the radiation study. Good Luck, MJ}

Nikkig

Thanks CarolynAnne....just.had my double mastectomy with saline implants as expanders because will be getting proton radiation. initially they had done a sentinel node biopsy which was positive in 2/3. Then I had the AC and Taxol. The MRI post-chemo showed an excellent reduction in the tumor and no enlarged nodes, but I had an axillary lymph node dissection one week prior to the mastectomy and 8 were positive. Now I am getting radiation on top of everything. I am totally engulfed in fear....can't seem to shake it. Please let me know how you girls stay calm.