Type of surgery and how many nodes to remove?

daisydaisy

Dear members, first of all, I am so glad I was sent to this wonderful community with tons of information that I yet have to process. Let me introduce myself. I am here on behalf of my mother, 59 yo. Back in 2013 she was diagnosed with stage 2 colon cancer, and I became a member of Colon Club, a great community of people with colorectal cancer. On the same day, but exactly two years later after a US we learned that there is a tumour in one of her breasts now with an enlarged axillary node.

So where we are now. Core biopsy - done, waiting for results next week. Bone scan, liver US, chest X-ray - done, clean (thanks God!). Blood for BRCA1/2, CHEK - done, results not coming so soon (19 days, wow). General blood & urine tests plus CEA, CA 15-3, CA 125 - done, results next week. Pelvic US next week. After that we will discuss the treatment plan with our surgeon (seems we found a good one, oh, I forgot to mention, we are in Russia). Our surgeon is just back from Breast Cancer Symposium in San Antonio on Dec 7-13 (I hope he knows all the latest advances in treatment and surgeries).

Now my question is:

What happens to lymph nodes, if one is potentially affected on US picture (it has this bad shape, so the docs are 100% sure)? Do they take all lymph nodes they can find (which from what I understand can have some adverse effects) or do they biopsy it or is sentinel node biopsy required? I am sorry if I am asking stupid questions, my mind is still blurred from all the shock of getting another primary in 2 years. I just want to make sure we know all the options and ask the surgeon all the necessary questions before the surgery. So far I think there will be neoadjuvant chemo, then surgery, then probably more chemo and radiation.

Thanks everyone for your input - it is so precious at this moment in our lives! Best wishes to everyone!

Moderators

Hi daisydaisy, and welcome to Breastcancer.org! We're sorry you have to be here, but really glad you found us!

While you wait for the ever-helpful advice from our other incredible members, you may be interested in checking out the main Breastcancer.org site's page on How Many Lymph Nodes Removed? to help understand what your mom will be facing.

We hope this helps, and please keep us posted on how things go! We're all here for you!

--The Mods

Hopeful82014

Daisy, I'm sorry about your mother's illnesses. I know how hard it is to see one's mother go through this.

The next step should be to biopsy the enlarged node. Some surgeons insist on a full lymph node removal (ALND) if it is malignant but the newer thinking is to do a regular sentinel node biopsy during the lumpectomy or mastectomy. Many, many times women will have only one positive node out of of 10-12 (or more) nodes removed, which can indeed create future problems. Frankly, there's a fair amount of disagreement on the best approach to this type of situation. Surgeons tends to be conservative and change their approaches slowly. In addition, their focus is usually on removing cancer - quality of life issues are way down their list of concerns.

I think in this case, however, a lot will depend on the pathology report from the core biopsy, and the characteristics of the case. since this is a 2nd primary tumor a more aggressive approach may seem best.

I wish both of you the best as you deal with this. Please keep us posted.

ElaineTherese

daisy,

Sorry to hear about your Mom. My doctors could see an enlarged node on my scans as well. A radiologist performed a fine needle biopsy on my compromised lymph node, and it tested positive for cancer. However, the radiologist did not insert a surgical clip in it so we could keep track of it.

Because my cancer was big, aggressive (Grade 3) and HER2+, I ended up doing neoadjuvant chemo (chemo before surgery). After five months of chemo, an MRI and a PET scan revealed that my lump was gone and my nodes were cleared. Then it was time for surgery (a lumpectomy and lymph node removal). The big question: since the nodes were clear, how many should be taken out? My medical oncologist thought we could just take out the compromised node and a few of its neighbors. But, we didn't know what node it was anymore since the radiologist never inserted a surgical clip. So, my radiation oncologist argued that the surgeon should take out all Levels 1 and 2 lymph nodes, just to be sure we got the previously-compromised node. Ugh. I ended up having 20 nodes removed. That increased my chances of lymphedema! But, I've been fortunate; no lymphedema yet.

The moral of this long story: if your mom does neoadjuvant chemo and gets the node biopsied, ask the radiologist to put a clip in it! Best wishes1

daisydaisy

Thank you, Moderators, Hopeful82014 and ElaineTherese! I will definitely have something to discuss with the surgeon now. ElaineTherese, I am so glad that you don't have lymphedema and hope you never will. Breast cancer seems to be such a puzzle to me now. This community helps a lot!

Hopeful82014

Elaine - thanks for bringing up the issue of a biopsy marker in the node. Like you, none was placed during my first biopsy of the node but I did have one placed during my 2nd biopsy, at my surgeon's insistence. Thank goodness!

Daisy - yes, breast cancer IS one giant puzzle and the pieces seem to be different for each of us. I'm glad the community's helpful for you - I know it has been for me.

ravdeb

hi,

I am a 10 year survivor and was active on BC.org throughout my treatments and even afterwards. If any of you are familiar, I am a part of the Rocktober Sisters who went through chemo together in October 2005.

And now....my close friend has just been diagnosed after a core biopsy. The only info I have on her is that she is ER/PR positive, Her2 negative and I believe her tumor is 1 cm.

She is currently hospitalized and on IV antibiotics for a gall bladder issue unrelated.

The doctors there have decided she should deal,with the cancer first and after that she needs to have her gall bladder removed. So she had a consult with a breast surgeon (with a good reputation) who said she is a good candidate for inter operative lumpectomy. And tho she is a good candidate he is unsure about it because there are not enough studies to prove it is good...he also said that sometiimes the scar doesn't heal well afterwards....

I was wondering if any of you knew anything about this. She would not be able to do this procedure with this doctor nor in the hospital where she is now. But that would not be a problem.

He basically recommended radiation and hormone therapy after conventional lumpectomy.

Any opinions would be very much appreciated

ravdeb

hi,

I am a 10 year survivor and was active on BC.org throughout my treatments and even afterwards. If any of you are familiar, I am a part of the Rocktober Sisters who went through chemo together in October 2005.

And now....my close friend has just been diagnosed after a core biopsy. The only info I have on her is that she is ER/PR positive, Her2 negative and I believe her tumor is 1 cm.

She is currently hospitalized and on IV antibiotics for a gall bladder issue unrelated.

The doctors there have decided she should deal,with the cancer first and after that she needs to have her gall bladder removed. So she had a consult with a breast surgeon (with a good reputation) who said she is a good candidate for inter operative lumpectomy. And tho she is a good candidate he is unsure about it because there are not enough studies to prove it is good...he also said that sometiimes the scar doesn't heal well afterwards....

I was wondering if any of you knew anything about this. She would not be able to do this procedure with this doctor nor in the hospital where she is now. But that would not be a problem.

He basically recommended radiation and hormone therapy after conventional lumpectomy.

Any opinions would be very much appreciated