lymph node involvement?

ealga

Hello,

I have my first in person appointment with my breast surgeon tomorrow to discuss my upcoming BMX. During our phone conversation, she indicated that she thinks the cancer is very small (around 4 mm) which was missed on mammo but found on MRI. Her approach would be to do the surgery, check the nodes, and if there is node involvement (she said she thinks it it unlikely) we would discuss next steps.

My question: should i ask for a lymph node biopsy before the surgery? Isn't it sometimes better to have chemo or rads beforehand vs after?

Any insight would be appreciated. xo

Beesie

"My question: should i ask for a lymph node biopsy before the surgery? Isn't it sometimes better to have chemo or rads beforehand vs after?"

No, not necessary. What's being recommended is normal standard of care for a small ER+ / HER2- cancer.

Chemo prior to surgery is commonly considered for HER2+ and triple negative cancers, if the tumor is larger than 2cm, or if the patient is node positive. But for ER+ / HER2- cancers, chemo before surgery would only be considered if the tumor is very large (to shrink the tumor prior to surgery, possibly thereby allowing for a lumpectomy instead of a MX) or if there are many positive nodes (which is almost certainly not going to be the case for you, with such a small tumor and I assume, no suggestion from imaging that there might be nodal involvement).

ealga

This is so helpful, Beesie, thank you!

2019whatayear

FWIW

I had a lymph node biopsy - it was a SN and it came back no cancer then when they my BMX the same sneaky son of a gun node came back with micromets so my doc did the ALND (8 additional nodes - no cancer)

So even if they do a lymph node biopsy it many not give a good picture

ealga

oh wow. sneaky cancer. UGH. thanks.

Lilir

My sentinel node biopsy is occurring during my mastectomy. Also, if there is lymph node involvement, I am getting an axillary node dissection... 😢 All this so scary.

Your surgeon wants to bring u back to do acillary modes if necessary

MinusTwo

I did not have ALND with my BMX. My SNBs were clear. I didn't have lymph involvement until 2 years down the road.

If you have a choice, discuss w/your oncologist what level of node involvement calls for ALND. Maybe if it's minor. maybe you don't need the whole excision - and maybe other treatments are available - like radiation &/or chemo.

cleocat14

Had a node biopsy on a suspicious looking node, and it came back negative. Surgery showed 2 tiny spots in 1 out of 5 sentinel lymph nodes removed. They just won't know about microscopic spots unless they take them out.