Number of lymp nodes

JayleeD

Im 36 years old. Im from BC Canada. Been diagnosed with ER/PR+ HER - breast cancer in April. 8/8 for both ER/PR grade 2. Upon diagnosis my tumor was 3cm. Biopsy confirmed that lymp node was involved. I did neoadjuvant chemo. 4 Ac and 4 taxol every two weeks. Two weeks after chemo I had a double mastectomy. Was shattered when I learned that chemo did not destroy all my cancer and only had a partial response. Tumor measures 1.5 cm, cancer was in 2/3 lump nodes. One measured 2.2mm and other 3mm. Had another surgery to do a level 1 and 2 lymp node dissection. Pathology showed that there was no lymp nodes found in the dissection. My surgeon said that the chemo destroyed my lymp nodes. My radiologist today said that its not possible and his explanation is that there was just not any lymp nodes in the sample where she did the dissection. I am so confused? Has this happend to anybody. Im meeting with my oncologist next week.

LW422

Wow, I've never heard of such a thing (but there are plenty of things I've never heard of). I tend to believe the radiologist is correct; there just weren't any nodes in the tissue the surgeon removed. I had a level 1 and 2 dissection and there were 32 nodes removed. My surgeon told me that the "node count" depends on the individual's anatomy; some people might have 9 nodes in that area but I had 32. They never know exactly how many until the surgical pathology is done. Also, I had 12 weeks of AC chemo and 12 weeks of Taxol; chemo did not "destroy" my lymph nodes.

Can you request an ultrasound to see exactly what is left in the dissected area? Sorry you have to have this anxiety on top of everything else. Good luck to you.

wondering44

JayleeD,

My pathology report showed five lymph nodes removed and one lymph node was not found during the pathology. I didn't quite know how to take that. I re-read the report to make sure I didn't miss anything. One portion said it was a sentinel that was taken and missing and one part said it was an axillary node that was missing. I am not sure what happened. The other four nodes were negative. I am not sure that the missing one makes a difference since everything was clean margins and negative.

JayleeD

Im sure after I meet with my oncologist i will feel better and have a more understanding of what is going on. Im sure its not possible that I only had 3 lymp nodes in my arm? Im done with radiation and on exemestane and Zoladex. Maybe do more chemo since i didnt have a complete response.

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MSWife

i don’t agree with the surgeon’s comment that the chemo destroyed the lymph nodes - post chemo lymph nodes tend to have fibrotic changes (and are still very much detectable as lymph nodes) if there was cancer that the chemo took care of.

A dissection resultcan be tricky in that some surgeons go for individual nodes while others do an ‘en bloc’ removal of tissue according to certain anatomy planes. You should ask your surgeon about this.

I don’t think you should worry about only having a ‘partial’ response to chemo - this is very typical of lower grade/hormone positive tumours. Anti-hormonal treatments and radiation are the bigger guns.

Good luck!

LaughingGull

Hi JayleeD,

Sorry that you find yourself here at such a young age. Your diagnosis and mine are very similar (except that I was HER+ besides ER+ and PR+); I had a 3.5 cm tumor, and two lymph nodes (lumped together) that biopsied positive for cancer at diagnosis, before chemo and surgery.

Because of the confirmed positive lymph nodes, my surgery plan included removal of all lymph nodes on the cancer side, i.e. ALND. I was very upset to learn after surgery that there was still a lot of cancer present in the breast and the lymph nodes, despite all the chemo. But please don't read too much into that. When your cancer has the hormonal component, it is very common not to have a complete response. You will get hormone treatment, which is very effective systemic treatment for your cancer, and hopefully it will take care of any stray cells anywhere, if any. You may also get radiation to take care of any stray cells in the area, did they offer radiation to you?

Now, to the number of nodes. I was shocked after surgery to hear that they were only 6 nodes total after a complete axillary lymph node dissection, including the two positive ones that were lumped together. My surgeon is top-notch, and he has been doing breast cancer surgeries for a very long time. He reassured me that there was absolutely no fatty tissue left behind (therefore no nodes left behind), and that, anatomically, different people have different total number of nodes. He also said that he has observed changes over the years in the way the lymph nodes are counted. According to him, pathologists are not as thorough now, and some tiny thingies in the sample are overlooked nowadays that used to be counted before. He also said that disease/chemo can make the lymph notes shrink and get lumped together (matted), further diminishing the number of nodes counted. I totally understand being puzzled by this (I was) and I think you should press for as thorough an explanation as possible, from the oncologist, the surgeon, and the pathologist if needed, as of why you only had 3 nodes total, and reassurances that no nodes were left behind. But it is probably not so unusual -at least not to my mind, since I was in the same boat.

Best of luck and let us know how it goes,

LaughingGull

JayleeD

Thank you for the reply LaughingGull. I have done radiation and I am on hormone therapy. Im on zoladex and exemestane. Will be the first time I meet with my oncologist after my second surgery. Im sure She wil answer all my questions and put my mind at ease.

LaughingGull

Press for answers -if she doesn't know, she can find out from others that are more experienced, talk to the surgeon/pathologist, etc. Experience, and having seen a lot of cases, counts when it comes to explain these not-so-usual things. Great thing that you got radiation, and you are getting further systemic treatment. Hopefully, our affected lymph nodes were successfully playing goalie.