negative nodes ending up with Mets - numbers?

JanMarch: I don't mean to sound negative, but I had clean nodes, no lympho or vascular invasion.  I was multifocal (had DCIS and IDC in many places), but the IDC was, at MOST, only 2.6mm!  However, they didn't really get as large of a clean margin as they wanted.  (Keep in mind, I was Grade 3.)  So somehow at least 12 cancer cells got out and ended up in my liver!  And there they each grew larger than any of the bc got in my breast...before the bc was even discovered in my breast!

Here is how I know, I had a breast MRI before the bc surgery.  I can now see the shadow of the liver cancer on that image (it was below my breastbone, the liver goes that high up inside you!).  But because (I guess) the people looking at my breast MRI were 'Breast Cancer Specialists', they weren't even looking at my liver.

I am sure I am the exception to the case.  But it doesn't hurt to be your own advocate.  Even after the docs found one lesion on my liver, they didn't think it could be cancer.  I had a doctor stake his reputation on that lesion in my liver being benign.  I just had a hunch that it was cancer. So I found another doc who would remove it, and it was.  And he found 11 more of them in there as well.

Well, that's my story, and I'm stickin' to it...

Ruth

Jan, you can ask your onc for a bone density test. If it shows you have some bone loss or mildly osteopenic, you can ask to have it perscribed for that reason. Insurance will probably not cover it since you had no chemo and stage 1, but they might perscribe it for bone loss due to age, menopaus ect.

JanMarch - I had stage 1 and got it for "prevention of osteoporosis" even though I had a bone density test and I had super dense bones to start with!  However of coarse my onc really prescribed it to reduce the chance of recurrence.   Some oncs seem to be willing to do it.  Others don't. Some insurance pays, some doesn't.  It doesn't hurt to ask.

yes, unless you had chemo or a family history. I would still ask your onc though.

There are a couple of studies with 20 or 30 yr follow up. Of course treatments were different, since a 30 yr follow-up in a paper published today would mean some patients were diagnosed 40 years ago so one has to extrapolate, using data about modern treatment effects ...

 I went through this really carefully when i was trying to decide if i had to go on AIs.  Unfortunately i did not keep the articles i used to  figure this out... It's hard to find them: there are so many articles on bc! Right now, i can only find two (and they are not the best ones!).

One is a study out of U Chicago, which looked at 826 women with node-negative bc, treated between 1927 and 1984. All had mastectomies of course.

Of those with tumors < 2 cm, 79% survived 20 years, disease free.
Of those with tumors > 2 cm, 64% survived 20 years, disease free.

No data on ER,PR or HER, nor on histology, and chemo was not available for half of that time; it is not mentioned. If you factor in improvements in treatment, i think the odds have gotten significantly better .... check back in 30 years ...

But one interesting point is that over half the recurrences in both groups were in the first 5 yrs. Apparently after that the risk per year ismuch lower. 

The other is a study out of Norway that begins by saying 30% of node-negative patients die of bc -- maybe that's where JillyG's onc got his data. But then it goes on to give  overall survival rates at 30 years of 68-87% depending on subclassification -- i'm sure some people died of something besides bc, so their disease-free survival rate is actually HIGHER than what they say at the beginning!

About the argument that you have to look at overall survival -- that depends. If you're comparing 2 treatments, yes, because you need to worry about side effects (like heart problems from old-style rads, other cancers from some chemo). But so many of us with bc are over 55 when diagnosed -- and mortality from almost all causes does go up with age!  So overall survival may give an unnecessarilly depressing picture. We all die eventually - JillyG's question is: how likely is it ot be from bc?

Remember that the studies that Mouser referred to tracked women BEFORE Tamoxifen or AI's were released (Tamoxifen may have been  in clinical trials in the early 1980's, but was not on the market) , and they have really improved the outlook for women who are ER+. The numbers should be better today.

Shelley, not all surgeons do a sentinel node biopsy or test when they perform their surgery for a number of reasons:

1) if you had chemo before surgery, it changes the landscape too much and they might get a negative on the SN when there is still cancer in an axillary node

2) if there is already some suspicion that cancer has moved to the axillary nodes...one or more are enlarged

3) and some feel that if they are doing a mastectomy, the SN nodes will be coming out with the breast tissue anyway...so they just move on up the chain.

Sentinel nodes are just the first in the chain leading from the breast, and therefore more likely to have trapped and developed the cancer. But all the lymph nodes in the breast area are in danger of developing cancer once it becomes invasive.

JanMarch--from what I know, yes. Cancer cells can travel either through the bloodstream (vascular) or lymph system.

Man I just found this thread while it is informative it also scared the #### out of me.We are suposed to think positive but those stats are just plain depressive.

Nancy D

If they took 21 out of me, how many levels do you think they took?

I had 1mm micromet in one sentinal node and the rest of 20 nodes were all clear. There was no vascular invasion and no lymphatic invasion in the tumor, then I don't understand why I had this 1mm micromet in one sentinal node?

Does anyone know if micromet prognosis is as good as node negative?

Even with negative sentinal and axillary nodes, it's possible for BC cells to spread via the mediastinal lymph nodes (in the center of your chest). These nodes are not routinely tested......also, depending on where your tumor was located, BC cells could have travelled to the mediastinal lymph nodes without detection. It's quite common for surgeons to test for the sentinel lymph node by injecting blue dye in your nipple/areola complex and watching the drainage pattern. The first node that is hit with blue dye is the "sentinel" node. However...........studies are showing that the blue dye should be injected near the location of the TUMOR in order to follow the drainage pattern, and oftentimes, the "sentinel" lymph node in these cases are in the medistinal lymph nodes. Sorry to add more worry - but this may explain why women who are node negative and Stage 1 STILL can get recurrences or mets. Here's a study concerning the mediastinal nodes, which I posted earlier on another thread entitled "Enlarged lymph nodes":

Internal Mammary Chain Drainage of Breast Cancer Borys R. Krynyckyi, MD, Jungho Shim, MD, and Chun K. Kim, MD

The article by Estourgie et al eloquently maps out the drainage patterns in breasts depending on the location of the primary lesion and therefore the injected radioactivity when using intratumoral injections. When primary lesions are medially and inferiorly located in the breast, the highest rate of internal mammary sentinel node (IM) visualization will occur. Depth of injection also had an effect, with deeper injections of nonpalpable tumor favoring the visualization of IM nodes.Indeed, it has also been extensively reported that only perilesional or intratumoral injections visualize IM nodes to any significant extent, whereas superficial (dermal or areolar) injections very rarely demonstrate IM nodes. One additional factor that is worth mentioning is the effect of breast size on IM visualization rate. We noted a marked effect that breast size has on the rate of IM visualization (besides injection depth). In patients with small breasts, the IM visualization rate was 46.2%; in those with medium breasts, 21.1%; and in those with large breasts, 0% in our series (P <0.017). This could be explained by a proximity effect to the internal mammary chain of nodes. The average lesion in the center of a large breast and the injected perilesional (subtumoral) radioactivity would be much farther from the chest wall and the deeper lymphatic channels that course to the parasternal IM sentinel nodes (SNs) than the average lesion in the center of a small breast, which would be much closer to these channels. The closer the injected activity to these channels, the higher the probability that injected radioactivity would reach the IM connected to them. A similar mechanism could potentially explain why <strong>nonpalpable lesions had a higher drainage rate to internal mammary nodes in the current article by Estourgie et al, assuming that they were, on average, situated deeper in the breast than palpable lesions.Interestingly, in our study, in the subgroup of women with small breasts, whether the primary lesion was located medially or laterally appeared to make less of an appreciable difference in IM visualization rate.Internal mammary nodes were visualized in 50% of those with medial lesions and in 44% of those with lateral lesions when the breasts were small. This is in contrast to an IM visualization frequency of 42% and 10% in those with medium breasts for medial and lateral lesions, respectively.This indirectly suggests that the proximity between the primary lesion and the IM chain of nodes in the chest wall has a substantial effect on IM SN visualization rate and could represent an important factor for tumor spread (and potentially treatment) in patients with small breasts with primary tumors located anywhere in the breast, that is, somewhat irrespective of the medial or lateral location of the primary tumor.Leppanen et al has shown that a greater chance of detecting IM nodes exists in patients who are younger, thinner (lower body mass index), those with primary lesions lower in the breast, and when the lesion is nonpalpable.A potential explanation for why inferior lesions would be more likely to visualize IM nodes is that these lesions would have "access" to more of the internal mammary chain than superior lesions, because they would be starting closer to the origin of the IM chain inferiorly in the chest, ie, "upstream." Additional theories have been described regarding factors affecting axillary node visualization such as increasing age, in which postmenopausal replacement of macrophage-type tissue by fat and/or decreased tissue turgor resulting in collapsed lymphatic vessels has been suggested as the mechanism of decreased visualization of axillary SNs.Whether these mechanisms also affect IM visualization is not clear. In summary, factors that favor IM visualization include deep injections (intratumoral/perilesional compared with shallow dermal injections), small breast size, medial and inferior primary breast lesions, younger age, lower body mass index, and nonpalpable tumors (vs. a palpable tumor in a same-sized breast), many of which could be explained by a simple proximity effect to the chest wall and/or IM chain.

Department of Radiology Division of Nuclear Medicine The Mount Sinai Medical Center New York, NY

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I wonder if someday soon radiologists will start routinely testing internal chest lymph nodes as well as the axilla lymph nodes..........just because the axilla lymph nodes test negative for cancer, doesn't mean the cancer hasn't already spread to the internal nodes!

Swimangel -can you define from the posted article "medially" and "inferiorly" located tumors or specify the breast quadrants to which those locations refer? 

I hear ya hollyann......

I have always said that I think it is easier being stage III.  Maybe not better statistically, but easier to make tx decisions.  They throw everything at you.  They assumed that there was probably cancer in my internal mammary nodes and treated me accordingly.   

Hi barbe, just discovered this site and read through all 4 pages.  Yes, we can participate in the Tailor X study here in Canada. I live in BC and have just recently been accepted into the trial study.  I am told that I should have my Recurrance score and allocation information in two to three weeks.