25/26 pos nodes - WTH??

mlv2356
mlv2356 Member Posts: 44
25/26 pos nodes - WTH??

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  • mlv2356
    mlv2356 Member Posts: 44
    edited July 2010

    Need some help from the wonderful ladies on here.  Background recap. Dx on July 1st with ILC in right breast and postive core biopsy of two nodes.  Fast forward to today, I had a dbl mast on Monday and right axillary lymph node removal of all three levels. I got the pathology report back with states that I had a 11.5cm mass in the right which we knew about, a 4mm mass in the left which I am glad we went aggressive on the dbl rather than single mast. What I'm confused about is the nodes, I am 25/26 positive.  When I had the CT/PET scan they only saw 5 "hot" nodes but now I have 25?? What does this mean? I had hung my hat on the PET scan that we were fighting a local war but know I'm not so sure.  With so many nodes being positive, could I have this elsewhere  ( mets ) that the scan did not pick up on??  I feel like I just got kicked in the stomach.  Any guideance would sure be appreciated.  thanks, Michele

  • dlb823
    dlb823 Member Posts: 9,430
    edited July 2010

    Hi, Michele ~  Well, thank goodness your bilateral mast is behind you and you know now that you absolutely did the right thing in opting for it over a unilateral.

    As far as your nodes, it sounds like the ones that didn't show up on the scan may have had very minimal amounts of cancer cells in them -- micromets, or slightly more, but not enough to light up on the scan.  An 11.5 cm mass sounds like it's been growing for quite awhile, so it sounds like your lymph nodes have been doing exactly what they're designed to do -- stop those bc cells from getting any further.  Let's just hope & pray that's why you had so many positive ones -- that they stopped every cell in its tracks.

    I can imagine how you're feeling -- kicked in the stomach... rug pulled out from under you... blindsided...  in a nightmare you will surely awaken from.  Many of us have been there and understand.  And it sounds like this has all happened in a relatively short span of time -- from diagnosis to today, which is fabulous from the aspect of getting the bc removed as quickly as you have, but may be harder to process today's news when everything else must still be kind of surreal.  Hopefully, your docs will have some good news for you to balance out the unexpected news you've had today. 

    Thinking of you and praying that everything's been found and removed.  (((Hugs)))  Deanna 

  • Gitane
    Gitane Member Posts: 1,885
    edited July 2010

    Hello  and big hugs Michele,

    I was reading some of your previous posts, too.  You have been on the bullet train for sure.  Yet, you are writing coherent paragraphs on your computer and seem to have been getting good care, both good signs.   I remember how tough it was at the beginning.  It's so overwhelming.  

    I would say that a clean CT/PET is a very good indication that you do not have mets anywhere else.  When you meet with your oncologist I would bet that he/she will tell you that you are good-to-go for further treatment.  I don't think your surgeon would have proceeded with surgery if he didn't believe that, also.

    Hang on to the thought that you are cancer free at this point according to all the tests they have given you.  Now you are moving on to treatments to give you some more insurance.  Hug those kids and hubby and know that you will be together for a long time! 

  • AnacortesGirl
    AnacortesGirl Member Posts: 1,758
    edited July 2010

    Sorry I'm so slow to reply to this -- between work and tx I don't have as much time.

    I completely understand how you feel.  I think the word that best sums up my feeling when I got my path report was betrayal.  Because I was on a study I went through 5 PETs and 6 MRIs during my neoadjuvant chemo.  And I had at least 4 ultrasounds.  The whole time they were only talking about 3, maybe 4, lymph nodes being involved.  Even the needle biopsy was uncertain.  And for the last 3 months of chemo they were telling me that the nodes looked normal.  So you can understand what my expectations were when it was time to go back to the surgeon to go over my path report.

    Well they had it nailed on the tumor size.  Still at the 4.9 cm that they were seeing on the MRIs (had a previous biopsy that removed a 1.8 cm tumor).  But then she tells me they removed 17 nodes and 14 of them were cancerous.  Eight had macromets, 6 had micromets and 1 had isolated tumor cells. Largest tumor was .7 cm.  Also had extracapsular extension (cancer spread out of the node - or maybe nodes?? - into the fatty tissue). 

    I was shocked.  I thought we had a good handle on what was going on.  And the other side of the coin was that almost every scan showed some activity that was of concern.  But the next scan would show a different area of concern and not flag what the previous scan showed.  So between the total miss on the nodes and the seemingly random "areas of concern" I have really lowered my expectations on what scans can do.

    All that being said I was in the same place that you are.  If the cancer made it that far then is it elsewhere?  Because I'm BRCA postive, grade 3, pleomorphic lobular and moved from IIIa to IIIc the onc and me decided to do one more regimen of chemo as prevention.  While going through rads I've been on low dose carboplatin.  Haven't had any significant SEs.  I'm finally at the place where there is no evidence of disease.  And I will not do another scan unless I have symptoms.  I'm not going to be chasing those ghosts again.

    Talk to your onc and ask about the posibility of low dose chemo, Zometa and hormone therapy.  Good luck! 

  • LindaLou53
    LindaLou53 Member Posts: 929
    edited July 2010

    Hi Michele,

    I can understand what you are going through.  I also had a PET/CT prior to my bilateral mastectomy which indicated some "hot" nodes in my left axilla but otherwise no signs of spread anywhere else in my body.  I never dreamed I would end up having 23 out of 23 positive nodes. I also had all three levels of nodes removed and my big question was if every node they took out was positive, what did that say about the nodes that still remained in my body??  I was scared that we had discovered this cancer too late.  My nodes were heavily involved with extranodal extension.  Officially I was a Stage IIIC but my oncologist and I both knew we were possibly dealing with early mets not yet detectable by PET.

    It is a hard place to be in both physically and psychologically especially when the news is still so fresh.  I was determined to be as aggressive as necessary in my treatments.  Because I already had a breast cancer dx in 2000 and was treated with DD AC/Taxol at that time, we had to choose a different chemo regimen for this new primary BC.  3 weeks after my surgery I started 6 months of oral Xeloda and 6 rounds of IV DD Taxotere.  We continued the oral Xeloda at a reduced dosage during my radiation tx which included 3 fields - chest / axilla / supraclavicular areas. I also started taking Aromasin immediately after finishing chemo and during radiation.  My onc started me on IV Zometa one month after completing rads which I have continued to take over the last 4 years at varying intervals.  I just had my annual CT scan of chest / abd / pelvis this past Monday and still remain normal (NED) after almost 5 years post dx.  I had my 10th dose of Zometa yesterday and my onc says one more dose next year and then no more Zometa.

    I mention my personal treatment path only to give you hope, just as the others who have posted, that this is a diagnosis you CAN successfully treat! Yes the first year of treatment is the most difficult when you are doing chemo, rads and adjusting to the hormonal drugs.  But it will go much more quickly than you can imagine and you CAN return to a new normal and quality life.  It took some time following active treatments but I feel better now than I have in years.

    I know that most of us with locally advanced BC may never feel free of the worry of recurrence but I have found that it doesn't mean you can't regain a fully productive and rewarding quality of life that does not have to revolve around BC.

    Michele my suggestion to you would be to develop an open and honest relationship with your oncologist and other medical team members.  Ask all the questions you need to satisfy your understanding of your treatment protocols.  Challenge your doctor with new research information when you come across it.  Ask specifically about the use of Zometa in your treatment plan.  It is now being given along with chemo in many cases since it is believed to be more effective during active treatment.

    You are still early in your treatment phase but you have also already successfully removed both affected breasts and those 25 positive nodes which as dlb823 says were effectively "doing their job".  Consider yourself cancer free now and let the chemo, rads and hormonals do the final "clean up" to keep you that way! Know that there are very many ladies on these forums with lots of positive nodes who are many years out from dx and still NED.

    Hang in there!

    Linda

  • mlv2356
    mlv2356 Member Posts: 44
    edited July 2010

    Ladies,

    Thank you all for you supportive comments.  

     Deanna - Thank you for pointing out that the nodes may have had small amounts of cancer - miromets.  I had never heard this term.  It put some of this in perspective.  When I first heard the number I immediately thought huge amounts but you are right, they did not light up on the scan so hopefully are small amounts.

     Gitane - Thank you for the supportive words.  I want to believe I am cancer free and that chemo is the insurance.  We meet with with Onc next thursday and am hoping she is ready to throw the kitchen sink at me.  

    AnacortesGirl - I am so sorry you had to endure the multiple scans there were false positives and false negatives. That would lead me to never rely on them again.  I so want to believe the scan did not pick up my multiple nodes because they were as Deanna put it Micromets.  On my left breast there was a 4mm mass that the scan did not pick up.  This is smaller than the 1/2cm size I was told the mass needed to be in order the for the scan to pick up.  I am praying the nodes were also small in size.  I am glad to hear you went with another cycle of chemo and are clean.  I look forward to that "official title".  

    Linda - Thank you for writing when you did and sharing your story.  Yesterday was a really rough day. I had a dr appt and finally went over my pathology report in detail.  That was when I figured out the report places me as a IIIc stage.  I am still trying to get my head around this staging.  All I could think about was that I am a hairline away from stave IV.  I want to be cancer free and return to my active Mom's life, not be a person taking drugs to keep cancer from advancing.  I keep telling those around me I want at least 40 years. Enough time to watch my kids mature and get families of their own.  So your post was both comforting and timely.  God knew I needed to hear from you at that moment.  To know there are other strong ladies out there with a IIIc stage and multiple nodes and are NED years later is a great motivator to stay positive and fight this.  I am so happy you are NED and living life not centered around BC.  I so look forward to that day for me.   Thank you again for sharing and for staying on these boards.  For those of us new to all this, your experience is priceless.

    Thank you to each of you,

    Michelle

    P.S. we see the Onc this coming Thurs.  Will try to post what she is recommending and get your feedback.  Hugs to you all.

  • AnacortesGirl
    AnacortesGirl Member Posts: 1,758
    edited July 2010

    Michelle -

    I'm glad we could help.   And we'll look forward to what you have to report back from your next onc visit. 

    I'm not sure why they make a differentiation between stage III a,b and c.  Sometimes when I'm in a lousy mood I think it's because they want to scare us.  But I don't feel any different when I thought I was stage IIIa then I do now when I know I'm stage IIIc.  Life is still as important, everyday is still as beautiful and I still plan on many, many more years.

  • mlv2356
    mlv2356 Member Posts: 44
    edited July 2010

    We met with the onc yesterday.  Her recommended treatment is 4 rounds of dense dose A/C followed with 4 rounds of Taxotere every 3 weeks. After that is 5 yrs on tomoxifine (sp?).  Feedback on this would be greatly appreciated.  I just don't feel this is throwing the kitchen sink at me.  thoughts?  Thanks,

    Michelle

  • helena67
    helena67 Member Posts: 357
    edited July 2010

    It does sound like a good, standard regimen. And then you also get radiation prior to starting hormone therapy.

    There are 3 other things I can think of:

    1) adding Xeloda during radiation (a few ladies on this board have done this)

    2) remove your ovaries and start immediately on an AI

    3) adding Zometa to the chemo regimen (or afterward).

    Did your Onc discuss any of these additional options?

  • mlv2356
    mlv2356 Member Posts: 44
    edited July 2010

    helena67 - Yes we discussed removing the ovaries ( especially since my 1st cousin at 42 fought ovarian cancer).  We will most likely do this after radiation.  We also discussed Zometa.  She was not opposed to it but wants to look into it more as I am only 42 and Zometa can cuase dense but brittle bones and now are introducing another problem long term for me.  She knows I am interested in taking this though.  Have not heard of Xeloda - will need to research what this is and if it would be a good addition to my treatment.  Thank you for these added items to consider.  Keeping up with all the options is so overwhelming.  Thank you also for confirming the ACT treatment.  I just thought I should be bombarded for 6+ months or something.  4 months just doesn't seem like enough.

    Thanks again, 

    Michelle

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