Trying to wrap my brain around node dissection

Josiekat · March 2012

So, I am at the point of making surgery decisions. I am really confused by what I've read and my last conversation with my Onc. When I had my PET before I started chemo, they determined I had 2 cancerous nodes that are inoperable. When I expressed my concern to my Onc, she said "what chemo doesn't get, we'll get with radiation". Ok, that makes me feel better. But, my confusion sets in when we then talk about the Axilla Nodes. We have determined that the chemo is working, and they are all getting much smaller. So, why does the surgeon need to do a node dissection, if surgery is not needed, and chemo/rads will get the cancer. I have been under the impression that node dissection is for staging/treatment plan purposes. I am past that point and into trying to get to NED. Meeting with surgeon next week. Trying to go in prepared.

Thanks in advance for any insight. You ladies are a wealth of knowledge. Xoxo

diana50 · March 2012

your qestions are good ones; i would make an appt with the breast surgeon and ask those questions that you posted.

they may want to get in there and be sure you don't have a bunch of positive nodes lurking; i had 10 fully encased lymph nodes and NONE of them showed on my initial PET scan. i was glad to have the surgery as taking out my cancerous lymph nodes reduces the tumor burden on the body. surgery is actually the first treatment option; chemo, rads and hormone treatment is specifically to "clean up " any cancer cells missed during surgery.

but yeah, i would discuss again with BS.

hang in there

diana50

Kathleen26 · March 2012

Your questions are good ones, that I also asked my surgeon. The answer I got was that they can only do radiation but so high up in the axillary area before risking damage to nerves to the arm. The same issue exists around the collarbone. I had some nodes show up on the PET just below the collarbone, which were also said to be inoperable, but that they were able to include in the radiation area.

Even with the risk of LE, if you can get cancer removed surgically, it is the best way of eliminating it from the body.

Josiekat · March 2012

Thank you for that info. That clears up so much for me. I am so freaked out by lymphadema, but getting rid of the cancer is obviously more important than anything.

Thanks again for giving me more food for thought.

SpecialK · March 2012

josiecat - My positive nodes were not found on my pre-surgery MRI, they were discovered on post-op pathology of my SNB, so they were a surprise. I did not have the advantage of neoadjuvent chemo to determine if it was effective. I was a lumpectomy candidate, but had elected a BMX. Both my BS (a very cutting edge, progressive surgeon) and MO insisted on axillary node dissection, which was a separate surgery 5 weeks later. I had a 6mm node further up in the axilla. I later asked my BS in conversation what percentage of patients with positive nodes have eradication with chemo, his answer was 60%. I was more nervous about damage and risks from rads than lymphedema. I am much more comfortable knowing that the nodes were surgically removed.

beth1965 · March 2012

Josiekat

In my surgery they ended up finding 17 very cancerous nodes, my surgeon knew there were a few but did not think there would be that many. I was lucky she changed her mind in the last few days before surgery and decided to take all my nodes out.

I was quite happy about the removal of all my nodes as i feel like i have a better chance of being or staying cancer free someday. Don't get me wrong i was not happy i had both my breasts removed and all my nodes but i do feel the more they can take of my cancerous body(There was alot of cancer) the better. I at least should not have to worry about these bodyparts getting cancer again as i do not have them anymore. I am in chemo and doing rads too. But in my opinion removal is the best.

LeanneP · April 2012

Hi joseiekat, I get it that you are concerned because I went through chemo, and will have my lumpectomy on April 13 and they will do the A removal because when I went for my biopsy after mammo and ultrasound, the a node was cancerous. I was diagnosed and 10 days later went into chemo. After chemo, the next thing was to see the surgeon and he stated he would take 10-20 lymph nodes and I am thinking WTF why so many, was not the chemo to take care of that and can they tell if a lymph node is cancerous by tests or by looking when in surgery. I do not know the answers. I was diagnosed with suspected mets because they biopsied on my auxillary lymph node and it was cancerous. I am hoping that when they do the lumpectomy they will only take lymph nodes that are suspect because I would certainly not want them to take innocent lymphnodes minding there own dam business and they have a very important job of keeping disease and illnesses from the rest of our bods. Keeping lymph nodes is a good thing if they are healthy.

AnacortesGirl · April 2012

Although cancerous axillary nodes are often referred to as metastic they are still conisdered local to the breast. So it's not the same as remote mets which is a Stage IV dx.

Lymph nodes exist as clusters. They can't just pick out the ones that are bad -- they take the cluster. The number of nodes in a cluster will vary from person to person. This is one reason why you see a different number of nodes for each woman. For myself, even though it originally appeared only 3 or 4 were involved, they removed levels I and II. Again, this is quite common with locally advanced breast cancer. During surgery, the surgeon use her hand to feel the level III nodes and determined that they felt OK. Since that was in agreement with my imaging, she left the level III nodes intact.

There's a good picture of the axillary nodes and the different levels on this website:

http://www.breastcancer.org/pictures/breast_anatomy/axillary_lymph_nodes.jsp

Ask your docs for more information. I found that understanding what was going on with lymph nodes one of the more confusing topics.

Josiekat · April 2012

Once again, thank you for the clear and insightful info. I am wondering if 5 years from now if oncologists will be sitting around tables saying, "remember when we used to do node dissections". I don't want to be at the end of a trend in medicine, unless it prolongs my survival.

jennyboog · April 2012

Hey Josie...I'm just seeing this and late replying but thought I'd chime in anyway. I had intermammary + LN that couldn't be taken with surgery and they were taken care of with chemo/rads. I also did neoadj. chemo and was unsure of exactly how many LN were +....my prechemo MRI and PET just read "several". I didn't do a ALND until my BMX which was after chemo and only residual cancer was found in 5 of 16. I did do a LN biopsy before chemo to make sure they were + and find out the path of them. I'll never know exactly how many were infected but glad to know the chemo was working and so far so good, I'm NED. I don't understand why dr's do different tx plans for similar dx. I hope you get answers to your questions soon.

Josiekat · April 2012

Jenny,

It's amazing how similar our diagnoses are. I am so happy to see you are through the rough stuff and doing well.

Meeting with breast surgeon on Thursday. Will let u know what she says.

Cheers.

jennyboog · April 2012

I hope everything goes well on Thurs...please do let me know what happens.

Trying to wrap my brain around node dissection

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