1 Positive Node, Mastectomy...did you do Rads?

I have not finished my surgery and treatments yet, but my understanding, from reading on these boards.....radiation After masectomy would depend on where the cancer was located in the breast. Additionally, not having clear margins after cancer removal could impact wether radiation would be given.



Your oncologist would help with that topic. I am meeting mine today to finally hear what my options are.



I'm sure there are more people here with more info.

Wishing you the best.

Pat

I had a 1 mm micromet in my sentinel node. The location of my tumor was such that radiation might have been suggested with mastectomy if cancer had grown into either the fascia or skin. The margins were clear on all sides of the tumor, although one of them was only 1 mm. Neither removal of more lymph nodes nor radiation was recommended to me, and I didn't do either. I've got something of a phobia about radiation, so I'm not sure I would have done it even if it had been recommended, especially after learning that my Oncotype score was borderline on the high-range, putting chemotherapy into my treatment plan. I probably would have agreed to ALND if it had been recommended.

(edited to add after mammalou's post--my path report said no LVI)

I had 1 node with a lot of cancer in it and cancer found in the skin of my breast. I also had LVI. I had 2 lumpectomies, chemo, then a mastectomy. I was told from the beginning (even before the skin was known) that I would need rads. I had 33 rads to breast and axilla, with boosts to skin area. I do feel like I had a lot of treatment. I think the rads was most important because of the LVI and the skin involvement.

Colt45-I had RADs with 2 positive sentinal nodes, 3mm (I'm also grade 1). I had a MX hoping to avoid RADs. My MO thought I should have an ALND but my BS & RO disagreed & thought RADs would be just as effective. The decision was left to me, either the ALND or RADs. I chose the RADs. It looks like your wife already had the additional nodes removed. Not sure RADs would offer her much. 

So that was my tumor on the left. My tumor on the right side had LVI & a "few isolated" cells in a sentinal node. I had RADs on that side too. The "tumor board" thought it was a good idea.

Hope your wife is doing well. It's great that you can help her sort all this out.

Hi Colt

I had negative nodes, clean margins, no lymph or vascular invasion but I still did rads.

Being Her2+ with a grade 3 tumour, I did not want to take any chances or look back and wish I could have done more.

I wish you and you wife well and am hoping for the best for you both.

Best wishes

Alice

colt45- Not sure if I remember the correct terminology. I had RADs to the chest wall & axilla on both sides. Is your wife being offered RADs to the axilla after having "clearance" with the ALND? Her diagnosis is similar to mine(my worst tumor). Her prognosis should be similar to mine. My thinking is that RADs(to the axilla) would increase her already elevated risk for lymphedema. I remember thinking that I only needed RADs to the axilla on the node positive(only 4 nodes removed-stage2,grade 1) side. And "chest wall" RADs to the LVI (stage 1,grade 1 tumor). I ended up getting both on both sides. From what you shared in this thread, & I was in your wife's shoes, I don't think I'd do RADs & I had a relatively easy time with RADs. The hardest part was having to go 5 days/wk for 6 wks. I did RADs instead of having an ALND.

I'm 2years out from my BMX & the discomfort in my arms & chest is minimal at this time. I am athletic and not limited in anyway form my "treatments" or "surgery".

I had 1 positive node and a mx, and RT was highly recommended to me by multiple rad oncs based on two things -- extracapsular extension with the positive node, plus an unspecified margin on a tiny 1 mm. malignant spot discovered during pathology in an uninked bit of trimmed tissue. 

Since then, I have read several research articles that seemed to confirm my decision, which was a difficult one to make at the time, but which I'm now very glad I was persuaded to do -- although your wife's situation, Colt, doesn't sound like mine or some of the others here.  Has she had more than one opinion?   Deanna

In Feb. 2012 I had a left UMX with SNB, 4 nodes removed. A .6 mm micrometastesis was found in one node. My IDC tumour was 1.8 cm with LV invasion. Wide clean margins were obtained during MX. They staged me at Stage 1c Grade 1. I did 4 cycles of T/C followed by 25 rads. I feel very comfortable that I have done everything available to me to prevent recurrence. Rads were the easy part, no skin breakdown, just red, itchy and a little sore towards the end, also slept a lot during rads and for the following few weeks. I have no LE, and I'm exercising harder than ever before in my life. I wear a LE sleeve when flying, don't lift any heavy objects with my left arm, and no needles or injections in that arm. So far, so good.

I had a BMX with one positive node. Largest tumor in the breast was 1.7cm and the node had 2.5mm of cancer. The other 17 nodes were negative. Some signs of LVI but not so clear. Margins from the mx were clear. I had 3 opinions from ROs -



1st one said definitely yes. Mostly because of my age (40) but also pointed a lot to the LVI



2nd one said - it's up to me and she would support me either way.



3rd one showed me a lot of studies with various cuts on the data (1-3 positive nodes, people under 45, with LVI). Those stats showed recurrence risks anywhere from 8-30% (roughly, I can't remember the exact stats). That's of course why this is in the grey zone - if you believe 8 you wouldn't do it, if you believe 30 you would). He said he would recommend radiation but acknowledged that he is biased b/c it's his job!



In the end I did it. Did NOT radiate the axilla (all 3 told me not to and that it would increase my risk if lymphedema to 50%). They tell me that radiating the breast and superclav increases my LE risk by 2% (I hope they're right).



My right side is tighter than my left but I am doing PT now which is really helping. And my PS has told me that nipple reconstruction is not an option on the right (he won't mess with radiated skin so will only do a 3d tattoo). My skin was very burned as radiation ended but almost 6 months later seems basically back to normal.



But I know that I needed to do radiation in order to sleep at night knowing I did everything possible. So I don't regret it. But it was a difficult decision.



Rose

I had ALND, rads to all three areas, MX, and implants. The rads was after the tissue expander was put in. I am going to be removing the implant and do a DIEP in June. I'm doing this to get a better outcome. The rads side is tight and has a lot if scare tissue. I have not had any problems with lymphedema yet😊