Radiation timing

percy4 · January 2014

Sorry to start another thread, but this is a specific question. I am concerned about waiting 2+ wks for Dr. Lagios' report, then having a node biopsy, then waiting (they tell me) 6 further wks before I can start radiation. This will be doing rads over 3 months after lumpectomy, and I'm worried about stray cells now. I think they should have done the node biopsy as soon as they so the micro-invasion, and am upset they didn't. Does anyone know if SNB can be done fter radiation, rather than the other way around, or is it possible the breast is too changed by the radiation to get clear channels to find the node accurately? Anyone ever heard of doing it this way; for instance if someone had just DCIS and rads, and not too much later had an invasive cancer, and only then had the SNB on a previously irradiated breast? Thanks - P.

keepthefaith · January 2014

I'm not really sure what you are asking...if you have already had a lumpectomy. I had my lumpectomy and SNB at the same time. I think they would do the SNB prior to rads in order to stage and plan treatment based on findings.

BayouBabe · January 2014

Those of us that have a mastectomy have to wait for healing to be complete in order to begin rads. You should be fine.

percy4 · January 2014

Sorry if I wasn't clear. I'm asking if you can do rads first, then SNB. I know it isn't usual. They should have done the SNB as soon as they found the micro, but they didn't, and I want it. Unlike someone with a mastectomy, I have a lot of breast tissue left for a stray cell to be growing now.

percy4 · January 2014

I understand this would be unusual, but I'm not happy waiting to do rads for 2 extra months, and why not wait another month for the SNB? They weren't going to do it at all, I would just be double-checking to make sure the chance of nodal involvement they are so sure is not there really isn't. The rads I want to get going with, while it still matters the most.

wyo · January 2014

I am a little confused Percy- the sentinel node procedure can be done independent of any other surgery or procedure??. They just inject a radio-isotope or dye then remove 1-3 nodes where any cancer would be most likely to be found based on the uptake of the material used.

I really can't figure out why a 6 week waiting period between SNB and Rads? I am like others on this thread who had SNB during lumpectomy surgery- I started Rads a month later- would have been earlier but scheduling was an issue.

I know you mentioned there was question about if there was or was not microinvasion in some of your other posts- since SNB is not part of standard treatment for DCIS unless you have: widespread areas DCIS, significant amt of high grade DCIS, diagnosis of DCIS under 40 and micro invasion. These clinical factors would drive doing or not doing the SNB

It does seem like an extended timeline to start the RADs- have you asked if it can be accelerated? I have not done the research on the benefits of radiation +lumpectomy for DCIS based on when the RADS tx is given.

ziggypop · January 2014

Percy, I think you are going to need to back track and explain the whole thing from the beginning - there are a lot of people on these threads, so it's hard for anybody to remember why you are waiting 2 weeks for a report or exactly where you are in treatment/treatment decisions. The only thing I can tell you is this - I don't think they'll do a SNB after doing rads because rads shrinks cancer cells - presumably (hopefully) & there wouldn't be enough cells left to know which nodes to remove, but also, they are not going to, for instance target your ANs if they have no reason to believe that there are any cancer cells in them. The node biopsy generally suggests the areas where rads will be or will not be targeted. You really need to talk to your oncologist and maybe not try to second guess what they are doing so much. Generally speaking, there is a standard protocol that is followed - it may have slight variations that seem like huge variations to us as patients - but really it's pretty standard.

I'm kind of confused here too - why are you having a SNB at all if you have DCIS of less than a cm and you plan on having RADS? Also you are er/pr + so I'm assuming an AI or SERM?

ballet12 · January 2014

Hi Percy, you need to do the SNB before the radiation, because of the very very very small chance of their finding invasion in the nodes. This would affect your treatment plan. In that scenario, which I might add is very very very unlikely, they would need to consider chemotherapy, which is given before radiation, and possibly radiation to the axillary area. About the time frame between lumpectomy and radiation, some facilities say a maximum of 6 weeks, but where I went, it was a very busy, high profile place with many patients needing to be scheduled. I had the surgery in October and the radiation in January (close to three months). No one thought it was a big deal. Again, I didn't have a microinvasion, so you are at a tiny bit more risk than I was, but I think many bc patients at my facility (Memorial Sloan Kettering), with IDC, also had to wait a long time to be scheduled. I would be surprised if they postponed the SNB until after the radiation. Sorry you are still under such incredible stress. I hope the consultation with Dr. Lagios will be helpful to you.

ballet12 · January 2014

Hi Ziggypop, Percy has an area of microinvasion, which calls for SNB (standard protocol).

CTMOM1234 · January 2014

Percy - I appreciate your concern! Once my lumpectomy pathology came back reporting 1.75 mm of grade 2 idc among the grade 2 DCIS, I, too, was worried about stray bc cells and waiting. Wanted to get rads in under that "6 weeks from surgery" window that we hear about, and this unexpected additional snb surgery was going to make that impossible.

But like ballet12 stated, the snb results are necessary to develop your treatment plan, which may very well not change and you'll move on to rads with only that relatively small delay.

Wishing you the best.

ziggypop · January 2014

Ah.. thanks ballet, I was confused.

percy4 · January 2014

Thanks, ladies. Yes. To clarify. I was originally diagnosed, from my lumpectomy, with only DCIS. 5 days later, they called to tell me that had been amended to include a micro-invasion. Still, they did not recommend a SNB, though it is standard. So now I want the SNB, whether they want to or not, but it will put my rads off a further 6 wks after the SNB, resulting in my rads being 3 months from lumpectomy. Was just wondering if the rads could be done first. Women who originally just have DCIS and rads sometimes are diagnosed with a small IDC soon after. They must then get the SNB after rads. I was just wanting to hurry up the rads, and then do the SNB, rads out of the way, and any further treatment (if there's anything in the nodes) after.

percy4 · January 2014

I was not happy about the "amendment". Really lacking pathology. Can you imagine how I felt?

percy4 · January 2014

Also; I have not figured out how to change my diagnosis here to DCIS with a micro-invasion.

ziggypop · January 2014

Okay, I'm going to try to walk through this, and this is just my understanding of thing, we're not docs & can't really give you the answers that I think you would like to receive but this is what I understand, -

Generally speaking the purpose of a SNB is to determine the spread of the cancer into the nodes in order to access 'risk' and based on that assessment determine the appropriate course of treatment. I many nodes are involved, then chemo will generally be given, micromets, then maybe rads to the nodal area in the armpit. The purpose of Rads is to shrink and kill cancer cells locally, the purpose of chemo, to kill them all over your body (including locally and distally).

Once you have treatment which is designed to shrink and kill cancer cells, then a SNB becomes inaccurate. Lets say that you find some cells in 3 nodes? what does that mean? Were there way more before the rads? What if you don't find any? What does that mean? Maybe the rads killed the cancer cells in the sentinel nodes (since that's where you are targeting the rads) but they still exist in the auxillary nodes?

Percy, at some point I think that you have to understand that while every doctor may not be the greatest doctor, they do know more about this than you do. They know more about it than I do. (they might not know more about it than Beesie : ) ) Their reputations are based on giving you the best treatment. If you're unhappy with the treatment plan laid out by your original docs, then go for a second opinion, but at some point you have to let go and let them do their jobs.

One question - who told you that they have to wait 6 weeks after a SNB to do rads? They started my rads 5 weeks after a mastectomy and AND?

This stuff is tough & you're right to work through it, but you need to find a team of docs you trust & go with their answers.

percy4 · January 2014

Thanks, ziggy. I do know I have to trust the team at some point, and I did, but all the strangeness has shown me that one is good at one thing, not so good at the other, etc. My surgeon is a great surgeon. Yet, she was wrong to give me a final path report to make me happy (I hadn't asked her to be fast) and then amend it days later. It was not "preliminary", it was "final". The pathologist is a good pathologist, but she was wrong to allow herself to be "pushed' (her words) into providing the surgeon with a final path report when she was still worried about one slide. That slide turned out to be the micro, and I had to tell myself, my parents, and my kids that I'd had an invasive cancer after all, after telling them it was all clear. As far as I can see, both my surgeon and MO (who I am replacing) were wrong, according to everything I've read here and everywhere else, to not recommend the SNB as soon as they found the micro, so now I will have to do the SNB to feel secure, and that puts off my rads. It is the RO who says I need 6 wks after the SNB. It was also the RO who was surprised they did not recommend it. So, while they know a lot more than me, I've been let down here along the way. I can't change, I am stuck with my HMO, which is usually great. I am getting a final/other opinion from Dr. Lagios. You can see why I feel I have to be on top of it, with all the stuff that's happened. I know I can't (and REALLY don't want to have to ) control it all. What you've explained about maybe missing something in the nodes hidden by doing rads first makes logical sense, so I guess I'll just have to wait. Thanks so much for taking all this time. xx

Radiation timing

Comments

Categories