Internal Mammary Node Treatment

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agness
agness Member Posts: 576
edited November 2015 in Not Diagnosed With a Recurrence or Metastases but Concerned
Internal Mammary Node Treatment
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  • agness
    agness Member Posts: 576
    edited July 2014

    I'm just finishing up chemo which was very successful in treating my HER2+ breast tumor and also it seems my axillary lymph nodes. My MRI and ultrasound from yesterday reveal that cancer remains in my biopsied sentinel node (which cancer had already started to invade the node tissue itself) and also in the internal mammary node (behind my breastbone).

    From all that I have read the internal mammary node is not well treated by radiation therapy and the site is considered a high risk for additional metastasis.

    I hope to consult with an interventional radiologist regarding options to ablate (RFA) this node. I'm not finding a lot of information about this being a treatment option but hopefully I can gain more insight from others with this affected node or who have looked into RFA.

    Thanks,

    Ann

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  • bevin
    bevin Member Posts: 1,902
    edited July 2014

    HI Ann,

    Im sorry you are going through this and while I don't have the same issues, I wanted to stop by and give support.  I know others with a similar path will be aong soon to chime in. Best wishes to you.

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  • jenjenl
    jenjenl Member Posts: 948
    edited July 2014

    Ann - I don't have much to offer other than I had a internal mammary node that was positive but mine was in my breast and was removed by MX.  I'll be watching this thread in hope that someone has some feedback for you. xo

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  • agness
    agness Member Posts: 576
    edited July 2014

    I haven't found any studies or mentions about it. I'm scared that radiation isn't going to zap it and it will just continue to grow inside my chest wall.

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  • AnnBR
    AnnBR Member Posts: 853
    edited July 2014

    Ann - I was recently diagnosed with a positive internal mammary node while undergoing a DIEP reconstruction procedure. My PS was removing part of a rib to get to a vessel and removed, in his words, 'a funny looking node.' My radiation oncologist has treated patients with positive internal nodes, but not discovered in the way mine was. She has never given me any indication that I am at a higher risk for mets and I've asked her multiple questions about my future. I am being treated at the Mayo Clinic in Rochester and will complete six weeks of rads next Friday. My treatments are a combination of fixed beam and rapid arc therapy. I was diagnosed with Stage 1 IDC in December 2012 and the node was found on April 30, 2014. When I meet with my RO next Thursday, I'll have her restate what she told me about my prognosis. I'll be seen by my MO in August and plan to ask her the same questions. I too, would love to hear from others if they have gone down this path. What a roller coaster ride this journey has been!

    Ann

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  • AnnBR
    AnnBR Member Posts: 853
    edited July 2014

    Ann - I recently underwent a DIEP reconstruction procedure where my plastic surgeon removed an internal mammary node which came back positive. My PS was removing part of a rib to get to a vessel and saw, in his words, 'a funny looking node.' This set in motion a series of tests, including a PET scan, bone biopsy and a few other tests. All came back negative, thank God. My medical oncologist said that rads would be the best treatment so within a few days, I was seen by a RO. She told me she has successfully treated patients with positive internal mammary nodes, but has never seen a case like mine, because of how it was found. She has never given me any indication that I am at a higher risk for mets and I've asked her multiple questions about my future. I am being treated at the Mayo Clinic in Rochester and will complete six weeks of rads next Friday. My treatments are a combination of fixed beam and rapid arc therapy along with a deep breath technique. The treatment you are inquiring about was never discussed. I was diagnosed with Stage 1 IDC in December 2012 and the node was found on April 30, 2014. When I meet with my RO next Thursday, I'll have her restate what she told me about my prognosis. I'll be seen by my MO in August and plan to ask her the same questions. What a roller coaster ride this journey has been.

    Ann

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  • agness
    agness Member Posts: 576
    edited July 2014

    My surgeon said she could talk to a thoracic surgeon about removing it but in looking at the MRI the node is nestled between two moderate-sized blood vessels. She said the risk of operating in that area is that if a blood vessel gets nicked they have to open you up to fix it.

    So, RT it will have to be. I need to re-consult with my RO 

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  • agness
    agness Member Posts: 576
    edited July 2014

    I met with two ROs in the past week at two different centers. The first one recommended whole brast with a boost (6 weeks tx). The second has access and expertise with proton therapy and thought that I might be a good candidate for it. 

    Being HER2+ I worry about the risks of Herceptin to my heart but then when you add on greater radiation exposure risks versus less accurate treatment (affecting more surrounding tissue) for my nose behind the chest wall then I start worry about trading off one set of problems for another. I might have to pay for it out of pocket though, not sure if my insurance will cover proton therapy -- but I have two little boys who need their mom.

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  • agness
    agness Member Posts: 576
    edited July 2015

    update: the internal msmmary mode appears to facilitate progression of HER2 disease to the brain.

    From a chinese medicine standpoint the internal quadrant is quite a serious location for breast disease.

    Some 31-43% of HER2 patients are expected to see brain mets, even with a good response to local therapy

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  • agness
    agness Member Posts: 576
    edited November 2015

    Since there isn't much written about the significance of local spread to the internal mammary node, I thought I would share when I find things that relate.

    This article is about ovarian cancer spread to the internal mammary node/s. There are three cases described and treatment entailed radiation therapy and/or surgical resection of the affected node/s. One patient developed brain mets.

    Solitary Internal Mammary Lymph Node Metastases Detected by 18F-FDG-PET/CT in Ovarian Cancer


    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114616/

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