Positive Sentinel Node question

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CatsRus
CatsRus Member Posts: 310
edited March 2015 in IDC (Invasive Ductal Carcinoma)

So got the news on Monday that one of two seminal nodes was positive for cancer. Boo.... Now apparently my case will be discussed by a panel on Friday and I will find out on next Monday what further treatment they recommend. The conversation with the BS went something like this.... 'the standard of care usually recommends further surgery to remove more lymph nodes but the topic is in flux at the moment and current thinking is swinging to not removing lymph nodes'. My surgeon is coming down on the side of NOT doing more surgery (which I found unusual as most people would tell you surgeons want to cut !) I have seen a report that says they found no significant difference in survival rates at the 5 year level in patients who had lymph nodes removed and those who hadn't. Just wondering if anyone else has encountered anything else like this... I have a feeling I am going to have a decision to make what side of the fence I want to come down on. I really don't want further surgery as I know some of the risks of removing lymph nodes, but part of my brain is screaming "GET *IT* OUT NOW"... I know I didn't ask enough questions on Monday so I want to be prepared for my next visit with lots of good ones. Obvious first one is why the BS would opt for no more surgery. Hopefully by then I should have the rest of my results on hormone receptors, etc., and together with the recommendations from the panel, it will become clearer.

Thanks all.

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  • inks
    inks Member Posts: 746
    edited March 2015

    I had a similar situation with 2 micromets in one lymph node. My surgeon was very opposed to full ALND. They discussed my case at the tumor board and only one doctor wanted to do full ALND. The decision was easier for me since I still needed radiation after mastectomy so we just opted for radiating the axilla. Radiation carries a risk of lymphedema but it is lower than with ALND. There was a recent study about ALND versus radiation with only a few nodes affected and the recommendation was in favor of radiation. Good luck with your descision.

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  • Jennie93
    Jennie93 Member Posts: 1,018
    edited March 2015

    My "sentinel node" was actually 6, and they found visible cancer in 3 of them, and later found a few microscopic cells in the 4th, even though nothing had showed up on the PET scan beforehand. My docs all agreed, positive lymph nodes meant I would need chemo and rads. They said that in the past, they would have taken the rest of the nodes out, but nowadays they believe it's better to just radiate the heck outta them instead.


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  • labelle
    labelle Member Posts: 721
    edited March 2015

    I ended up having 11 nodes pulled with my sentinel node biopsy-4 sentinel nodes and 7 aux nodes (they just "popped" out). 1 sentinel node was positive, but my surgeon did not even consider going in for more and I was told it was unlikely that there was cancer in the others. I was more concerned about whether or not this node would push me into chemo land. No one expected any in my nodes. none seen on imaging and a very small tumor. My oncotype test was done prior to surgery. With a score of 11 my OC had said no chemo prior to surgery but even with the positive node, both my surgeon and OC agreed it changed nothing in regards to chemo or my treatment plan-with a lumpectomy, radiation was the plan all along.

    I would not be in too big a hurry to demand an ALND as so many doctors seem to now believe limited node involvement doesn't change our plans or survival rates and lymphedema risks increase a lot w ALND. Lymphedema is much more than a minor annoyance and can be a very serious problem that negatively affects quality of life in a major way. Definitely something to be avoided if at all possible.

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  • Nancy2581
    Nancy2581 Member Posts: 1,234
    edited March 2015

    I had 1of 3 lymph nodes test positive for nasty C. I called my BS and asked if I had to do an ALND and she said no. She said since the cancer in the node was less than 5 mm (2.8mm) they would not take anymore. I did have chemo and rads. The rads included the auxiliary nodes as well.

    Nancy

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  • Jennie93
    Jennie93 Member Posts: 1,018
    edited March 2015

    Just saw this article today, as a matter of fact.....

    http://medicalxpress.com/news/2015-03-women-early-...


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  • CatsRus
    CatsRus Member Posts: 310
    edited March 2015

    Thanks for the responses.... I shall read up and have my questions ready for Monday. Think I may be leaning against ALDN, but that could change.... hopefully the rest of my results come back favourable including the CT scan I had today and the bone scan on Monday....scary stuff.... (The results, not so much the tests). Wish I could sleep...sigh...

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  • coraleliz
    coraleliz Member Posts: 1,523
    edited March 2015

    Hi Cats- I had ended up with bilateral BC. On my node positive side, 4 nodes were removed, 3 were sentinel nodes & 2 of those were positive.

    My MO sent me back to my BS to have an ALND. My BS wouldn't do it. She referred me to the RO. At first he sided with my MO, stating that if the MO feels he needs the extra information in order to treat me, I should have it done. I mentioned the study referenced above. He said he'd review the study but he didn't think it would change his mind. At that point it looked like I'd have to find another BS or another MO. About a week later, the RO called me back & said that after reviewing the study, he changed his mind. He now believed skipping the ALND & having RADs would be a better way to treat me.

    My MO expressed concern regarding lymphedema & ALND. I believe she said it was 30%.

    It looks like what you are going thru is very similar to my experience. Hope all the pieces fall into place for you soon. Wishing you a sleep filled night or 2 between now & you appt Monday.

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  • cp418
    cp418 Member Posts: 7,079
    edited March 2015

    http://medicalxpress.com/news/2015-03-women-early-...

    Most women with early-stage breast cancer avoid extensive lymph node removal

    A new study of women with early-stage breast cancer finds that surgeons no longer universally remove most of the lymph nodes in the underarm area when a biopsy of the nearby lymph nodes shows cancer—a major change in breast cancer management. The study, which evaluated data from 2.7 million U.S. breast cancer patients, is published as an "article in press" on the Journal of the American College of Surgeons website in advance of print publication later this year.

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  • CatsRus
    CatsRus Member Posts: 310
    edited March 2015

    just an update.. I am having ALND on April 16. I read all the reports on not having ALND but felt I really didn't qualify as only two nodes were taken in the SNB so not enough to fall within parameters for leaving it alone. Much as I would have liked to avoid ALND, I had sort of come to the conclusion it would be best and when I saw my BS today that was the recommendation of 'the panel'. At least we agreed on it.

    Thanks for the input, it helped

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  • Hopeful82014
    Hopeful82014 Member Posts: 3,480
    edited March 2015

    Cats, you might ask your surgeon about Axillary Reverse Mapping (rather than ALND). In AMR the nodes draining the arm are spared, which diminishes the likelihood of lymphedema.

    Either way, good luck with your surgery and healing.

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  • CatsRus
    CatsRus Member Posts: 310
    edited March 2015

    thanks...I will

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