Micrometastasis in the Sentinel Lymph Node

Syringa
Syringa Member Posts: 29
edited August 2015 in Just Diagnosed

Hi! I was diagnosed with a multifocal IDC, so I underwent a total mastectomy. During the surgery they removed 3 lymph nodes (one of them sentinel). Tumor was detected in one of them - micrometastasis. LVI was not observed. I already started chemo and I'll have radiation to the axilla.

Do you happen to know if the micromets in the SLN worsen my prognosis? Should I be concerned? I read that in case of micrometastasis in the SLN, according to the latest recommendations ALND is not needed, so I suppose it's not that bad.

P.S.

I am just curious what exactly is ALND? Do they remove the lymph nodes that are affected and several that are not, or do they remove all lymph nodes? How many nodes do they usually remove? Actually, does ALND guarantee the removal of all affected lymph nodes? Is it possible to have some nodes with cancerous cells left or is it possible to have recurrence there if all nodes are removed?

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  • Marie711
    Marie711 Member Posts: 87
    edited August 2015

    I had micro mets in the sentinel node and the oncologist did not seem too worried about it. We decided just to monitor the other nodes. There are so many decisions and so many different opinions with breast cancer it's really confusing. My surgeon and oncologist even have different ideas on what to do! I would be careful going by answers on a board, some people are really informed about things but you never know. Good luck

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  • ElaineTherese
    ElaineTherese Member Posts: 3,328
    edited August 2015

    Hi!

    When I was first diagnosed, an MRI and PET scan suggested that one node was compromised. This was confirmed by a fine needle biopsy. I then went on to have five months of chemo. After chemo, an MRI and PET scan suggested that my nodes were clear. My MO thought, "Oh, we'll just remove that initially compromised node and a few of its neighbors." That turned out to be impossible because the radiologist had not inserted a surgical marker in the cancerous node. So, during my lumpectomy, I had ALND, and my surgeon removed all the Levels 1 and 2 lymph nodes, which meant in my case, 20 nodes. The Level 3 nodes are still there.

    My surgeon took a rather old-fashioned approach to all this. Today, most surgeons try to minimize the number of nodes they remove so that the patient is less likely to develop lymphedema. It is possible to place a surgical marker in an affected node so your surgeon doesn't have to take all your Levels 1 and 2 out. Best wishes!

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  • jbdayton
    jbdayton Member Posts: 700
    edited August 2015

    I did pre chemo and after surgery my sentinel nodes were analyzed and 1 appeared to have maybe had a micromet but was dead the other one showed no signs of any involvement. I followed surgery with rads and I am to assume we did all we could do and I have a good prognosis of remaining NED. You have to put your trust in your oncologist (or tumor board) they have the studies to support their recommendations.

    It appears you are doing everything possible. If you are ER+ then the hormonal therapy will be one more treatment to stave off a recurrence or new cancer.

    The only other thing I can do is keep my faith.

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  • Syringa
    Syringa Member Posts: 29
    edited August 2015

    Thank you!

    Yep, I trust my doctors and believe they know what is best for me. They are professionals.

    Just wanted to learn more about this SLND/ALND stuff and how do surgeons usually decide how many nodes to remove?

    For example, I had only 1 sentinel, but they removed 2 more nodes from level 2? I think.

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  • SpecialK
    SpecialK Member Posts: 16,486
    edited August 2015

    LRR - how many nodes light up as "sentinel" nodes can be uncertain and varies from person to person. More than likely all of the ones you had removed did take up dye/tracer, and were removed together. Nodes are often encased in a fat pad, which is extracted by the surgeon without really being certain how many nodes are contained, and examined by the pathologist. That may be the only fatty area that takes up dye and tracer and it can contain 1 node or 5, it is an individual thing. You will see members here who have ALND - removal of all nodes in levels 1&2, and that yielded a total of 12 in my case, or 35 for another patient. It is less likely that your surgeon arbitrarily removed nodes from level 2, that would be quite a bit more invasive and increase risk, defeating the purpose of SNB, unless specific node(s) had been indicated by a previous biopsy and marked for removal. Here is a chart that illustrates the axilla that shows all three levels of nodes.

    image


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  • Syringa
    Syringa Member Posts: 29
    edited August 2015

    Thanks, SpecialK! I think I understand now

    One more question: Is it possible to have negative nodes at level 1, but positive at level 2 or even level 3?


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

    It certainly is, LRR. Mine skipped all the way up to level 3, surprising all of us.


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  • ShetlandPony
    ShetlandPony Member Posts: 4,924
    edited August 2015

    LLR, you might be interested in the ACOSOG Z0011 study.It addresses your first set of questions. My surgical oncologist considered it an important one.

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  • Syringa
    Syringa Member Posts: 29
    edited August 2015

    Well...so, even if they decide to take more nodes out, there's still risk of having cancerous cells somewhere in the axilla...that's bad Unfortunately, no one can guarantee that everything would be clear after a surgery.

    I hope radiation would kill everything bad there.


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  • Hopeful82014
    Hopeful82014 Member Posts: 3,480
    edited August 2015
    That's pretty mich it, LRR - no guarantees with cancer, sadly.

    Radiation to the nodes carries less risk of lymphedema than full lymph node dissection. Doing both ALND and radiation carries the highest risk of lymphedema.
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