my doctor says only need level 1 axillary node surgery??

Hi scaredashell, I just want to add a few words. As Gracie said they don't try to remove all the impacted nodes because research shows this does not improve outcomes but increases the risks of lymphedema and other issues. With invasive disease you will be recommended chemo and radiation to lymph nodes that will take care of whatever remaining cancer might still be there.
Trust your surgeon and good luck with the surgery!

Scared, here is an explanation of what the sentinel node biopsy is: http://www.breastcancer.org/treatment/surgery/lymph_node_removal/sentinel_dissection

It sounds as if the MRI has shown that there may be multiple positive nodes, and perhaps that is why they (MSK) don't want to do the sentinel node biopsy (SNB), and instead are planning to do a more extensive node dissection. You need to ask for a better explanation of this, because they really are not communicating with you well to leave you with so much doubt. On the face of it, it sounds aggressive to me too.

If i am understanding you correctly, 2 docs from MSK indicate that they want to do multi level node removal. A third said he would dissect one level, and your fourth doc seems to indicate that he will do an SNB (since you reference the use of dye.) As Muska indicated, having a lot of nodes removed can cause issues down the road without necessarily improving your outcome, so you want some reassurance that docs 1,2 and 3 are proposing this for a good reason. They can always remove more nodes, but they can't put them back once they are gone. If you are going to feel at peace with any of these plans, you need them to explain it in a way that makes sense to you, so please do follow up with them (MSK and #3) about their reasoning, and also speak further to #4 to understand why he/she is OK with trying the SNB first. Sorry if I have gotten any of this wrong regarding the # of docs/plans. The beginning is a hard, confusing time! Wishing you the best.

The tide is beginning to turn against not just ALND but even SNB—just one positive node affects staging, removing more of them doesn’t prevent spread because by the time it’s in the nodes there are at least micromets, and systemic therapy (chemo, targeted, and/or hormonal) takes care of that. And the conventional wisdom that lymphedema is relatively rare is similarly falling by the wayside as more and more patients report it after not just ALND but even SNB (writer raises occasionally swollen hand).

scared, Have you tried Rutgers for another opinion? My mom went there for a second opinion and was very, very happy with the team of doctors tehre.

Gracie, I'm having a very hard time understanding that myself. I do think that MSK tends to be fairly rigid in its institutional culture (and I think that blanket recommendation speaks to that) and sometimes resistant to new therapies/approaches but that's just my personal observation. I certainly have not seen anything that would lead me to think that neo-adj. chemo for all node positives would be THE way to go. I'll be interested to see if anyone else has any insights on this.

My BS and MO both said that neo-adj. is the way most large breast centers are going. Shrink what you have first to minimize surgery and its side effects, LE, etc. Especially when in lymph nodes to get everything that may have gotten "past" them, no matter how small. Hopefully keeping surgery to minimal nodes removed. Seems to make sense

Scared, I just ran from one doctor to another because of that. When I first received my dx, the surgeon wanted me to shrink the tumor with chemo and rt before submitting me to surgery. Then because rt damage the skin, he wanted to do flap reconstruction, after that he wanted more chemo and rt. My common sense or sixth sense (I see irresponsible crazy doctors) made me run away from him. He received the positive report and for three weeks he didn't call me. I was looking for him because I was bleeding from the sutures of the biopsy. I just went to a BS who after looking at my pathology report, he asked for the Oncotype. He also put me in hormone therapy to shrink the tumor. By MRI, my tumor was encapsulated and measured 9 cm by 6 cm. When he removed the tumor, it had shrunk to 4.5 by 3 cm. No need to make outstanding procedures that debilitate the body. Oncotype is more of use for MOs and ROs that need to know how "spreadable" a tumor is. But they have antigens tests to do that. Chemo is given when Oncotype score is 16 or less because chemo toxicity outweighs its benefits.

As the other roommates have stated, the procedures you are being submitted are too aggressive. If the center you are dealing with is too traditional in its approach and you don't feel comfortable, just move away until you find yourself quite well with the team you are working with. Guidelines for irradiating women with mastectomy and with one to three lymph nodes affected have changed. This site provide you with those guidelines and check them with your dr. Most MOs recommend chemo followed by rt after surgery.

I have IDC Stage II Luminal B type Onco 26. With 21 days of hormone therapy my tumor shrank to half the size.The original size of the tumor covered two thirds of the breast before reduction and the BS decided to remove the complete breast because breast would have looked deformed. I decided for a reconstruction. I didn't let him remove all nodes from axilla because of lymphedema. I already have lymphedema in my trunk (swelling does not go away - complications with recon surgery) I am 66 and Medicare does not cover it. Also, SS won't incapacitate you because of it. The chance of developing lymphedema goes from 6% with SNB, 40% with rt, variable when you lift things heavier than 15 pounds (how frequent and how much you lift), and variable from chemo depending on the cytotoxic agents they use. And a note for all of us, our body does not function by adding up the parts. Instead, it can go up exponentially after lifting or just by having rt in your armpit.

From the first post you wrote in this page, I think the dr was conservative doing the SNB. That is quite good. If you are still working and need your arms to do everything, don't go to axillary dissection. One node is not enough justification.This is your body and no physician can order you to do what you don't want. They suggest, they do not command. If they were entitled to, they would not give you the document exonerating them from mistakes. (That document does not guarantee that they won't make mistakes; it only says that you were informed of the consequences of the procedures and you accepted to go for it). So, in summary, MOs use chemo if Onco score is 17 or greater, RT if you do not have the criteria of the guidelines of post mastectomy women (especially age) and hormone therapy which is now part of the protocol of care. Also, they are supposed to give you a service, you are not supposed to make them happy. (I deal with arrogant physicians in their own terms, with knowledge. I read and bring them arguments they can or cannot debate and they must convince me. Otherwise, I do not comply.)

Good luck, scared, make decisions that you won't regret in the near or not so near future.

Sweet dreams, you all.

Maria

Hi scaredashell07, we knew about 2+ nodes prior to chemo, and yes, they were the reason for neoadj chemo. Perhaps also the grade of my tumors (one was a 2). My tumors were small, about 1cm, and they were recommending mx anyway, so it wasn't to shrink tumors. I did not have oncotype, never mentioned. My 2nd opinion at Dana Farber was at the end of chemo, and they offered lx, which I did. The MO consulted there said she would have begun with neoadj hormone therapy but that ship had sailed.

I asked for SNB but the surgeon thought they needed to go and she was right (7/17).

chiSandy - I don't think the majority of hospitals are just administering chemo without getting the full picture...

At my cancer center they determine if you are a chemo candidate, being Her2, Triple Neg automatically get you a seat at the chemo lounge and therefore there is the option of doing chemo before surgery. The cut off at many places is size/nodal status. At mine any aggressive cancer over 2cm or has positive nodes they recommend chemo before surgery for the obvious high risk ladies.

Before my pathology came in they said that the final results would determine chemo before surgery - if chemo is a given then this is an option - if I was her2 neg they would have done surgery first (In fact it was booked then cancelled once by her2 score came back)

now back to OP - i see what it is grey in terms of chemo prior to surgery, you are definitely not a clear cut case. Looks like everyone is recommending chemo just not in the same order. If the point to chemo first is to clear the nodes so they don't have to take as many here is what my RO told me. He said that they treat positive lymph nodes the same whether they are clear after chemo or not.....meaning they radiate level 1 if you had a node positive prior to starting chemo then chemo destroyed the cancer. I believe rads to the lymph nodes vs dissection carries a lower risk of lymphedema though. Things may have changed now with how they handle nodes that are clear after chemo but had tested positive prior. I would definitely ask a lot of questions before I let them remove too many nodes. Many studies have shown that this does not give a survival benefit -I'm sure someone will come along to post studies