Lymph node dissection question

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VL22
VL22 Member Posts: 851
edited September 2017 in Surgery - Before, During, and After

My lumpectomy is 6/15. BS doesn't believe lymph nodes affected, but obviously this can change. On my surgery sheet is says possible ax node dissection. At the time of surgery, can the BS tell that a sentinel node is cancerous and then move on to the ax nodes?

Thanks

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  • SpecialK
    SpecialK Member Posts: 16,486
    edited June 2017

    VL22 - you will have an injection(s) prior to surgery that will send tracer, dye, or both, to your sentinel lymph node, which is usually the closest node away from the breast. This node is removed during surgery, and the pathologist will take an immediate look at it, while you are still in the OR. If it is found to be cancerous, your BS may go on to remove additional lymph nodes from the axilla. It is worth having a conversation with your BS about what his/her threshold is for removing additional nodes - will the axilla remain undisturbed if they only find a micromet, or would that prompt removal of more nodes?

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  • VL22
    VL22 Member Posts: 851
    edited June 2017

    SpecialK - thanks so much for the fast response. I believe he went over this with me, but it is information overload I will be sure to ask him about his threshold for node removal.

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  • LeesaD
    LeesaD Member Posts: 383
    edited June 2017
    I wish I had discussed threshold with my Breast surgeon prior. I had signed consent for both Sentinal Node biopsy and ALND if needed but I wish we would have discussed in detail my wishes. I had a bilateral mastectomy with tumor thought to be 6- 8 mm based on biopsy and MRI. MRI also showed no lymph involvement. Sentinal node biopsy during surgery showed 1 of 4 with micromestasis. Surgeon did not perform ALND during mastectomy and I wish he had. Pathology showed tumor actually 3 cm's and 2 of 4 sentinel nodes with micro mets not just the 1. I pushed for ALND which he agreed so had second surgery 3 weeks after mastectomy. And they found 2 of 14 fully positive nodes during ALND. So my sentinel nodes were micromets and my axillary fully positive which I have been told is rare. When my surgeon told me about the micromets post surgery I immediately wish he had done the ALND right then and there as I knew automatically I was going to push for a second surgery. Hindsight...
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  • AliceAgnes
    AliceAgnes Member Posts: 78
    edited September 2017

    Pre-op I also consented to a sentinel node biopsy and axillary node dissection if needed. I went into surgery after receiving chemo for multicentric breast cancer including one tumor measuring 1.7cm and one cancerous lymph node that had been clipped. When no node with a clip showed up in the sentinel node biopsy, the surgeon proceeded to remove two layers of axillary nodes because she was concerned about getting that one known cancerous node out of there. The pathology report later showed that a total of 20 nodes had been removed, and TWO were positive for cancer. She was very glad she had made the decision to proceed with the dissection, and so was I. Clearly the cancer had spread a little further than originally thought. Radiation is next for me.

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