Lymph node involvement

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  • mimioleary
    mimioleary Member Posts: 5
    edited March 2017

    I had two positive nodes out of four. When I met with the genetics nurse about my genetic testing, she told me that now cancer with five or less positive nodes is considered curable. Has anyone else heard this? I have not found that statement in any of my reading but that is what she said. I would LOVE for that to be true, but I want to hear it again from another reliable source. In the meantime, I continue through my chemo regimen and pray that it is working.

  • bclibrary
    bclibrary Member Posts: 12
    edited March 2017

    Hi everyone -

    I just had bi-lateral lumpectomies last week, and the surgeon just called with Sentinel biopsy results (or whatever it's called). First, apparently there is cancer in the margins on the right, so she has to go back in and cut more.....ughhhhh. The nodes on the left (took samples from 4 or 5) all had cancer so she is removing all of them. She removed one that was found to be cancerous prior to chemo.

    I don't know why cancer didn't appear in all of these lymphnodes before??

    I did read (I think on this site...) that 1 out of 4 lumpectomies end up having to go back in to make larger margins, but it still upsetting!! RIght when you think you'e on to radiation.

    Has anyone experienced this with re-doing a lumpectomy or finding more cancer in other lymphnodes?

    Thanks for any feedback.

    Barbara

  • labelle
    labelle Member Posts: 721
    edited March 2017

    mimioleary, oftentimes people with many positive nodes go on to live out their full lifespans with no recurrence of BC. Some people on here object to the word "cured" but there are people with Stage I, II and III cancer who complete their treatments and are never bother by BC again-whether you want to call in "cured" or "NED" or "in remission"-the end result is the same, they die of something else.

    With one positive node, my oncologist considers me to be a low risk for a recurrence and did not even recommend chemo. Lots of things besides stage, including the type and aggressiveness of the cancer, go into the prognosis. While everyone would prefer to be node negative, I think it is important to clear up the misconception that having positive nodes means you are doomed. It does not.

  • Emily2008
    Emily2008 Member Posts: 605
    edited March 2017

    Barbara, I initially underwent a lumpectomy in 2008, only to find out that one of the margins had bisected another tumor, so more surgery was required. After lots of research and opinions, I elected to have a mastectomy. The path report after that surgery showed a satellite tumor and DCIS in the remaining breast tissue. I was very glad I elected to have the mastectomy.

    Good luck!

  • mimioleary
    mimioleary Member Posts: 5
    edited March 2017

    Very good points. Thank you.

  • cindysmom
    cindysmom Member Posts: 15
    edited April 2017
    Hi I'm new here. I was diagnosed with IDC stage 2 BC. When they did the biopsy they also they also found cancer in one of the lymph nodes. I had 8 rounds of Chemo 4 A C and 4 Taxol. Had surgery on 4/5/2017 they tested the lymph nodes and there was still cancer in the nodes. It seems that there was some response to Chemo just not totally. Still waiting for the pathology report to come back but really afraid of what it may show.Has anyone ever had the same experience, wondering what could be the next steps.


  • Wildplaces
    Wildplaces Member Posts: 864
    edited April 2017

    Cindysmom,

    What was your surgery?

    Did you have chemo before the surgery?

    Depending on your surgery and the extent of lymph node involvement you may or may not be offered radiation.

    If your BC is hormone positive depending on your premenopausal status you will be then beoffered Tamoxifen or Aromatase inhibitors.

    If you fill in your history and make it public - it will be a little easier to comment.

    It's a tough time waiting for the pathology - hang in there - stage 2b is a tumour less then 5 cm with less then 3 nodes involved - lots of potential for it to be cured.

  • Matryoshka
    Matryoshka Member Posts: 35
    edited April 2017

    Really appreciate this topic and all of your sharing. My MRI and US shows clear lymph nodes, but guess I will only know for sure after my lumpectomy.

    Keeping positivity and hoping no node involvement and clear margins!

  • cindysmom
    cindysmom Member Posts: 15
    edited April 2017

    Yes, I had Chemo before surgery that's when they said it was 2a, but during surgery they found the Chemo had not killed all the cancer cells. Do they do second rounds of Chemo doesn't that mean the cancer that I had at the time of the biospy was still active and could have spread. Going to insist on a PET scan, Does hormonal therapy work like Chemo (ie kill cancer cells or does it just prevent reoccurence). Just losing it around here, hoping for a cure somehow....

  • Wildplaces
    Wildplaces Member Posts: 864
    edited April 2017

    ok, stage 2 a or b is still highly curable so sit tight ( the size for 2 is the same - 2-5cm but it's b if lymph nodes are associated.

    It is not unusual for the chemo not to kill al cancer cells especially in lower grade ( not a stage but a representation of pathology of how aggressive a cancer is - nuclei, tubules, mitosis).

    Once you get your pathology - they will be a decision on radiotherapy and then hornone therapy - they will both reduce your risk of recurrence.😊

    The post chemo time plus surgery is very taxing emotionally and physically but it sounds you have a good plan.


  • NCBeachGirl
    NCBeachGirl Member Posts: 66
    edited April 2017

    Hi,

    I have sentinel node biopsy surgery scheduled for April 12 (Wednesday). They'll do the dye/marker/whatever, the remove some sentinels. They'll freeze and test the nodes while I'm still in surgery (I'm also having a cervical polyp removed). If the nodes test positive, the BS will remove the rest of the nodes.

    Well, that sounded fine to me at first, but now I'm wondering. I'm Her2+, and haven't met with an ONC yet (waiting for the node info). BS said the usual treatment for my cancer is surgery (had 9mm mass removed during biopsy, but margins were narrow and BS wants them better) with node biopsy (possible removal), with radiation and chemo plus targeted therapy (most likely Herceptin).

    My question for this thread is: if I'm going to be stuck doing chemo anyway because of the HER2+ status, is there any point in removing all the lymph nodes and putting me at risk of lymphedema? Even if the sentinels are positive, can we leave them in and rely on the radiation and chemo to kill any cancer in the nodes? (BS says there's no palpable node masses.)

    Thanks for any info and advice.

  • NCBeachGirl
    NCBeachGirl Member Posts: 66
    edited April 2017

    Oh, and I read in another post somewhere on this site that HER2+ cancer can spread into the blood without showing up in the lymph nodes. Another piece of info that makes me think I need chemo. I'm new to cancer...aren't there blood tests to see if there's cancer swimming around in there?

    Thanks again.


  • NCBeachGirl
    NCBeachGirl Member Posts: 66
    edited April 2017

    Hi,

    Not sure if anyone is following my posts, but here's an update.

    I had a second surgery Wednesday April 12th. BS reopened the site where the mass was because she wanted to make the narrowly-clear margins from the initial lumpectomy/biopsy bigger. She removed one lymph node, it felt normal to her, so she closed me up and will send the node for pathology. I had done some research about node removal, and we decided to remove all the nodes only if the sentinel nodes were riddled with cancer. Also, my gynecologist removed a cervical polyp. Yay to them both for coordinating it so i could get both surgeries in one shot!

    Next step is a followup with BS when the pathology report comes in. Then off to an oncologist.

    Before the node biopsy, I'm stage 1, but I have aggressive HER2 3+positive, grade 3, ER/PR neg, Ki-67 74% cancer. BS initially told me the standard treatment for this is both radiation and chemo with Herceptin. But there seem to be variations among people.

    I'm torn between wanting to avoid as much toxic and potentially harmful treatment as possible, versus hitting the cancer with everything they've got, and just dealing with then side effects. I'm only 55. But I have a ton of chronic co-morbidities, including fibromyalgia and bipolar, plus lots of other stuff. I'm already on disability, not working. Already in chronic pain, fatigue, depression. It's not like a year or two of unpleasant treatment is going to make a whole lot of difference in my QOL!!! LOL!

    Bye for now.

  • AliceAgnes
    AliceAgnes Member Posts: 78
    edited August 2017

    NC Beach Girl, how are you doing now? It's the end of August but I only stumbled across this topic today. I, too, have fibromyalgia and no longer work for a variety of reasons, although I have not yet reached the standard retirement age.

    I finished my 6th and last chemo treatment six weeks ago and am headed for surgery this Monday--a unilateral mastectomy, sentinel node biopsy, removal of one affected lymph node that was biopsied in March, and possibly an axillary node dissection depending on what the surgeon learns from the sentinel node biopsy.

  • peppopat
    peppopat Member Posts: 90
    edited August 2017

    New primary in the same breast. After learning 2 months ago that I have to get another lumpectomy, I did. Now, my surgeon informs me that during the next operation he will emove a couple lymph nodes He will then rush them to the lab and see if any of them are more than 2 mms. If any are, he's going to take them ALL out ( I think that's over 20.)

    I looked at other women's posts on this formum and noticed that hardly anyone had all their lymph nodes taken out. What am I missing here? Isn't this somewhat of an overkill? Thanks and my best to all of you

  • AliceAgnes
    AliceAgnes Member Posts: 78
    edited August 2017

    Peppopat, what I have read is that the number of nodes taken in an axillary dissection varies widely among individuals. Some women have only five of them and some have thirty. Most fall somewhere between those two numbers. It is too risky to save them all when a couple of them reach a certain size. Chances are the other nodes have cancer detectable only at the microscopic level (micromets). He is going by standard practice.

  • AliceAgnes
    AliceAgnes Member Posts: 78
    edited August 2017

    PS Sending positive thoughts your way and hoping both of us won't need that procedure!

  • peppopat
    peppopat Member Posts: 90
    edited August 2017

    The guidelines also say:

    • Women with negative sentinel node biopsies shouldn't have axillary node surgery.
    • Women with one or two positive sentinel nodes who plan to have lumpectomy plus radiation also don't need axillary node surgery.
    • Women who have one or more positive sentinel nodes and plan to have mastectomy with no radiation should be offered axillary node surgery

    I am NOT going to give up my first line of defense by allowing the harvesting of ALL my axilla nodes. Not if I'm willing to cave-in to radiotherapy. It is my only intention to have a sentinal biopsy. That is not the intention of the surgeon as of this moment.

    I'm of the opinion that this is some sort of punishment by the oncologists for 6 years ago when I chose to do very minimal treatment. no rads, only 2 years letrozole. My surgeon would love for me to believe that my former conservative decision is the reason my NEW PRIMARY has surfaced. REALLY????

    Big thanks to Alice!

  • Leilals
    Leilals Member Posts: 37
    edited August 2017

    Hi Cherry, I had a BMX last month. My sentinel nodes looked fine during surgery. They sent them out for more testing. 2 out of my 3 nodes we're positive. One was completely full. There is about a 10% chance that it can be missed during surgery. I went back in for auxillary node dissection on the 16 of this month. The rest of the nodes we're negative. I didn't realize how scared I was until the results came back. Staying at stage 2b was a big relief. I hope the best for you. I'm new at this, so my emotions are all over the place. The unknown is scary. I am sending the warmest wishes your way and will be hoping for the best. Leils

  • AliceAgnes
    AliceAgnes Member Posts: 78
    edited August 2017

    Hmm, that's interesting, peppopat. I can see why you are concerned.

    I can only speak for myself. I know that on Monday I will have a mastectomy and sentinel node biopsy. I have one malignant axillary node, which was clipped at the time it was found and biopsied in March. However, the doc explained to me that the clipped node might be difficult to find because all kinds of crazy things can happen during six rounds of chemo, and if the clipped node doesn't "light up" as part of the sentinel node biopsy, she may have to resort to a complete axillary node dissection to find it and get rid of it.

    I will be getting radiation in the armpit area and chest wall six weeks after Monday's surgery, so she obviously isn't confident that radiation will handle the cancerous node as thoroughly as simply removing it now will handle it.

  • peppopat
    peppopat Member Posts: 90
    edited August 2017

    has anyone here with stage 2A breast-cancer ever had this scenario? And if so how did you manage to catch it in time ?

    I mean, why would anyone even have a sentinel node biopsy if there was no cancer in the breast ? Makes no sense to me.

    - Stage IIA describes invasive breast cancer in which: no tumor can be found in the breast, but cancer (larger than 2 millimeters) is found in 1 to 3 axillary lymph nodes (the lymph nodes under the arm) or in the lymph nodes near the breastbone (found during a sentinel node biop

  • marijen
    marijen Member Posts: 3,731
    edited August 2017

    So peppopot, I have IIA, with occult primary and 1/12 positive ALND removed with lumpectomy for DCIS. But I don'tget what you are asking? RO told me they never get all the nodes because they are smaller and hard to see in the fat. BS told me there can be 10 to 60 nodes total which blew me away. After it was over I told hin I could have use those 11 good nodes. My one positive was 3mm after 6 months letrozole first

  • peppopat
    peppopat Member Posts: 90
    edited August 2017

    let me clarify. What I'm asking is how could someone have lymph node disease but no cancer in their breast. That is considered a stage IIA cancer


  • Falconer
    Falconer Member Posts: 1,192
    edited August 2017

    Cancer of unknown primary.

    https://www.cancer.org/cancer/cancer-unknown-prima...

    Is that what you're referring to peppopat

  • peppopat
    peppopat Member Posts: 90
    edited August 2017

    no I don't think so. I looked at the link and I don't think that that's what I am puzzled about here. I read somewhere on the website that you could have breast cancer cells in the lymph node without the primary. How does that happen? They call of the stage 2A, like I copied and pasted in this thre

  • lisabekind
    lisabekind Member Posts: 89
    edited August 2017

    peppopat, I'm 2A and had a primary tumor. Here is a definition of 2A. https://www.cancer.gov/publications/dictionaries/cancer-terms?cdrid=45146

  • peppopat
    peppopat Member Posts: 90
    edited August 2017

    dear Lisa

    Wow, how did u end up with so many positive nodes for such a small tumor and grade?

    Thanks for web link. Still wondering if anyone on this forum has fallen into the class of no primary but disease in the nodes as a stage

  • Tri-lady7
    Tri-lady7 Member Posts: 133
    edited September 2017

    Hi Everyone- I had a lumpectomy on Sept. 11 with sentinel node dissection. I met with my MO the other day to review the pathology report and it came back with two nodes positive with only two nodes removed. One of the nodes had extra- capular extension the other did not. My concern is that only two nodes were removed and both were positive. My MO said best treatment is chemo then radiation as this has the same prognosis as axillary node dissection with less side effects (lymphodema). I am very concerned there are more effected nodes. Just wondering if anyone has been in this situation and what there thoughts were. Thank you for any input!

  • AliceAgnes
    AliceAgnes Member Posts: 78
    edited September 2017

    Tri-lady7, I had an axillary node dissection as part of my mastectomy on August 28. I signed papers giving my surgeon the go-ahead to do so if she thought it necessary after opening me up. Bear in mind, though, that I had an invasive, multicentric cancer that rendered impossible a simple lumpectomy. And biopsies had shown that one lymph node was already cancerous when the breast cancer was caught. My surgeon ended up taking away 20 nodes in all from two layers of tissue. She was glad she did when the pathologist later reported there were microscopic cancer growths on two of the removed nodes. This means that six weeks of chemo aimed at shrinking my main tumor, which the chemo did do, still did not eliminate all traces of cancer from my system. Are my doctors worried? No, because what chemo did not get, radiation will. I am slated to begin six weeks of radiation sometime in October. Anything remaining behind in the chest wall and axillary node area will get zapped.

    If I were you, I think I'd trust my doctor's recommendation on this one. It was only reluctantly that my surgeon took those two layers of nodes because now I am at a lifetime risk of developing lymphedema in my left arm. I already had a session with an occupational therapist in which I learned how to watch for signs of lymphedema and which preventive measures to take going forward.

    I might add that radiation, also, adds to the risk of developing lymphedema somewhere down the road, but the risk is lower than it is with an axillary node dissection. When you go for your regular mammograms after this, they will catch images of affected nodes in your armpit area, I believe. At least that was what happened to me when I had 3D mammograms done this past March. (They are more expensive than the usual mammograms, but I had skipped several years of check-ups and knew I had to be thorough this time.)

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