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Sara536 · March 2018

Traveltext, Wildplaces, Maybe it depends on whether we are focused on living or if we are focused on dying. Too often, medicine throws the baby out with the bathwater.

Traveltext · March 2018

"What if the lymph nodes rather than afocus of spread - where actually like all lymph activity - a manner of trying to contain disease?"

Wildplaces, this may not be so far-fetched. The fact that bc patients with LN involvement don't all go on to develop mets is a significant point. Distant recurrence has so many individual factors that one answer why this is so may never be found in the days of individual treatment, individual prognoses become surely as important.

Sara536, I focus on living, but I'm certainly interested in how my dying might come about. A bit morbid, perhaps, but at the end of the day I don't have too much control of my medical future.

Wildplaces · March 2018

Sara - you are correct.😊 If you are hoping to get more attention to the baby as well as the bath water I think there is a name for it - integrative medicine - Paget called it SOIL and I being a gardener love that term.

It helps to understand the reasons behind it.

First it is useful to separate medicine - your doctor, your night nurse or your researcher from healthcare - pharmaceutical companies, hospital appointment systems, care policies, tonnes of paperwork, computer systems that are not well integrated, pharmacy funding.

(Something as simple as car parking availability being crappy can completely throw an elderly patient or some one with disability, or a mother who brought her young child with her off - by the time they have managed to scramble through corridors and lifts to a consult room any cohesive thought has vanished. Bringing a buddy partially rezolves that but not everyone can and if oncology app are three monthly - out goes the opportunity to be heard for half a year.)

Although the two must function as one in individual treatment, they have different aims and priorities.

Oncology, psychiatry and age care is heavily under represented in healthcare - although I think USA is catching up on cancer because of the sheer volume of numbers that need care.

And in the above fields medicine has also been underfunded and burdened with death more so than in other specialties - there are areas where much work is needed and overdue.

Given what they see everyday - I think oncologists are eternal optimists.

To return to the thread question - it would be a YES for me ( I am 49)if I can hold steady in the side effects profile. There are tests that help you gage how you are doing with those. Ask me in 5 years and my personal take on the " evidence" might be different.

Amelia01 · March 2018

Interesting read but my MO has said that they've known for quite some time that lymph node involvement isn't a precursor to spread (or maybe that is what she tells me to make me feel better). What would be interesting is to know for those who were diagnosed as stage 4 with mets if lymph nodes were also involved. I would imagine that there are few node negative stage 4s.

It also should debunk the exclusion of oncotype testing for node positive, wouldn't it?

trinigirl50 · April 2018

My Stage 3A friend (ER+) with no lymph nodes involved is now stage 4 - one and half years later. Still no lymph node involvement.

My Stage 2 friend (triple positive) with no lymph node involvement went to stage 4, 1year later - she is still with us (5 years)

My Stage 3A friend triple negative with 9 nodes involved is fine 9 years later. Both are roughly the same age and were in the same good health.

My Stage 0 friend is now stage 4, 4years later. No nodes.

7of9 · April 2018

Trini girl....thanks for the stats about friends. It didn't bother me (well for myself I was more down when first diagnosed and the "probability of lymph node involvement") than when I was diagnosed the second time with 10/14 in axilla. I had already had a clean CAT and bone scan before my surgery so it was still very very very disappointing. I have a good friend who's cousin was diagnosed out of the shoot stage 4 with a lot of mets at 49. I presume she either caught herself or had been getting checkups. Here I am 6 yrs after orig, 2 + yrs after recurrence with axillary 10/14 and honestly other than neuropathy and anxiety...doing pretty darn well. My friends never made me feel bad about it, but for the first time, I feel...almost guilty? I have reassured them that she's done zero treatments until now and wait and see how it clears up hopefully or they beat it back.

bluepearl · April 2018

There are no guarantees. Cancer can and does travel through different mechanisms, primarily through lymph and blood. Statistically, over a large number of women, node positive is linked to higher risks for mets. There will always be exceptions either way. My friend had stage 2, one node, and she only did surgery...nothing else....and is 12 years out.....but I would never recommend that as a treatment plan for most stage 2. node positive or node negative gals. That said, you do the best you can and hope for the best. Risk goes up the larger the tumour, the higher the grade, and the Hers+ and hormone negativity. Someone with a stage 1a, but her2+ or hormone negative is at higher risk than someone with stage 1a, her2- and hormone+ (putting aside oncotypedx for the moment)......it doesn't guarantee that a good prognosis won't turn into stage 4 and vice versa. However, the above 40% is taking everyone into account from stage1 to 3 with all the variables. Even a PR- has a greater risk despite being estrogen positive.....and the new genomes mean a lot too. But this is statistics. You or I may not fall into them, good or bad. Concentrate on NOW and the life saved NOW.

SSInUK · August 2018

This is a very late post to this thread but if it's of any interest I understand the significance of lymph node involvement is that it demonstrates one's cancer has 'some extra OLevels' - ie some cells have mutated and developed the ability to travel away from the main tumour and breast tissue and start growing elsewhere. That's a particular set of mutations. Not all cancer cells can do that (cf DCIS). It’s not that the cancer cells in the lymph nodes itself then spreads to other areas. (But who wants to live with cancer eating it’s way out of lymph nodes?). It’s that once you have such extra-qualified mutant cells as evidenced by lymph node mets the likelihood that other mutant cells may be wandering around able to set up shop elsewhere goes up.In very broad general terms the bigger the tumour the more cells it has therefore the more likely it will contain mutations of that nature - ergo bigger tumours tend to be associated with lymph node mets (many exceptions obvs). But, for comfort, I was told the ability to travel through the lymphatic system does not automatically equate to the ability to survive in the bloodstream - that potentially needs even more qualifications for the little suckers. This rationale does explain why distant mets are more likely with larger tumours and lymph node involvement but also why it can go the other way

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