Confused About the Treatment Plan

So sorry to hear your mom is going through this kind of stress. The diagnosis is stressful enough without the added stress of all these additional surgeries. Here is the answer to your question: not all hospitals are equipped the same. It sounds like the hospital your mom had her surgery at did not study the 3 lymph nodes that were removed while she was still sedated in the surgery room. I went to Dana Farber and the surgeon explained to me that the most current protocol is to only remove the first 3 nodes. If those nodes are found to contain cancer than to remove more. She also told me their hospital checked nodes immediately after she removed them so if removal is necessary, they can do it immediately preventing second surgery. I asked the question why not just remove them all and they said they would only do that if evidence of cancer in first 3. There are side effects (lymphademia) for the complete removal and that is reserved for those that have evidence of spread. The first 3 nodes are a filter that protects the other nodes. If the filter is clean, no worries. Hope this answered your question.

It is not at all uncommon, especially for ER+ cancers for the chemo to leave cancer cells behind. After the same diagnosis as your mom, I had surgery and they found cancer cells in 8 nodes out of 16 that were removed. That was 8 years ago so it does not mean there is no hope. Radiation will help clean up after her node surgery. But the real key and in many cases the most important treatment for ER+ cancer is either an AI like anastrazole, or tamoxifen, taken for up to 10 years. She should speak to her oncologist about when she will start that. Your mom will not necessarily be given additional chemo.

As far as the surgeon goes, yeah, you should call him out on what went so wrong that she will need a third surgery. As an earlier poster mentioned, not all hospitals have the same abilities, but it may have been something as simple as the pathology lab was short-handed that day and the surgeon had to get out of the operating room before the evaluation was complete. Or he may have visually decided that he didn't need to wait. But he should explain it if it contradicts what he told you earlier.

I think it's a shame if the oncologist led you all to believe that everything is "all clear" when she hadn't even had her nodes looked at, as if she were somehow cured by the chemo. It typically doesn't happen that way. I think they must be trying to make frightened people feel better in the moment, because no matter what they tell you, they cannot promise one prognosis or another. They just do not know how it will turn out. That's one of the hardest things to deal with in breast cancer.

Best of luck to your mom; she is lucky to have you by her side as she goes through this. The radiation will also tire her out, so she could use your support through that also. She should do all she can to fight the cancer, then hope for the best, and try to move on with her life.

Hi!

I'm sorry that your Mom has to have a third surgery. Sometimes, a quick examination will reveal whether or not nodes are cancerous, and the doctor can immediately remove the rest of the Levels 1 and 2 nodes during the same surgery. However, sometimes the cancerous nodes only become apparent during a more careful examination afterwards. That is what appears to have happened to your Mom. Today, surgeons would like to remove fewer nodes because the removal of all the Levels 1 and 2 nodes is associated with a higher risk of lymphadema. I had all my Levels 1 and 2 nodes removed, but I haven't developed lymphadema. Hopefully, your Mom will be as lucky. But, you might want to have a lymphdema specialist measure her arm now so that she has a baseline set of measurements for the purpose of comparison. ((Hugs))

Sorry your mom is going through this. In the ER they tested my four nodes and the test said they were clear. Once they were dissected by the pathologist, they found tumors in two nodes and cancer cells in two. They thought I had a 2cm tumor based on ultrasound, mammogram and MRI, but it was determined to be 10cm in pathology. Some cancer just doesn't show up on images and quick tests. I have found other accounts similar to mine and your moms, where the OR test was clear and path report said otherwise. It's frustrating that with modern technology, cancer can still be so sneaky. Wishing you and your family well.