Sentinel Nodes

This all depends on your imaging & your pathology, your cancer diagnosis so far & what your doctor is recommending. It's a difficult decision not to be made lightly.

Just food for thought—I was told I had an 8mm mass with no nodal involvement. Piece of cake. Pretty confident of this after the MRI.

After surgery....pathology showed 25mm mass with 8mm of cancer in node. I was shocked. The more info you have the more precise you can be with your treatment. If I didn’t know about the node....my treatment would have been different.

I actually asked if I REALLY needed the node out myself and my dr was like....yes. Sometimes we get surprised. And with me, they did.

Also...you really only need to get one node out. They used to go back with a positive node and get more....but now they just radiate the area. Just as effective as removing them surgically and reduces lymphedema risk. I’m sure you could take more, but that’s one way of being minimal in your approach. Good luck!

my experience is similar....scan prior to surgery looked good. I felt confident. After lumpectomy, 2 of the 4 nodes they took out tested + for cancer. 1mm in one node and micro cells in the other node. No harm in having the sentinel nodes out. Now we are adding chemo to the treatment plan

An SNB is not required for DCIS, although it's usually done when someone has a MX just in case some invasive cancer is found in the final pathology, since an SNB can't be done (easily, at least) after a MX. With a lumpectomy, a SNB can always be done afterwards if invasive cancer is found. But some overly aggressive surgeons do SNBs on DCIS patients having lumpectomies - and this is totally unnecessary. I suspect that Cherisse's preliminary diagnosis is invasive cancer, not DCIS, but that's why I asked.

As for the number of nodes, an SNB might only be one node but it often is more. It all depends on how many nodes are invaded by the blue dye and/or isotopes that are injected into the breast prior to the procedure. If the dye/isotopes move to more than one node, as often happens, then the surgeon needs to remove all of those nodes, since they are all equally sentinel nodes. The theory of an SNB is that the injection will follow the same path to the nodes that cancer cells would have followed, if cancer cells had entered the lymphatic system in the breast. So if the injection moves into several nodes, obviously cancer cells could also have entered any or all of those nodes, and the surgeon can't just choose one because the cancer cells could be hiding in one of the others. In my case, I had 3 sentinel nodes.

I have to say, of all the treatment protocols suggested to me, I never once thought of not having the sentinel node surgery. That seemed like a no brainer for me; as others have pointed out, that node or those nodes are the gatekeeper to the rest of my body.

Are you contemplating not doing this because of concerns about how it feels afterwards? Or perhaps concerned about side effects or lymphadema?

I am new to the forum. Recently diagnosed with high grade DCIS in right breast. Had prior LCIS in left. Met with surgeon yesterday and have chosen BMX to lower risk as much as possible. I am however very concerned about doing a sentinel node biopsy at this time, which she recommends, due to risk of lymphedema. Some literature seems to say it’s not necessary. Would appreciate your thoughts. Thanks!

vicroc - I had a BMX with DCIS. Yes you CAN get lymphadema from SNB, but I opted to have the sentinel node biopsies done for exactly the reason Beesie is explaining. Once your breasts are gone, there's no way to back track and check.

Lymphadema is certainly scary and we should do anything we can to avoid getting it. Or making it worse if we have it. Unfortunately I had a recurrence at 2 years in a lymph node by my collar bone and had to have ALND. I do now have mild breast & truncal LE.

Still, I would have done the same thing again with my original mastectomy - done the SNBs on both sides.

Cherisse,

What is your diagnosis? If you are having a mammogram followed the next day by surgery, is this cancer surgery? Or is this an excisional biopsy, i.e. a surgery to remove the mass to determine if it is cancer? If it's the latter, then you definitely should not be having nodes removed. Nodes should not be removed until you have a diagnosis of invasive breast cancer.

But if you do have an invasive cancer diagnosis from a prior biopsy, then to your question "Can i just get the lump out and have the pathologist determine the rate of cancer from that?" the answer is NO. As others have pointed out in their posts, in some cases even a very small cancer might shed some cells into the nodes. You could have a 5cm tumor with no nodal involvement and you could have a 5mm tumor with nodal involvement. And although grade 3 (more aggressive) tumors are more likely to have nodal involvement, many grade 3 tumors are node negative, and sometimes grade 1 tumors, seemingly not very aggressive, are node positive. The cancer in the tumor provides no indication as to the nodal involvement.

"Is there any advantage of taking sentinel nodes out other than determining if the cancer has spread to lymph nodes?" I suppose not, but determining if the cancer has spread to the lymph nodes is one of the most important parts of a diagnosis. Lymph node involvement will likely change the radiation plan and while it won't necessarily mean that chemo is necessary, it will increase the likelihood that chemo might be recommended. The concern with a breast cancer diagnosis is not the cancer in the breast but the risk that the cancer might have moved beyond the breast. Breasts are not vital to our survival so cancer in the breast is not a threat to our lives. But when cancer cells move beyond the breast into the body, that's when the cancer is life threatening. The lymph nodes are the guards. If there is cancer in the nodes, hopefully the nodes are holding tight to those cancer cells, keeping the cancer from moving on into the rest of the body. But the fact that the cancer cells moved from the breast into the nodes does indicate that these cells are prone to travel, so the risk is higher than there may be some rogue cells that have moved beyond the nodes. You hope that the nodes hold tight onto all the cancer cells, but that doesn't always happen. This is hugely important information in one's diagnosis and treatment plan.

Not checking the nodes, if you have invasive cancer, is to not get a complete diagnosis. That in turn might mean an inappropriate treatment plan - either too aggressive if the oncologist is compensating for not knowing the nodal status and therefore over-treating, or not aggressive enough, if the oncologist assumes node negative when in fact there is nodal involvement. Both those scenarios come with some very unwanted side effects. So in not having an SNB, you are trading off one set of risks for another set of risks - the second set of risks including some that might be life threatening.

Edited to add: Yes, your understanding of the Pink Lotus methodology is correct. But since you are mentioning discovering whether any invasive cancer is present, does that mean that your diagnosis is DCIS or that you don't have a diagnosis yet? In that case, there is absolutely no reason to remove any nodes.

Cherisee, I just want to add my case, and many others similar to my case: a tinny 3 mm cancer was found in my breast and a node-positive out of 4 SLN. Then the surgeon told me she grabbed another node that wasn't SLN but it was in a way and that one was positive too. From one small cancer, I have 2 positive nodes. I regret I didn't ask to remove all of the nodes to see if there are other positive nodes. Removing SLN is a small price to pay in comparison with the future consequences of recurrence.