removing lymphe nodes

Sue,

You are right that all the BC treatment decisions we must make can be overwhelming.  I fully understand where you are coming from since I was faced with the exact same situation in 2000.  I will share my reasoning with you only as another perspective to consider.

I too had a lumpectomy and SNB in 2000 on the right breast for a small invasive ductal cancer.  The preliminary path report my surgeon received while I was still on the table was that my nodes were all clear.  She had removed 6 nodes in the SNB procedure.  My onc told me she planned to only do radiation of the breast and no chemo would be needed.

One week later we got back the final pathology report which included the Histochemistry...these showed that I had micromets to 2 of the sentinel nodes.  My surgeon also wanted to take me back for a complete axillary dissection.  My onc told me that the presence of any cancer cells in the nodes kicked me into needing chemo.  The plan was to use standard chemo protocol (which back then was AC/Taxol) radiation of the breast plus the lower axilla, and start on Tamoxifen.

I chose to not have any additional axillary nodes removed because I had only a very tiny amount of cancer found in the 2 nodes, the other 4 were clear, and now that I would have chemo anyway my treatment plan would be the same whether I had additional nodes removed or not.  I knew there was a risk in making that decision but had my oncs support and felt the risk of LE was greater in my specific situation.

As it turns out that cancer was very successfully treated without any recurrence or development of LE in my right arm.  In 2005 however, we found a brand new primary BC, this time Lobular in the opposite breast.  My decision process this time was much different because of the much more advanced pathology.  We knew based on MRI and PET that I definitely had nodal involvement on the left.  A SNB was attempted at the time of my bilateral mastectomy but not surprisingly the surgeon had to do a total axillary clearance including all 3 levels of nodes.  23 nodes were removed, all 23 positive. In this situation I knew the removal of so many cancerous nodes was essential in my goal of successful treatment along with full chemo, radiation and hormonal therapies.

I developed LE of the left arm within 2 months of surgery and while taking chemo.  I am very grateful today that my dominant right arm remains non-affected by LE even though I recognize it will always be at risk. 

Binney very appropriately points out that the decision making process MUST be focused first on the successful treatment of your cancer.  The type of cancer (ductal vs lobular or other types), the grade, degree of nodal involvement and plan for chemo/radiation and hormonals should all come into play when deciding whether to have further nodes removed.

I have had experience now with 2 very different situations and thus 2 different decisions.  I do not regret either of my decisions made in 2000 or 2005.  As much as we all hope to find a "roadmap" that will tell us what to do, we must make our decisions based on the best current information provided to us by our professionals and then go with what feels right for us.

I wish you the best in your journey!  Please come here often for support.  You will find that many of us have dealt with very similar feelings, fears and anxiety and you never have to feel alone.

Sonnebe: I think the rationale is very similar to why we have a lumpectomy or mastectomy to remove the cancer from our breasts ...   if cancer is found in the lymph nodes the doctors want to remove as many lymph nodes as they need to to remove as much of the cancer cells as they can ...   they do not want to bet that the chemo and/or radiation will remove any/all traces of cancer cells - they want to remove as much as they can surgically to ensure you have the best prognosis going forward.   I'm not a medical professional - but this seems to be the rationale from everything I've seen.

Doreen  

I just got my path rpt from Monday's surgery.  The left breast had no cancer but the bs removed 4 nodes when he took the breast.  Is this normal?  Does he get paid by the node?  Anyway, is my left arm now at risk too?  In the hospital they were taking blood and bps in that arm repeatedly.  I didn't know until now that any nodes were removed from the "good" side.

I had a bilateral mast last June. SNB came back negative intraoperatively but showed micromets on the path report.  I agreed to a full ALND on the left side.  My BS felt very strongly that 'sampling' nodes didn't provide sufficient information and still left a strong possibility that missed nodes contained cancer.  I opted to have all potential cancerous nodes removed.  As it turned out, the other 14 removed with the full dissection came back negative.  I'm now going through radiation (which I also didn't plan for) but despite the increased risk of lymphedema, I'd rather throw everything possible at this now than regret not having done everything I could.  The surgeries established a level of risk for lymphedema; the radiation increases the risk but as the onc pointed out... better lymphedema than a more dire alternative.

Marian, I'm sorry to hear of your path report.  You must be very tired of all this and very scared of the outcome.  I too had positive nodes after neoadjuvant chemo so understand the dissapointment in the outcome.  As for 'volunteered' nodes I think that's typical since the nodes are throughout the breast tissue.  My SNB also produced an extra, unplanned node (which was positive too).  I've heard good things about Xeloda...I hope it kicks the crap right out of any remaining cancer.  I'll PM you separately as I am thinking about you...

t

Bump for Kayleigh and London-Virgina