How many nodes did you have that showed C ?

During surgery my sentinel node was positive and my breast surgeon took out more nodes.  The end result was one sentinel node positive, one sentinel node negative and 6 auxillery nodes negative.  My breast surgeon was happy with that results.  I did however, have rads to the auxilla by choice.  I was in the gray area with one positive node.  I also had multifocal and bi-lateral mastectomy with tissue expanders.  Ended up having rads to chest wall, supraclavical and auxilla.  It gives me peace of mind having the rads since I only had 8 nodes removed. 

Tri - My Sent Node was positive. My surgeon was quite adamant about the importance of an AXND. So I did. And 11 of 11 were negative. But...I've never heard of anyone having an AXND after all treatment has ended. I'm not being much help here...sorry. I guess if you had the AXND and some were positive, it would be a very good thing for them to be removed, to prevent further metastisis.?

OMG - I love it...I have to remember that one! LOL

Okay...I'm confused. I've never heard that radiation would kill cancerous nodes. I was told that chemo could possibly kill any micro mets to nodes. But...I think the standard is "removal" of cancerous nodes, as opposed to treatment of cancerous nodes. I'm really surprised that with 2 malignant Sent Nodes, an AXNB wasn't immediatly done. JMO - If I had vascular involvement and positive lymph nodes, I would want every possible treatment. But like I've said b/4 - I am a paranoid chicken sh**.

I hope someone with more knowledge chimes in here...

Laura,

In my case the sentinel nodes were negative intraoperatively but the IHC later showed them positive with micro mets.  This might have been the case with trigeek.  Also, there's some controversy about micro mets and full ALND.  One of those gray areas I think.  My surgeon was of the opinion that micro mets or not, without the ALND, there is no way of knowing whether there's further spread or of removing any remaining potential cancerous nodes.  He strongly recommended the ALND for those reasons.

Oh so did my BS.. he felt very strongly that they needed to come out, despite the fact that it meant another surgery one month after the mastectomy .  In any case, from my reading, I understand that the IHC is turning up more micromets than ever before.  So, it's probably not unusual to have the HE produce negative results intraoperatively and the IHC to produce positive results postop. 

Ditto to Laura's comment trigeek...hope some of this is helping and that you get the best medical advice possible to aid in your decision.

t

Late edit:  oops, think I got the HE and IHC backwards...

trigeek, Here's my story:  My breast surgeon (Chief breast surgeon and Director at Johns Hopkins) did not recommend rads after bi-lateral.  He felt very confident taking out only 8 nodes.  He did however refer me to a rads oncologist (also at Hopkins).  My rads oncologist discussed two studies with me which showed rads after mastectomy with 1 to 3 positive nodes did reduce chance of local recurrence to the auxilla from 15% down 5%.  He left the choice up to me.  Because my  tumor was multi-focal, close to the chest wall, close to the skin plus only removed 8 nodes, I chose to do rads.  It was a tough decision because of my tissue expanders and I knew that my plastic surgeon would not be thrilled and I could lose my implants.  At first I was going to do the exchange after chemo before rads but my white blood cell counts were still too low after chemo and I didn't want to wait on rads so I went ahead and had rads on tissue expanders.  My plastic surgeon wanted to wait at least 6 months after rads before final implant exchange.  I ended up having my tissue expanders in for 15 months before I finally got my final implants.  I have had my final implants for almost a year and have had no problems.  However, my plastic surgeon does not want to take any chances with nipples so I am nippleless which is fine by me cause I never have to wear a bra (always seem to find a silver lining).

Why is this never simple?



I had a big @#@#@#@ tumor and surgeon felt one enlarged node, so I had neoadjuvant chemo (after biopsy, before surgery), then had a lumpectomy and full dissection. I had asked for SNB but surgeon said he needed more. I had 17 negative nodes out of 17, and was found to have not just IDC but ILC and DCIS and LCIS. I would have wanted them out if they were cancerous. The enlarged node didn't test as cancerous, but the chemo could have knocked out the cancer there and elsewhere without leaving enough scar tissue to know for sure. I had a re-excision for better margins, then had rads. My docs are pretty sure I'm done. Keeping my breasts was right for me then and I can live with it now.





Micromets are kind of a new area of research and thought. Maybe before more recent techniques, they were viewed as negative and now we say positive.



Ask all your docs all your questions. Make sure you know the risks/benefits for you for each path you might take.



One of my docs told me "If two docs you trust give you different opinions, then both are right and you take the path you can live with". Made sense to me, and that's how I made some of my decisions.



The study you cited had a really small number enrolled and has only run for a short time, so there is not data to say not doing the ax is safe, but it sounds like some researchers are thinking it might be safe since chemo should take care of cancer in the nodes.



When you get your questions answered and get the info you are seeking, you'll be able to make a decision you can live with.



Sounds like you are doing what you can to take the next best step for you, which is always healthy.



Take care,

--Hattie

trigeek, of the 8 nodes removed only one was positive and it was

8 mm.  Were your 2 nodes considered microscopic or just positive?  It is my understanding that up to 2 mm is micro and anything more than 2 mm is just considered positive. 

I read that if you have at least one positive node, any other microscopic nodes will be considered positive as well.  I had one positive and 7 negative.   My rads oncologist told me they like to see 10 removed but I only had 8 in the first level.  Guess I don't have as many nodes as some other people.  Both my breast surgeon and rads oncologist were OK with just 8 removed.  Have you decided to have more nodes removes even though you had six removed already?  I feel very confortable as do my doctors with 8 removed along with chemo and rads to the auxilla. 

Here´s my story! I had a very large ILC tumor (9x10 cm), three nodes were suspicious at diagnosis. Thanks to neoadjuvant chemo, the tumor shrank all the way to 4.5 mm (yes, millimeters) though leaving 4.5x5 cm fibrosis behind. As to the nodes, they took out 11. Out of 9 level I nodes, one had 1mm micro metastasis. Two level II nodes were free. However, all 11 nodes - scary - showed strong fibrosis meaning that all of them must have been positive before chemo.

Now, I was left with the decision, rads or not, because I had had a mastectomy and the chemo had done such a good job. The decision to have rads to the chest wall was easy enough. But there was also a recommendation to have rads to the axilla just in case there were more infected nodes. So I did quite a bit of research about rads to the axilla and was not convinced. Apparently there´s controversy about the benefits and if at all they are very small because lymphnode metastasis is rare anyway. On the other hand, the chance to get lymph edema goes up significantly through axilla radiation. And that was the one thing I was really paranoid about.

So I decided not to have rads to the axilla. Basically I felt the odds were that the one micromet was all that was left - after all 10 nodes didn´t show a single cancer cell. I still feel good about my decision. So far no edema - couldn´t imagine quality of life for myself if I contracted one.

Once I had made my decision my radiologist said she felt comfortable with it because for once I would be on AHT which should take care of anything left in the nodes and second because at regular checkups they can have a good look at the axilla in case something shows up. Ultrasound seems to be quite effective for that purpose as I´m thin in that area. In case something crops up, I can still get rads then. I would even have committed myself to more chemo only to avoid more risk of lymph edema which as I said is my biggest fear!

All the best to you!!

Susaloh