Microscopic cancer in one lymph node
Comments
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Well, our breast surgeon/oncologist just called with the results from the final pathology report. Just to reiterate, my wife had a bilateral mastectomy with sentinel node dissection a week ago.
First of all, what was initially thought to be a 1.6cm tumor was determined to be 2.4cm. Margins are negative, though. Also, at the time of the surgery, the 4 lymph nodes that were tested appeared to be clear of cancer. Well, that also changed because a few microscopic cancer cells were found in 1 of the 4 sentinel lymph nodes dissected. So, instead of the anticipated Stage 1, the disease is now Stage 2. Our breast surgeon/oncologist doctor still sounded positive and seemed to downplay the microscopic cancer. Of course, to my wife and I, it's still cancer with node involvment.
My wife does not want to undergo radiation treatment. Therefore, in order to avoid radiation treatment, it looks like she will have to undergo another surgery to remove some lymph nodes. Now, it is also certain that she will also undergo chemotherapy.
Anyway, perhaps we should still feel positive, but that is difficult at this time.
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Indy
I know it is all so scarey, but I had stage 2 because of the size of my tumor, the same as your wifes....but I did not have any node involvment and didnt have chemo only lumpectomy and rads...
Im 18 months out a feel wonderful and just passed another 6 month followup with a NED status....there are many many of us here with similar, if not the same dx as yours and we are all doing wonderfully....
Best Wishes
Jule
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Indy-
I know how devastating that can be. I had mast. w/ SNB and had an original report of clean nodes only to find out at my follow-up that the final pathology report showed 1 mm in one of the nodes...I think I cried for 3 days. But, hang in there it does get better.
I did DD A/C and Taxol chemo. and then had another surgery to take out more nodes. My surgeon said this was just to be safe (due to my age 38) and he was right...out of the 10 more nodes taken out none had any cancer. I will be starting radiation in a few days and then hopefully can move on.
Please tell your wife to hang in there...I was so disappointed to find out about the node involvement too, but have spoken to many people who have had + nodes and are doing well now. One girl I know had 22/24 nodes positive and is 4 years NED!
Take Care!
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The margins with her mastectomy were negative, meaning they didn't get good margins?
If they got good margins, and she has a 2.4 cm tumor with only micromets to the sentinal node, she shouldn't have to do radiation unless the tumor was on the chest wall.
Chemotherapy,however, is a given... but rads are only recommended with a lumpectomy, or a mastectomy with three or more positive nodes, or a tumor close to the chest wall.
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Indy,
I rarely post anymore, but I had to respond to you. My situation was similar to your wife's. A week after my bilateral mastectomy in May 2007, I was told I had one node with less than 1mm of cancer cells. Initially I was devasted, especially knowing I would need chemo. But as I read more and learned more, I think I was grateful that those small cells were found. Years ago they may not have found them. I started chemo last June and finished in October. I feel great...in fact...I have to brag...I just hiked to the top of Half Dome in Yosemite last week. A 17 mile hike up to 8,800 feet. I tell you this only to emphasize that when your wife finishes chemo she will get her life back. Chemo is tough while you are going through it, harder on some of us than others, but when it is over things get back to normal fairly quickly. At least they did for me. Knowing that your wife has a supportive and caring husband will make a big difference in her recovery. And on this website you will continue to find great support. Best wishes to you both.
xoxo
Kathleen
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Thanks for all of your information and kind words. I thought I would give you all an update. This may also be beneficial to some who have a similar diagnosis as my wife.
Just to reiterate, on May 30, my wife had a bi-lateral mastectomy with a SNB in which a 1cm micromet was discovered in the sentinal lymph node. The other three lymph nodes were clear.
My wife's breat surgeon onc, radiological onc and medical onc have been reviewing the pathological report and discussing my wife's case. First of all, based upon my wife's data, the oncs say that there is a 16% chance that cancer still exists in one of more existing axillary lymph nodes. Of course, I take that as meaning there is an 84% chance that cancer isn't present in any axillary lymph nodes. The oncs said that they like to see the probablility <10% before they would recommend no removal of axillary lymph nodes. So, my wife agreed and we have surgery scheduled for June 23 to remove 15 axillary lymph nodes.
Below is what else the oncs informed my wife and I:
1. If any cancer is found in any axillary lymph nodes, including micromets, chemotherapy will be recommended, irrespective of the Oncotype score.
2. If cancer isn't found in any axillary lymph nodes and my wife's Oncotype score is in the low range, chemotherapy will not be recommended.
3. If the Oncotype score is intermediate or high, chemotherapy will be recommended even if the axillary lymph nodes are clear.
4. Radiation treatment will not be recommended unless cancer is found in multiple axillary lymph nodes.
My wife and I now feel much better now that we have a game plan. We trust the oncs and we appreciate the way the oncs come together as a team and discuss these breast cancer cases.
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Indy,
I have a very similar diagnosis as your wife. Two weeks ago had a mastectomy of the right breast. They did not think any lymph nodes were involved, though when final path report came back one sentinal node out of the four nodes tested has cancer.
My breast surgeons original thought was to go back and remove more nodes. My medical oncologist does not see any reason for more surgery as he stated that the diagnosis, treatment or outcome will not change but there are significant risk involved in removing more nodes, such as lymphedema and blood clots for the rest of my life. He does not feel that benefits (peace of mind) outweight risk. My radiation onco says that to "go by the books" would indicate more lymph node removal, only for peace of mind. The radiation which is needed should take care the cancer should any other lymph nodes be diseased.
I meet with my surgeon this week to discuss all the info, but at this point am not planning to go thru the additional surgery and risk. I am still researching these risk and you might want to do the same.
Marla
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My wife has just been diagnosed with microscopic cancerous cells in both her breast and sentinel node. She had a partial mastectomy ( lumpectomy) and the surgeon was confident that with the removal of the very small lump and initial operating theatre diagnosis of the node, that that was that for the time being. Not to be. The lab found the microscopic cells in both the node and the skin surrounding the lump. We are seeing the surgeon today but he has already signalled further surgery ( full mastectomy). My wife was shattered, but on the phone he said it was now survival at stake. What are these microscopic cells and what are the consequences?
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Liefde,
My situation sounds similiar in that I also had "microscopic cancer cells" found in the sentinel node. In my case, the cells were found at the time of surgery and all my lymph nodes were removed - none of the other nodes showed any signs of cancer. From my understanding, there is some controversy about whether microscopic cancer cells in one lymph node is defined as "lymph node positive or negative". In either case - one node is better than many and less cancer is better than more - so while I would have preferred to not have all nodes removed and wish the cells hadn't been found in my lymph node (let's face it - I would preferred not have breast cancer at all!) - the prognosis is still very good.
My oncologist recommended the standard treatment for a lymph node positive cancer - 6tx of chemo (tac in my case). But, I was eligible for the Oncotype test which is typically for hormone positive, node negative cancers - so by their definition I fell into the node negative category. My Oncotype test came back right in the middle at a score of 25 and I am doing the chemotherapy. You may find the Oncotype test helps you make the chemo decision.
My "margins" were clear so I did not need further surgery. Though with a partial masectomey - I believe that radiation is unavoidable. I know that sometimes the surgeon can go back in and take more tissue and avoid a masectomy when margins are not clear - but every situation is different - I would just ask the surgeon why he is recommending masectomy and if re-excision isn't a viable option.
I know it is a difficult time with so many decisions that have to be made - just keep asking lots of questions so that you feel comfortable that yo have all the info you need to make an informed decision that is right for you and your wife.
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I am now 40 years old and had a double mastectomy September 2007 with only 1 lymph node involved. I have been on Chemotherapy for the past 8 months and at present I am doing well and on my last chemo treatment. Because I had a mastectomy I did not have to take radiation. I am glad I chose to have the mastectomies, while it can be devastating for some women I have done very well at coping. My husband has played a big role in my recovery. I think it's important that your wife know that she is still needed and loved.
There are many more decisions to be made and many months of treatment to come, but all is possible with God. Remember to keep a positive attitude and weigh out all of your options before you decide what needs to be done.
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Mine started as DCIS and I had a mastectomy on 13th January and seven nodes removed. Tests now show invasive 4mm in breast tissue with microscopic in one node. I was and am devastated as to me lymph involvement changes the whole thing. I am waiting now for HER2 test and will then agree treatment with Oncologist. She also downplayed the node involvement and they will not remove anymore. She thinks because the cancer is grade 1 and small Tamoxifen is likely the best option as the disadvantages of chemo will outweigh the advantages. I am terrified. If I don't have chemo and it comes back elsewhere then it may be incurable. What should I do? It just seems to be going from bad to worse and I am fully preprared for her to change her mind on Tuesday especially if it is HER2. In a way I would rather do the chemo and then at least I will feel that I have done all that I can to beat it. Will I have a choice or can they say no to chemo in my case?
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My story is like Tamara's. The one lymph node removed indicates positive, although microscopic. Because microscopic can go either way, poaitve or negative node, my dr considered it as a negative, enough to do the Oncotype DX test. I am waiting on those results to determine whether or not to do chemo. I hope NOT to have to do the chemo!!
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hi, am from singapore. chanced upon this forum while researching for more info. mine was DCIS, lumpectomy and 1/3 nodes removed indicates positive. am waiting for ER/PR and HER2 report to decide on 2 options : surgery to remove all nodes or chemo.
what's the preferred option? thanks.
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me2u: I would recommend waiting for the ER/PR and HER2 reports. You mention your cancer was DCIS but in your diagnosis line you have IDC listed. What was the size and grade of your tumor? That will help in the decision as well. Every piece of information helps, and I would only trust an oncologist with his/her recommendation, not someone else with a similar diagnosis, but rather someone who has reviewed your entire report and medical history.
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hi ezscriiibe, still waiting for the reports cos pathologist was on leave these 2 days. mine started with dcis and a week later after surgery, the histopathology report shows dcis with microinvasion in 1/3 nodes. hv yet to meet up my oncologist to ask what stage am i in and am i still dcis or idc??
the waiting for reports are agony......
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hi, am back. ER+, PR+ and HER2 equivocal. will be starting my chemo 2 weeks from now....meanwhile, taking PET scan on fri.
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Me2u: You are having chemo done due to microscopic cells in one node? I have the same thing (microscopic in one node) and was told I may not need chemo. I am waiting on my Oncotype test results to see if chemo is needed.
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Wasn';t there a lot of hoopla about the benefits of chemo even for isolated tumor cells a while back?
I have to check back and look it up.
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OneBadBoob, are you talking about the study out of the Netherlands last August? I happened upon several articles describing how this study, although imperfect, indicates that women with even microscopic cancer in any lymph node should consider more aggressive treatment. It suggests that even isolated cancer cells in the nodes raises a woman's chance of cancer reappearing in the breast or elsewhere by 50% in 5 years.
There are many articles on this study, and here is a link to one of them, an MSNBC article.
http://www.msnbc.msn.com/id/32390246
(I don't know if that created a link, but just copy and paste it into your browser window.)
I haven't seen anything to follow up this study, but they should be interesting.
Cindy
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Yes Cindy, that is the study I am speaking of.
I had two isolated tumor cells, outside of the capsule, and one onc said no chemo the cells probably broke off during surgery (.8mm tumor) and 24 onco score, and two other oncos said yes to chemo.
I did CMF chemo and I have no regrets.
I had mastectomy and no rads.
I am now on Arimidex, and feel I have treated this agressively.
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OneBadBoob, I am like you and want to treat this aggressively. I had one node that had only one cell, and they also told me it probably broke off during surgery. Another had only 11 cells. But my sentinel node had a small amount in the capsule, just enough to declare it positive. My low onco score of 11 made me pause for a little while, but then I figured I couldn't trust it completely because there was something in the nodes.
I am glad to hear you have no regrets. I am also getting a pass on rads, one reason I ended up going with mastectomy. I'll be on Tamoxifen after the chemo. I don't want to risk something happening down the road knowing that three months of chemo may have prevented it.
Cindy
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I feel so much better having read all of your comments. Mine did turn out to be HER2 Grade ! with microscopic in one Lymph Node. The Oncologist gave me the option of Tamoxifen only or 6 sessions of chemo followed by Herceptin and then Tamoxifen . I also want to throw everything at it. I am dreading the chemo but as the forums show everyone reacts differently. I certainly don't want to risk something happening down the line for the sake of a few months of hell.
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I am so glad I found this discussion forum. I just joined yesterday and already feel good about my prognosis and I thank each of you for the willingness to share your stories. I had a right mastectomy with SNB on 1/11/10. After surgery, my BS said "my lymph nodes look good". However, a week after the surgery, he indicated there were two small, microscopic traces in 2 of my nodes, I was .010 mm, the other was about 1mm. He then told me that "the chemo would take care of those". I am fortunate that my BS is the SNB/Dissection expert at my care facility, so I feel confident in his sx and treatment plan. He said going back into surgery to remove the nodes would be unnecessary. I am somewhat worried about chemo, not knowing how many cycles, what the drugs are, etc. I have no idea what the oncotype dx is. My surgical nurse practitioner is supposed to call me this afternoon to explain more. Am hoping you all could help me with the clarity, what questions to ask, etc. Thanks so much
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Hi all - I had bmx w/snb last week 2/2. One sn taken from each side. One side all clear, one side w/micromets that surgeon says were probably knocked loose during surgery. I don't need aux node dissection so that's good, surgeon's role is done, but he mentioned the onc will prob want to do chemo. Not sure if tamox alone is considered chemo but I see onc 2/23 so will know then. For sure I'll be following this thread and sending out best wishes to all.
If you haven't already, I highly recommend reading the NYT article cp418 cited above June 6, 2008.
Tiffany - your appt prob already happened by the time you read this...hope it went well. {{hugs}}
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Saw onc yesterday, official staging per path report from bmx is IIb (T2 N1mi) - tumor 2.5 cm and 1 node involved with a 0.1 cm (1 mm) micromet in one of the sentinel nodes. Since the met is tiny, I have a choice of chemotherapies: AC+T or TC.
AC+T: Adriamycin & Cytoxan once every 3 weeks x 4 treatments THEN Taxol once a week x 12 treatments
OR
TC: Taxotere & Cytoxan once every 3 weeks x 6 treatments
We had a good discussion about the risks and side effects and onc said either tx would work for me but he is not directive and did not tell me what to do, just said he would be OK with the TC option, but the ultimate decision is mine.
AC+T has a 2% greater chance of permanent heart damage; TC has a 2% greater chance of ca reoccurrence. Yikes!
All that because of microscopic cancer in one lymph node...
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Yup, groundhog, there's an awful lot of nasty stuffed into that teeny tiny piece of ***t.
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Indeed! I'm leaning toward the AC+T, I see my primary care doc this afternoon to discuss. Gonna lose my hair either way, may as well do the more aggressive tx...the theory being feel a little worse for a little longer and kick its little *ss.
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Indy, when I had my mastectomy in March my the tumor they thought was going to be 4.8 cm with no node involvement turned out to be 5.2 with positive cells in the SN even though it looked clear. My Breast surgeon wanted me to come back the following week for an axillary node dissection and he removed 17 mor nodes and one also was positive for cells. So instead of being stage 2b I turned out to be 3a. Anyway, cell growth in the nodes proves that the cells from the primary breast tumor has spread and it's a good thing to have them removed. Hang in there.
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Saw primary care doc yesterday, he's been my doc for 20 years so he knows me well and I trust him. He recommended against Adriamycin due to family history of heart disease. So it's TCx6 for me, every 3 weeks starting 3/9.
Did you read cp418's research post "The Mathematics of Cancer" in the clinical trials forum? Interesting theories about cell behavior and treatment frequency. For example, for some people, having infusions every 2 weeks instead of every 3 weeks increases good outcomes *if memory serves* 26%.
BTW, made an appt for next week to have my long hair cut and donated to Locks of Love - LOL ??
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