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All TopicsForum: Surgery - Before, During, and After → Topic: Complete Lymph Node Disection

Topic: Complete Lymph Node Disection

Forum: Surgery - Before, During, and After — Surgical options and helpful tips for recovery and side effects.

Posted on: Oct 15, 2011 02:14PM, edited Jan 11, 2012 01:49AM by J-Bug

J-Bug wrote:

Has anyone had a complete lymph node dissection over a sentinal biopsy? Would you choose that option again? What are your thoughts on this method?

This method is being suggested for me because of the large tumor size (8.6 cm). 

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Oct 15, 2011 03:13PM dlb823 wrote:

J-Bug, I don't think I would go for the complete axillary dissection UNLESS I got a 2nd and maybe even a 3rd opinion -- preferably from one or more experienced breast surgeons -- agreeing it was necessary.  With a very large tumor, I can see how node involvement might sound highly probable.  But if it turns out your nodes are clear, then you've risked a lifetime of lymphedema possibly unnecessarily.  

Have you had an MRI?  Were they able to tell anything about your nodes from that?    

I would also ask how your neoadjuvant chemo impacts their ability to ascertain if your nodes were ever involved even if they appear clean now.   Deanna 

"The soul would have no rainbow if the eyes had no tears" Native American proverb

Dx 2/1/2008, 1cm, Stage IIa, Grade 3, 1/16 nodes, ER+/PR+, HER2-Dx 1/3/2014, Stage IV
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Oct 15, 2011 05:17PM, edited Oct 15, 2011 05:18PM by Faith316

I had an axillary node dissection twice because my oncologist thought I was 'undersampled' the first time.  When I was first dx with IDC in 4/08, I had a sentinal node biopsy (I actually had 2 sentinal nodes) and both were malignant, so she continued and did a node dissection at the same time as my lumpectomy.  2 of the 8 nodes taken were malignant.  A year later, I was dx with IBC.  After 6 more months of different chemo since the first 4 chemos hadn't worked, I had another node dissection when I had my uni-mx.  All the nodes taken that time were clear.  It was my oncologist from MD Anderson who wanted me to have the second node dissection.  I had been referred to him when I was dx with IBC.  He had me see a surgeon there in Houston who also wanted me to take out all of the supraclavical nodes, but I chose not to do that.  The risk from lymphedema would have gone up tremendously by doing it and I already have slight lymphedema as it is.  I elected to have my mx locally instead of at MDA.  Wanted to recover at home instead of half way across the country. in a hotel room.

DX 4/08 IDC, ER-, PR-, HER2+, IIB, Grade 3,lumpectomy,2/8 nodes,4 AC,12 wks.Taxol,Herceptin,30 rads. DX IBC 6/09 while still in treatment. Now Stage III. 6 mo. of Xeloda done, still on Tykerb. Uni-mx & another node dissection 2/4/10.

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Oct 15, 2011 06:51PM J-Bug wrote:

Thank you both of you. I am definitely working on a list of questions this weekend to clear my head of all these issues. The more I can hear from those who have had the full dissection, the more that helps. 

Age 40 at diagnosis.

Dx 6/10/2011, IDC, 6cm+, Grade 2, 0/4 nodes, ER+/PR-, HER2-Chemotherapy 07/01/2011 Adriamycin, Cytoxan, TaxolSurgery 11/09/2011 Mastectomy (Both); Lymph Node Removal: Sentinel Lymph Node Dissection (Both)Radiation Therapy 01/10/2012 ExternalHormonal Therapy 04/13/2012 TamoxifenSurgery 08/22/2012 Reconstruction: DIEP flap (Both)Surgery 12/11/2012 Reconstruction: Nipple reconstruction (Both)
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Oct 15, 2011 07:46PM SpecialK wrote:

j-bug - hi!  I had an AND 5 weeks after my BMX because what initially looked in the OR like a clear SNB, in fact had a micromet of less than 20 cells.  Both my BS and MO rather emphatically said I needed to have the AND.  I asked why since I was having chemo anyway, but they both pretty much insisted.  I waited the 5 weeks because my BS was attending conferences out of the country.  My AND yielded an additional positive node that was 6mm - considerably larger than the SNB.  Six months later I asked my BS how often chemo will eradicate a node that large, his answer was 60%.  I am glad they removed all known cancer prior to the start of chemo, even with the additional risk of LE.  Not to minimize LE (I have a very mild case) but it isn't going to kill me, triple pos cancer could, so I am glad to have had the nodes out.

Dx 9/27/2010, DCIS, Grade 3Dx 9/27/2010, IDC, 2cm, Stage IIb, Grade 3, 2/14 nodes, ER+/PR+, HER2+Surgery 11/01/2010 Mastectomy (Both); Reconstruction: Tissue expander placement (Both)Surgery 12/06/2010 Lymph Node Removal: Axillary Lymph Node Dissection (Right)Surgery 12/21/2010 Reconstruction (Left)Surgery 01/07/2011 Reconstruction (Left)Surgery 01/21/2011 Reconstruction (Left)Chemotherapy 02/17/2011 carboplatin, TaxotereTargeted Therapy 02/17/2011 HerceptinSurgery 07/20/2011 Reconstruction: Tissue expander placement (Left)Hormonal Therapy 08/01/2011 FemaraSurgery 02/24/2012 Reconstruction: Breast implants (permanent) (Both)Hormonal Therapy 06/20/2012 ArimidexSurgery 12/14/2012 Reconstruction (Both)Hormonal Therapy 07/18/2013 FemaraSurgery 03/07/2014 Reconstruction (Both)Surgery 04/02/2014 Reconstruction: Breast implants (permanent) (Left)
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Oct 15, 2011 08:46PM J-Bug wrote:

Hi SpecialK! As always, you have a very relevant story and information. Thank you so much for sharing!!

Did you have any imaging that showed that your nodes were clear? I have had a breast MRI every month since June all through chemo as well to verify that it was working. I also had a PET at the beginning of this in June and all testing showed no activity in the nodes. That is another thing that makes me wonder about doing this.

However, I also have some "activity" that has shown up in my "good" breast during chemo and has grown. They found what they think is a schwannoma after my PET. I also had a benign pelvis biopsy. After five different biopsies, I am definitely concerned about chances of reoccurence. But, as a graphic designer making a living in front of the computer, I am concerned about coming out of all of this being able to make a living.

Age 40 at diagnosis.

Dx 6/10/2011, IDC, 6cm+, Grade 2, 0/4 nodes, ER+/PR-, HER2-Chemotherapy 07/01/2011 Adriamycin, Cytoxan, TaxolSurgery 11/09/2011 Mastectomy (Both); Lymph Node Removal: Sentinel Lymph Node Dissection (Both)Radiation Therapy 01/10/2012 ExternalHormonal Therapy 04/13/2012 TamoxifenSurgery 08/22/2012 Reconstruction: DIEP flap (Both)Surgery 12/11/2012 Reconstruction: Nipple reconstruction (Both)
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Oct 15, 2011 09:40PM JSwan wrote:

I had a large tumor (7cm) that shrunk down to 2.2cm as a result of neoadjuvant hormone therapy.  My surgeon told me that having the SNB was sufficient.  When my pathology report came back with a positive sentinel node (micrometastasis) and insufficient margins I was given the option of having a full node dissection when I have the re-excision or axillary radiation.  My surgeon told me that there was no survival benefit to having the full node dissection over radiation.  I chose the radiation. 

Dx 8/12/2010, ILC, 6cm+, Grade 1, 1/1 nodes, ER+/PR+, HER2-Hormonal Therapy 08/21/2010 ArimidexSurgery 09/14/2011 Lumpectomy (Right); Lymph Node Removal: Sentinel Lymph Node Dissection (Right)Radiation Therapy 11/14/2011 External
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Oct 15, 2011 10:22PM, edited Oct 15, 2011 10:22PM by Romansma

Hi there.  I had neoadjuvant chemo to shrink a tumor that was thought to be about 6 cm from the MRI.  I also had a needle biopsy of a few of the enlarged nodes that came back negative.  After 4 rounds of TAC, I had a BMX and they took 10 nodes.....9 were positive and something I found interesting, the top node taken was positive too.  Oh yeah, the 6 cm tumor that was supposed to be shrunk to do the surgery came out as 8 cm.....either the chemo didn't work, or it was a HUGE one to start with.  I did 4 more rounds of abraxane and cytoxin, and then on to 36 rounds of radiation.  If there was still cancer in the nodes, the radiation had to have fried it!  I have mild lymphodema, but nothing that is a big problem at this time.  It's my opinion that even if you don't have the nodes taken out, the radiation could cause the lymphodema problems.....soooooo.....good luck with your decision, I wish you well!

Hope

Dx 10/22/2010, ILC, 6cm+, Stage IIIa, Grade 2, 9/10 nodes, ER+/PR+, HER2-Dx 8/2013, ILC, Stage IV, mets, ER+/PR-, HER2-Chemotherapy 11/01/2010 Adriamycin, Cytoxan, TaxotereSurgery 02/14/2011 Mastectomy (Right); Lymph Node Removal: Axillary Lymph Node Dissection (Right); Prophylactic Mastectomy (Left)Chemotherapy 04/01/2011 Abraxane, CytoxanRadiation Therapy 06/08/2011 ExternalHormonal Therapy 08/07/2011 TamoxifenSurgery 11/29/2011 Prophylactic Ovary Removal (Both)Hormonal Therapy 12/15/2011 ArimidexHormonal Therapy 09/17/2013 FaslodexHormonal Therapy 09/17/2013 FemaraHormonal Therapy 01/25/2014 AromasinTargeted Therapy 01/25/2014 AfinitorRadiation Therapy 02/11/2014 External
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Jan 15, 2012 12:28AM J-Bug wrote:

So in the end, my surgeon took this information to a conference and shared with some colleagues. They all seemed to agree that since I had done chemo which would cover the entire system and would be doing radiation for the nodes, then I would be okay to just do the SNB. However, my surgeon said that if he had any positive nodes he would be right in there doing an AND immediately.

I did surgery on 11-09 and had 0/4 nodes positive. 

Age 40 at diagnosis.

Dx 6/10/2011, IDC, 6cm+, Grade 2, 0/4 nodes, ER+/PR-, HER2-Chemotherapy 07/01/2011 Adriamycin, Cytoxan, TaxolSurgery 11/09/2011 Mastectomy (Both); Lymph Node Removal: Sentinel Lymph Node Dissection (Both)Radiation Therapy 01/10/2012 ExternalHormonal Therapy 04/13/2012 TamoxifenSurgery 08/22/2012 Reconstruction: DIEP flap (Both)Surgery 12/11/2012 Reconstruction: Nipple reconstruction (Both)