Stage II w/Lymph Node Involvement
Comments
-
My lumpectomies were two separate surgeries. I had skin biopsies at the same time and on the second lumpectomy they found cancer in the dermal lymphatics of my breast. That was frightening!
0 -
Covelman...sounds like we had similar details...lumpectomy, 1 sentinel node pos....chemo then rads. Losing the hair was difficult at first but it gets much easier...7 months out of last chemo...I now have enough to pass off as pixie cut! You will get through this!
0 -
covelmom, I thought losing my hair would not be the worst that could happen to me, and I was right ultimately, but it sure was disheartening to see it plugging up the tub drain, even though I had gotten a buzz cut a week prior..... hang in there, you are tougher than you think right now! Best wishes, and lots of encouragement coming to you - Linda
0 -
I declined RADS and ALND or sentinal node - went through chemo and the two nodes that were positive on PET scan were completely gone after chemo. I know the risks and benefits, chose the risk of recurrence over the risk of LE, axillary nerve damage, and other SEs, and am comfortable with my choice (can't say my PCP, MO, BC, and RO are...). They use the 3 modalities as a sort of "shot-gun" approach to cancer treatment because they cannot predict who will respond to which treatment, and they would rather over-treat than undertreat. I believe I did the best for me as an individual, but would not recommend that is the "right" choice for most women, but the statistics are based on populations, not individuals. Go with the best advice from your team and don't ignore your gut feelings as well.
Linda
0 -
Mamma - oh so they were in two different places, your lumpectomies? Mine was in the same place both times but they had to go back a second time due to margins not being clear. After second lumpectomy three were clear, one was close, but that wasn't good enough. I did chemo at that point and then had the MX (uni) after I was done with chemo... and continued with one year of Herceptin of course. Sounds like it was in your skin ("dermal")? I think maybe being that invasive, even though only 1 node, is the reason for the radiation recommendation.
0 -
No, my lumpectomies were in the same place because they didn't get clean margins. They just added the 2 different skin biopsies to that becuase I had redness and skin thickening on MRI. They recommended chemo and rads for the invasive cancer and lymphatic invasion.
0 -
I had a BMX with TE 6/17/11 and have a multdisciplinary meeting tomorrow with the MO,RO,BS to find out follow up treatment. 1 sentinal node was positive and the rest were negative in the surgical path report, unfortunately the posterior margin was not clear and I have a microinvasion into the chest wall. My concern is the follow up treatment and how they handle that when I have had bil reconstuction (TE). Initially I was told it was DCIS, caught very early and a mastectomy would take care of it. Now I'm a Stage IIb and looking at the possibility of chemo and radiation....
0 -
Just wanted to chime in on MX and rads discussion....my RO told me that the new study shows great benefit for BMX patients with ANY positive nodes. It's just another tool in our arsenal! I had a BMX in December with 32 nodes removed, DD ACx4 followed by DD Tx4, 28 regular rads ( whole breast, axillary and supraclav) and 8 boosts (mx scar) and I'll take Tami for 5 years possibly followed by an AI. Overkill??? Possibly. I've had a pretty easy time of it though and I'm pretty much have myself convinced I won't be dealing with this again
Tammy0 -
My PS was adamant about having the exchange surgery before rads started. He said the tissue won't stretch as well after rads and he could tweak things the rads affected with a revision. So, I did the fills and chemo at the same time. It was rough, but worth it IMO.
Tammy0 -
debb: I'm sorry you have to go thru this,. It is hard when they come back with worse things. On my first biopsy they said I had a benign tumor then I went for follow up and the radiologists said they didn't think that could be right. I was very upset. We had to follow with and ultra sound wire and MRI wire guided lumpectomy to discover a whole different tumor from the benign one. It was IDC. Hang in there. Chemo and radiation are doable and it's good that they found it now. I had a TE put in and am now doing radiation. It is not a problem for chemo at all and can be done with radiation. They is a greater risk for encapsulation, but they can handle that.
0 -
Hey all,
The newest study shows women who have even one positive lymph benefit from rads when it comes to mets and local recurrence.
Might think about it.
My cancer center radiates all lumpectomies, and all MXs if there are ANY lymphs...they've been doing it for years...but now it looks as if it is going to become standard care....
http://www.sciencedaily.com/releases/2011/06/110604181907.htm
0 -
I so appreciate your responses, unless I travel to Baltimore my care is limited to the Eastern Shore of Delmarva. There is a Cancer Care Center but Dr's are limited so I am glad to hear options for care as I feel limited to whatever is recommended to me. Just diagnosed 5/17/11 I initially did alot of reading but not regarding chemo and radiation, mostly pathology and surgery/reconstruction. I almost regret having done immed. reconstruction now that radiation/chemo looks like its in my future.
How do I add my diagnosis to the bottom of my replies?
0 -
Go to "My Home" and edit your diagnosis,
0 -
Deb,
I have a final rad tomorrow...I have a TE, and so far, so good
0 -
TonLee -- both of those articles specifically discuss the benefit of radiation for women who have had breast-conserving surgery (i.e. lumpectomies) not MX. At least, that is what I read -- did I read it wrong?
0 -
I have read all articles posted and I read them as radiation is needed for LUMPECTOMY always and for MX if there are 3-4 or more nodes... I had one positve node and chemo and I had 4 doctors tell me I did NOT need radiation after my MX... had I just had my lumectmy, then I for sure would need rads... opted out and having MX instead.
0 -
I recall from discussions with oncologists---if you had lumpectomy then radiation was generally a given. If you had MX--radiation for those with over 3 positive nodes or any other invasion. I am guessing that some oncologists may suggest--seems like even though people may have same diagnosis--not exactly same treatment. I had lumpectomy and radiation was part of my treatment plan that they presented to me.
0 -
Lilah,
You are correct. The 1800 women studied were lumpectomies. However, they extrapolated from the results that Regional Lymph Node Irradiation (RNI) is beneficial to women with 1-3 positive nodes. The type of surgery doesn't really matter, it's about lymph node involvement.
"After a five-year follow-up, interim analysis of the data showed a greater than 30 per cent improvement in disease-free survival for those receiving RNI. This resulted from a 41 per cent lower rate of recurrences in the breast and lymph nodes and a 36 per cent lower rate of cancer recurrence in other parts of the body."
BDavis,
This is news as of this month (presented in Chicago)...most ROs are just learning of it...but the NCI supported the study and expects it to change TX for women with positive nodes dramatically...hence the reason it is all over the news.
At the time of your diagnosis, it sounds as if you were given the standard of care.
But it looks like that standard is a'changin.
Edited to add: This is radiation to the lymph node area...not necessarily the whole breast...they're saying any activity in the nodes that receive RNI have better statistics for recurrence and survival.
0 -
The article referenced is the *exact* reason that my RO is zappin' my nodes. I balked at it because of the LE risk, but I think I'd rather deal with LE than cancer or mets.
I had one positive node - 3.0mm of a 5.7cm node.
0 -
Well... I fall into a weird category... I had a micromet in one node= .38mm so super small... had it been .18 mm smaller, it wou dhave been considered negative... BUT This is exactly what I asked my MO... I asked if I was in ANY way compromising my care by skipping rads and getting MX instead, and all doctors, 2 BS, MO and RO all said no... And I specifically asked about regional recurrance... but they say my chemo took care of that.
Pejkug: did you have chemo?
0 -
Yes, I had TCH x 6. Finished up on June 9 and started rads yesterday.
0 -
Betsy -- I had the same experience. All of my doctors said no rads for 1 node. I'm OK with that.
0 -
There wouldn't have been a compromise in care when we were all diagnosed (by skipping rads) because the standard of care WAS generally that 1-3 lymphs received a case by case review.
I posted this for informational purposes and for women who are being diagnosed right now. It doesn't affect us (already treated), but will for Stage 2 women diagnosed in the future whether they have MX or Lumpectomy.
0 -
TonLee-I agree with you, the standard is changing. I think that women need to remember that all pathology reports that show 1 positive node are not the same. Micromets, may be treated differently then Macromets > 2mm. The studies referenced are all looking at positive nodes with marcromets > 2mm.
I had my 3 month post rads follow-up with my RO this week. She told me that for women who have 1-3 positive nodes and/or lymphovascular invasion, she is changing their radiation plans mid treatment because of this study. She is adding lymph node radiation (axillary and supraclavicular) for women who did not have it in their original plan.
0 -
Too much,
Thank you for making the point about micro vs macro.
I forget some Oncs/Tumor Boards consider micromet and isolated tumor cells (ITCs) as "negative" when staging. I asked my Onc if those nodes are truly "negative" then does that mean they aren't cancer?
Cancer is cancer. Isn't the whole point of chemo to hit the "microscopic" travelers? And yet when those same cells are in a lymph it is considered "negative."
Well, I'm glad to hear your RO is changing plans already. I read it may take up to 12 months for the rest of the country (outside more educational/progressive cancer centers) to catch up.
My Cancer Center has always recommended rads to lymph nodes (super clav and axilla ..under the arm) if there is even a single positive node....so they aren't changing anything. Now they have the data to back up their aggressive tx.
At this rate, we may not recognize cancer tx in 10 years! lol
0 -
This is all very reassuring to me starting rads this week. I didn't feel very confident in my rads center but it seems that they are doing treatments according to the new standards of care. And that is comforting.
You ladies are a wealth of info!
0 -
Pej,
Until I had radiation (just finished today WOOT)..I didn't realize there are 4 "fields" a woman with BC may get radiated (super clav, axilla, whole chest, skin/scar line (often with bolus).
I guess I just assumed everyone got all of it in the same amount until my RO educated me....If they'd have told me that to start, I might not have fought so hard to try and get out of it! lol
0 -
Gee, I feel lucky now cause I'm getting all four.
0 -
Mammalou - I'm another who had all 4 and I don't regret it for a minute. I did get mild lymphedema in arm though. If you haven't been referred to a lymphedema therapist you may want to ask now. There is some thought that early intervention with manual lymphedema drainage and compression can limit the extent of the LE. I wore a compression sleeve on my AND side every day through treatment and did MLD, ROM exercises and exercised. My LE is mild. Who knows, it may have been anyway but my RO believes that increasing blood flow to the upper chest and arms during radiation is an important factor in decreasing risks of complications during rads. She recommended swimming every day as long as my skin looked good. Anyway, something to talk about with your RO if you wish.
0 -
Thanks for the info. I am already working the arm as I went into all the BC stuff with a frozen shoulder on the same side. I'm going tomorrow to be part of a LE study and I'll have to get some advice on early intervention.
0
