Stage II w/Lymph Node Involvement
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I was just diagnosed with Stage 2A - had a lumpectomy with clear margins, but 2/3 lymph nodes tested positive. Awaiting results from onco test. Has anyone had positive lymph node involvement and NOT gotten chemo? I thought once the nodes were involved, you had to have chemo and radiation - I am confused and anxious.
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Warrior517.....what a positive attitude you can sense through all of your posts. I pray that I can keep this same upbeat attitude as I start my treatment (AC) tomorrow. Thanks for taking the time to help all of us even though it looks as though your posts ended in '09.
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Hi Justina. I had hoped to avoid chemo also, but because one node was involved my oncologist said that a cancer cell could have gotten by the nodes into another part of my body. Thus, the need for chemo. He said the chemo is like an insurance agent going through the body ridding the body of any cancer cells that could have slipped by. Good luck to you.
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Justina,
I'm sorry to read about your diagnosis.
You will have chemo and radiation.
Chemo because it was in the lymphs, radiation because it is done with a lumpectomy (to get the same survival/recurrence rates as a MX) and because the very latest research shows huge benefit in survival/recurrence when radiation is given where there is even a single positive lymph. What most people don't know in my experience, is there are different "fields" for radiation.
If your lymphs were clear you might only get a full breast shot with your lumpectomy.
Since they weren't your RO will likely recommend the full breast (for the lumpectomy), as well as the super clav lymphs (collar bone area), and the axilla area under the arm...in other words pretty much everything....(I had the max Rads and it isn't bad, just makes you tired.)
Hope this helps.
Good luck!
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Justina... I had a lumpectomy and chemo (one node positive) and then chose to have a BMX instead of radiation... which was an option because it was only one node... At some point, 3-4 nodes, hey give radiation regardless of whether you have MX or lumpectomy.
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Hi, I had a sparing sking unilateral mastectomy w/implant on 5/16 (one node positive) and I have a 2nd surgery 15 days later to remove 20 more nodes (all negative)
It's really good to hear positive news. Thank you, this forum made the difference for me.
I am starting chemo on July 19th (A/C 4 times every 2 weeks followe by 12 weekly Taxol) I'll keep you posted
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BDavis,
That is incorrect.
Your treatment is not the standard of care anymore. Generally since the second week in June 2011...1-3 positive lymphs get rads whether lumpectomy or MX now (where as before it was more a case by case, clinic by clinic basis).
This has been covered here already with links to the newest data.
"Women with early breast cancer and as few as 1 to 3 positive nodes should be offered radiation treatment to their regional lymph nodes, in addition to standard whole-breast radiation (WBI), according to a study presented here at the American Society of Clinical Oncology (ASCO®) 2011 Annual Meeting."
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With the new studies there are RO's that are recommending radiation for those that have lymphovascular invasion, dermal invasion or margins close to the chest wall even without positive nodes. The recommendations are in constant evolution.
I think it's important for the newly diagnosed to know this and to discuss potential benefits from having radiation with their oncologists. I also think that it makes sense for anyone with a positive node or any of the above to have a consult with a radiation oncologist.
It is definitely not standard of care anymore to discount radiation for women with 1-3 positive nodes.
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christine47 - I had a NS BMX with immediate TE placement last Nov, then AND early Dec. Just a few days before Christmas the left TE burst through the skin (had some healing issues on the skin surface where it didn't re-establish a blood supply) and I had an emergency surgery. In Jan. I had another excision and when that still didn't heal I had another excision and the left TE removed. I kept the right with the original surgical fill, so they are putting the left one back in next week (yay! No more prosthesis!) since I am now done with chemo. I do not have rads in my plan since I did BMX and AND.
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TonLee... this IS correct FOR ME when I was diagnosed... I can't comment on TODAY's standard of care since I am past that. All of my decisions were made prior to new standards... Plus I had a MICROMET...so I am in a category all outside the standards. I was telling justina what I had, not what she should have
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Hold on folks, I want to ask for some clarification. I read an article "ASCO 2011-BREAST RADIATION EVEN FOR N1 DISEASE IMPROVES DFS- A PRACTICE CHANGING STUDY?" http://cancerology.blogspot.com/2011/06/asco-2011-breast-radiation-even-for-n1.html
This article states that the study was conducted on woman "... who averaged 53 years in age, had all been treated with breast-conserving surgery and adjuvant systemic therapy - either chemotherapy (91%) or endocrine therapy (71%). As noted above, most had 1 to 3 positive nodes, but a small proportion of the women had either more than 4 positive nodes (5%) or high-risk node-negative breast cancer (10%). "
Breast conserving surgery is a lumpectomy. This study was did not include patients who had a Mastectomy according to the article.
For those of us who had a MX, depending on our specific pathology, we still fall into the 'grey area' with 1-3 positive lymph nodes. Although this study is informative for us in making a decision in consultation with our doctors.
Or was there another study that I am confusing it with?
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specialK, so sorry you have had all the trouble post surgery and glad you are moving on to getting you TE back. No RADs for me, but on to exchange and port removal on thursday.
Proudmom- I thought the same thing as you, maybe I missed something??
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christine47 - so happy for you to be having your exchange and port removal. Can't wait until I can do the same. Probably won't happen at the same time though because I still have a ways to go with Herceptin. I will be curious to know what everyone thinks of their exchanges now that we are reaching that point. I am sweating whether my PS can achieve symmetry with the TE's next week. I am afraid of right looking decent and left pointing off in some weird direction!
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PWM,
It doesn't matter if they studied women with lumpectomies...because lumpectomy and rads has roughly the same survival/recurrence rate as MX. Therefore, the findings are extrapolated to ALL BC patients.
This isn't about the breast tissue, this is about the lymphs. If the cancer has traveled into the lymphs (1-3 nodes) this study shows it is significantly beneficial to have rads to the axilla. Do you think women who choose lumpectomies (from the study) have some sort of super sonic different cancer in the lymphs than women who choose MX?
BDavis, I get that you made the best decision with the information you had at the time. But Justina is obviously newly diagnosed and telling her the "old" standard of care is at best confusing.
Not to mention (and it may be the way I'm reading it) but you seem to blow off the newest research (you mention reading it earlier in this post, but then you go on to comment and it's obvious you haven't read it, or read it all because it is pretty easy to understand). But, you continue to comment as if your old standard of care (no rads with 1 - 3 lymph involvement) is just as good. It's not. This research proves that.
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TonLee - I have an easy question - I just went to look at the study link but didn't want to create an account. Did the study participants have Lump/AND/Rads or Lump/Rads?
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I recently had a lumpectomy June 3rd s/b with dye which came back one node suspicious
It was so small they could not detect it.
.My B S said she wants to take out the rest of the nodes as a precaution
.I see the oncol july 14th and rado july 21st
I know I am having Chemo and Rads just dont know the cocktail yet.I wish I was in more of a positive frame of mind still cant get my head around all of this
.Would love to hear some positive stories some of the stories on this site have been scaring me.
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Justina, Not all node positve women get chemo. Usually the oncotype test comes into play when chemo is decided against.
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Special K,
They had some level of AND, that is how they knew the lymphs were positive.
"This study was designed to look for a benefit to adding radiation therapy to treatment for women who would not normally have radiation therapy to the regional lymph nodes.
The study included 1,832 women with node-positive breast cancer or high-risk, node-negative breast cancer who had breast-conserving surgery and chemotherapy or hormone therapy and then received either radiation therapy to the breast only or radiation therapy to the breast and the regional lymph nodes."
Lump/AND/Rads...
What this means for patients
"These results will encourage doctors to offer all women with node-positive disease the option of receiving radiation therapy to the regional lymph nodes," said Timothy J. Whelan, BM, BCh, lead study investigator for the National Cancer Institute of Canada Clinical Trials Group and Professor of Oncology and Division Head of Radiation Oncology at McMaster University in Ontario, Canada.
"This treatment improved disease-free survival, lowered the risk of recurrences, and there was a positive trend toward overall survival, while not greatly increasing side effects."
You don't have to be a member to read about this latest research. It's pretty big news and all over the web. Google should take you to it pretty quick.
Here is a link to the particulars of the study groups.
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Could someone tell me what AND means thxs
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Coral,
You're right. I am Her2+ so I forget there is an Onco test to determine likelyhood of recurrence in 10 years. And if it is low enough some women decide to forgo Chemo.
Thanks for the reminder.
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Sandy,
Axillary Node Dissection
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Thank you TonyLee im still learning all the lingo sometimes its confusing.
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I think this on-going study MA.20 Trial is important, and yes the 'standard of care' for some bc patients may be changing due to the results, but you also need to look at what the eligibility requirements were for those who partipated, because not all bc patients with 1-3 positive nodes fall into these categories.
- Must have histologically proven invasive ca of the breast w/o evidence of metastic dz.
- Pts. must have been treated w/breast conservation therapy (BCT) and axillary dissection or sentinel node bx. Must be a candidate for breast XRT.
- Must be at high risk of regional recurrence, due to: positive axillary nodes, or negative axillary nodes and primary tumor 2 cm or greater or primary tumor at least 5 cm or greater and less than 10 axillary nodes removed and one of the following: ER-, SBR grade 3 or lymphovascular invasion.
- Sentinel node pts. are eligable if they are node negative, but still meet criteria for high risk pts. If positive sentinel nodes, must have a level I and II ALND.
Edited: Thanks TonLee for that link for more details on the study, I was typing and didn't see it until after I posted.
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So you're saying women who are Stage 4 may not get rads.
Um, ok. This wasn't about Stage 4 it was about "early stage." Some Stage 4 women get rads, some don't. But this isn't about them. It's a study about early stage breast cancer that has spread to the nodes.
For the purposes of the study they used women who had lumpectomies. YES! Why do you think that is?? BECAUSE STANDARD OF CARE AT THE TIME WAS TO GIVE LUMPECTOMIES RADS!!! So it was an available and accessible group.
However, "This study was designed to look for a benefit to adding radiation therapy to treatment for women who would not normally have radiation therapy to the regional lymph nodes."
That is directly from the researcher.
If you're implying the treatment population outside the study must match the control group exactly(which appears to be what you posted above) to benefit, then you may not understand research methods.
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I am sorry you misread my post.
I would never ever tell anyone whether or not they should have a particular treatment. I was posting what the criteria of the population from the trial that I found at http://www.stjohnprovidence.org/Trials/TrialDetails.aspx?TrialID=170.
As with all research, people should know who was included/excluded from the population study in order to see how their particular cancer might be treated because we all need to make informed decision. No two cancers are alike, so the studies are there to help us make informed decisions.
Everyone makes their own decisions for their own treatment of cancer. Studies help people with the research they do along with the consulations with their doctors to make the decisions which are right for them.
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I agree that understanding the study means understanding the control group's characteristics but we do not have to match it to benefit from the results. (It was lumpectomies as well as partial MXs in the control group btw).
The reason this study is so important is because up until last month, women who had 1-3 positive lymphs (mastectomy AND Lumpectomy) weren't always offered rads to the AXILLA. There was a case by case kind of approach because the research wasn't there to support rads, or not, definitively one way or the other. And what was available seemed contradictory.
I'm not telling anyone what tx they should get. But we have new women coming to this board and reading for information.
They should know the latest research is changing standard of care so that 1-3 nodes (Mx and Lump) are recommended for rads in women up to stage 3 and are not a low Onco score....
It's not me making this change based on the research, it's the field of Radiology/Oncology.
If this would have come out sooner, I know my treatment would have been different. I chose the MX because I didn't want rads. But a MX is no guarantee. Not before this research, and especially not after.
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Everning everyone: I want to chime in -- just saw the BS regarding the results of my Tumor Board Conference --
1) I will NOT have additional nodes removed
2) I will have a re-excision next Thursday to get the DCIS in the lateral and medial area of my breast
3) My BS said that during the conference one of the RO's wanted to "radiate the hell out of my breast" -- meaning he wanted to do upper shoulder, collar bone and under the arm. They argued that it's almost better if they take out extra nodes, because either way -- I would be at risk for LE.
Also, the BS said that when they radiate that high up, you could hit arteries and have other problems, so he was against that. Anyone want to offer up knowledge on this??
4) If they don't get clear margins this time, I've been recommended to have a mastectomy. I am fine with that.
The BS recommended that I see a RO that will do the breast; but when I eventually have a meeting with the RO; I will ask what the risks are of radiation so high up. I want to hear it myself and see what my options are.
Wish me luck on the 2nd surgery next week; it's supposed to be relatively easy and short (under an hour), so I hope they get clear margins! Thanks for listening.
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well good luck crystal... sounds like you are in good hands.
Toni... I have to say that your posts sounds very aggressive... and a bit condescending,... lighten up.
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Hi can someone tell me the difference between IDC & DCIS im having a hard time reading my
patholigy report.
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IDC = Invasive cancer. Cancer that has broken through the walls of the milk ducts and invaded the tissue around it. This is cancer that spreads to the lymph nodes and can spread to the rest of the body.
DCIS = Cancer that is still contained within the ducts. It can become an invasive cancer if left unchecked. Once it breaks through the ducts, it is called IDC.
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