Sentinel Node Biopsy
Hello all,
My wife was recently diagnosed with TNBC and upon scans it showed that her tumor was roughly 5cm. She did a PET, Bone and MRI. The drs said that the scans showed no cancer in the lymph nodes. Everywhere I am reading I see that people get a sentinel node biopsy as well to determine whether the nodes were affected. Our drs never brought this up and she went directly to chemotherapy.
My question is whether this is common or if she was supposed to also have a sentinel node biopsy done. I am really worried since the size is rather large and that perhaps the scans did not reveal something that may be there.
Thank you for your time.
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Rosieroman - A sentinel node biopsy is done at the time of surgery. If she is doing chemo first, it will hopefully shrink the tumor down before surgery and they will do a sentinel node biopsy at that time.
Hope this helps, and very sorry to hear about your wife's situation.
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Thank you very much. I must have read it wrong in my studying. I thought that they do the sentinel node biopsy prior to deciding what course of treatment to utilize and for staging. Perhaps I am thinking of something else. I read that they put a dye in to determine what node it drains to and then they take it out to check for cancer.
If anyone else has only had scans to determine lymph node status before neoadjuvant chemotherapy that would be great to know. I'm sorry I am not well versed in this and am trying to learn as much as possible for my wife. Thank you all for your help!
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Rosieroman - There's so much to learn! I really sympathize with what you are going through. We've all been there, trust me.
Usually at the time of surgery they inject the blue dye. There's also a similar way that they can do it without dye, but I am not up on that. I think it's some kind of a tracer. The dye takes up in any nodes that have cancer, so it gives them an idea of what they are looking at and how to proceed with the surgery. The idea is that if the sentinel node is "clean" the other nodes probably are too. If the sentinel node shows cancer and they get several that take up the dye, then they have to take out more nodes to look for cancer.
I only had scans to determine node status before I had neoadjuvant chemo. The scans showed no nodes. In my case then the sentinel node they took at the time of surgery also showed no cancer, so it was assumed that I had no node involvement.
Take all the learning at a slow pace. Sometimes it can just be too much for anyone's brain to take in all at once. It is so nice of you to do all of this for your wife!
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Rosieroman - Threetree has given you a great explanation. My tumor was just under 5cm. I had a PET and MRI which showed no lymph node involvement. and did chemo first. However when I went in for surgery, after chemo, the blue dye was injected and four lymph nodes lit up and were removed; one of those four tested positive. Radiation was on the table, but the RO and the second opinion RO did not feel it was necessary, so I was put on Xeloda, which is standard course of treatment for this situation.
I think it's great that you are learning about your wife's diagnosis and treatment(s)! It is all very overwhelming though.
I really hope that all goes well for your wife. Please keep us posted.
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Thank you both for all of the information. I truly appreciate you taking the time to come on and answer these questions. I hope that everything is going well and continues to go well for you both.
For my wife, she is currently on the keynote-522 regimen (12 weeks of paclitaxel, carboplatin, keytruda and then 12 weeks of doxorubicin, cyclophosphamide, keytruda). They then said double mastectomy because she tested positive for PALB2, radiation, and keytruda for 9 cycles. I was wondering if she is able to get PCR would they change the need for radiation? Serendipity09 - it seems you had a very similar case and I see that they did not recommend radiation.
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Rosieroman - In the end I was given the option of doing rads, they left it up to me and I chose not do it. I ended up with a recurrence in July 2021 which then led to having to do 25 sessions of rads. I blame myself for just not wanting to do it instead of just doing it as a precautionary measure. They felt that because there was no evidence of cancer in the lymph nodes when I first was diagnosed and that it was only in one of the four, that it really didn't warrant rads.
The reality is that this beast is so unpredictable, it's a crapshoot all the way around (I hope I don't offend anyone with that word.)
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serendipity09 - Thank you and I'm very sorry to hear about the recurrence. I'm praying that everything is going well and continues to go well with that treatment. Yes, I do see in my research that it is so unpredictable and there really is no way of knowing one way or the other how your body is going to respond.
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