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All TopicsForum: Surgery - Before, During, and After → Topic: Micro-metastasis? Caused by biopsy?

Topic: Micro-metastasis? Caused by biopsy?

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

Posted on: Apr 12, 2010 03:01AM, edited Apr 12, 2010 03:09AM by dcrm

dcrm wrote:

Hi there,

I'm not sure which 'forum' this question goes on.   Several folks reported in different places that  individual cancer cells were found in their lymph nodes that reportedly came from their biopsies.  They implied that these micromets were not significant to their treatment, per their docs.

Is it a known thing that biopsies send loose cancer cells into the lymph system?  I asked my BS and she told me that cells might move out of the tumor but that they wouldn't have the genetic changes that cause metastasis.  She said we all have such cells floating around our bodies all the time.  Few grow into cancer.  Her response fits with what several posts implied: that those micromets are of no concern.  I realize that the traditional way of analyzing lymph nodes is to call them negative in this scenario. 

 Do biopsies regularly or often dislodge cancer cells and send them into circulation outside the tumor?  

If so, it troubles me because it took so long to schedule my surgery -- from late February biopsy to April 26.  (IDC, Grade 2, ER+, PR+, HER2-) 

The idea that these micromets are insignificant differs from what we learned when my then- 25-year-old daughter had micrometastasis of melanoma found by sentinel lymph node mapping in 1998.  She had to undergo a terrible year of treatment with alpha-interferon.  What we understood at the time was that finding the micromets by careful pathology saved her life; that micromets like these had been missed for the preceding 100 years -- perhaps explaining why melanoma was so often fatal, even when lymph nodes were thought to be clear.  As explained to us then, they used to cut the lymph node in half and examine it.  But it was like looking for a grape in a loaf of bread.  So the idea of examining the sentinel lymph node was to slice up the loaf of bread and look for the grapes.  The micrometastasis.

Are there many people who found micromets in the sentinel node who did fine without chemo?

If you had micromets, what did your medical oncologist recommend for you next?

Have any of you who had micromets attributed to the biopsy also had to have chemo?

Have any of you with micromets in the sentinel lymph node subsequently developed metastatic disease?  

If there is some thread where a newbie can learn about this I would appreciate being steered to it.  My site searches did not yield any results.

Thank you for any light you can shed. 

Be well.

 Deirdre

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Apr 12, 2010 08:56PM TenderIsOurMight wrote:

I can only offer you my non-expert derivation from breast cancer reading. As I understand it, surgery is uncommonly thought of as the etiology of lymph node micromets by most breast cancer experts. Regrettably too, as with melanoma, lymph node micromets do reflect real spread, and hence a propensity of one's cancer to be the spreadable type. Most experts I read do suggest lymph node micromets be taken seriously wrt treatment.

If you go to the home breastcancer.org page, you will find experts who address some of the valid questions you ask.

I hope your daughter is doing well, Deirdre, and wish you all the best on this journey and with treatment. Second, sometimes third opinions often help in situations such as this.

Tender

It cannot be emphasized too strongly that treatment of each patient is a highly individualized matter. (FDA-approved labeling for warfarin (Coumadin) NDA 9-218/5-105)
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Apr 12, 2010 10:37PM dcrm wrote:

Dear Tender,

Thank you for your helpful reply and for taking the time to consider my long post!  I'm glad you have read that such micromets should be taken seriously.  I plan to know whether my sentinel node has any cancer cells at all and then be aggressive, if so.  

Just to confirm my understanding: Based on your observations from your reading, most experts do not think that surgery is the etiology of lymph node micromets.  Did I get that right?  

Happy to say my daughter is now 37, happily married with three children.  She is wonderful and doing wonderfully.  

Best,  Deirdre

 

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Apr 13, 2010 12:49AM dcrm wrote:

Answer is on this website:  Isolated cancer cells in lymph nodes matter.  (I found the research archives by signing up for email updates.)

www.breastcancer.org/symptoms/...

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Apr 13, 2010 09:51AM TenderIsOurMight wrote:

Just checking back. There has been discussion if the act of biopsy/surgery itself on the breast tumor can "seed" the sentinel node physically with isolated bc tumor cells. I think it's fair to say most breast cancer researchers feel that such, if it occurs at all, is very rare. I guess the bigger point is that once there, in the lymph node, they have to be considered wrt their eradication and other potential micromets throughout the body as disseminated by the blood stream and lymphatics. 

I'm so happy to hear your daughter has three children and is doing well. Glad she got cutting edge knowledge and treatment when her problem arose.

Tender

It cannot be emphasized too strongly that treatment of each patient is a highly individualized matter. (FDA-approved labeling for warfarin (Coumadin) NDA 9-218/5-105)
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Apr 13, 2010 03:07PM dcrm wrote:

Thank you again.

 What troubles me is that a great number of patients who write into these discussion boards are not apparently being more aggressive if micromets or isolated cells are found in the lymph nodes.   Their docs are not picking up on this as far as I can tell.

Best,

Deirdre

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Apr 13, 2010 03:37PM monee wrote:

I had micromets according to my pathology. I was treated with chemo 4xTC. Age is an important factor to consider as well.  I had Stage 1 in 1999 on one side and Stage II in 2008 with micromets  on the other. I was 40 and 49 at the time.

Dx 6/6/2008, IDC, 1cm, Stage II, Grade 2, 1/10 nodes, ER+/PR+, HER2-
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Apr 21, 2010 04:14PM mrsb wrote:

 I was diagnosed in 2003 ,I had 2 micromets in axilla nodes i had mastectomy and radation,due to micromets and the fact that my oncologist wanted to dose the subcalvian nodes. I did not have  chemo due to prior cardiac problems..(the risks outweighed the benefits). I am 7 years NED and by choise am still on Femara.Myself and my oncologist took the micromets very seriuosly and I am glad we did.

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Apr 21, 2010 10:48PM dcrm wrote:

Thank you.  Your report is very helpful and I'm so glad you are doing well. 

 Very interesting that you continue on the Femara.  

 Again, many thanks.  

 Deirdre