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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 11:14AM, edited Jan 10, 2012 10:49PM 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). 

Age 40 at diagnosis. Dx 6/10/2011, IDC, 6cm+, Grade 2, 0/4 nodes, ER+/PR-, HER2- Chemotherapy 6/30/2011 AC + T (Taxol) Surgery 11/8/2011 Mastectomy: Left, Right; Lymph node removal: Sentinel, Left, Right Radiation Therapy 1/9/2012 Breast, Lymph nodes Hormonal Therapy 4/12/2012 Surgery 8/21/2012 Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap Hormonal Therapy 11/14/2012 Arimidex (anastrozole) Surgery 12/10/2012 Reconstruction (left): Nipple reconstruction; Reconstruction (right): Nipple reconstruction
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Oct 15, 2011 12:13PM 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 02:17PM , edited Oct 15, 2011 02:18PM 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 03:51PM 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 6/30/2011 AC + T (Taxol) Surgery 11/8/2011 Mastectomy: Left, Right; Lymph node removal: Sentinel, Left, Right Radiation Therapy 1/9/2012 Breast, Lymph nodes Hormonal Therapy 4/12/2012 Surgery 8/21/2012 Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap Hormonal Therapy 11/14/2012 Arimidex (anastrozole) Surgery 12/10/2012 Reconstruction (left): Nipple reconstruction; Reconstruction (right): Nipple reconstruction
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Oct 15, 2011 04:46PM 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.

BMX w/ TE 11/1/10, ALND 12/6/10. Twelve additional surgeries. TCHx6 2/17-6/2/11. Herceptin until 1/19/12. Femara 8/1/11, Arimidex 6/20/12, back to Femara 6/18/13-present. Dx 9/27/2010, IDC, Right, 2cm, Stage IIB, Grade 3, 2/14 nodes, ER+/PR+, HER2+ Dx 9/27/2010, DCIS, Stage 0, Grade 3
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Oct 15, 2011 05:46PM 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 6/30/2011 AC + T (Taxol) Surgery 11/8/2011 Mastectomy: Left, Right; Lymph node removal: Sentinel, Left, Right Radiation Therapy 1/9/2012 Breast, Lymph nodes Hormonal Therapy 4/12/2012 Surgery 8/21/2012 Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap Hormonal Therapy 11/14/2012 Arimidex (anastrozole) Surgery 12/10/2012 Reconstruction (left): Nipple reconstruction; Reconstruction (right): Nipple reconstruction
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Oct 15, 2011 06:40PM 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 8/20/2010 Arimidex (anastrozole) Surgery 9/13/2011 Lumpectomy: Right; Lymph node removal: Sentinel, Right Radiation Therapy 11/13/2011 Breast, Lymph nodes
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Oct 15, 2011 07:22PM , edited Oct 15, 2011 07:22PM 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, Right, 6cm+, Stage IIIB, Grade 2, 9/10 nodes, ER+/PR+, HER2- (FISH) Chemotherapy 11/1/2010 Adriamycin (doxorubicin), Cytoxan (cyclophosphamide), Taxotere (docetaxel) Chemotherapy 4/1/2011 Abraxane (albumin-bound or nab-paclitaxel), Cytoxan (cyclophosphamide) Radiation Therapy 6/8/2011 Whole-breast: Breast, Lymph nodes, Chest wall Surgery 11/29/2011 Prophylactic ovary removal Dx 8/2013, ILC, Stage IV, mets, ER+/PR-, HER2- (FISH) Hormonal Therapy 9/17/2013 Faslodex (fulvestrant) Targeted Therapy 1/25/2014 Afinitor (everolimus) Radiation Therapy 2/11/2014 External: Bone Chemotherapy 12/6/2014 Xeloda (capecitabine) Hormonal Therapy 2/20/2015 Femara (letrozole) Targeted Therapy 2/20/2015 Ibrance (palbociclib)
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Jan 14, 2012 09:28PM 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 6/30/2011 AC + T (Taxol) Surgery 11/8/2011 Mastectomy: Left, Right; Lymph node removal: Sentinel, Left, Right Radiation Therapy 1/9/2012 Breast, Lymph nodes Hormonal Therapy 4/12/2012 Surgery 8/21/2012 Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap Hormonal Therapy 11/14/2012 Arimidex (anastrozole) Surgery 12/10/2012 Reconstruction (left): Nipple reconstruction; Reconstruction (right): Nipple reconstruction