Jan 24, 2009 08:44PM - edited Apr 28, 2009 06:22PM by yellowrose
Posted on: Jan 24, 2009 07:27PM - edited Jan 24, 2009 07:31PM by Britt
I wonder if anyone else has experienced this:
I had a lumpectomy/SNB on 1/16/09. At the time, BS said everything looked node negative and margins clear. Finally got path report yesterday and met with BS for post-op exam and discussion. During the pathology study, they found 0.2mm of "nasty stuff" in the sentinel node itself. One other axillary node was taken out, and that was found to be negative. Also, thankfully, margins were totally clear. My tumor was 2.3 cm, Grade 2. Staging on report was T2, N1mi, MX - I know that MX means that they were not able to determine if the cancer has spread to the rest of the body. I also am aware that N1 means cancer found in 1 to 3 axillary nodes. Does anyone know what the "mi" means? Perhaps it stands for "micromets?"
Anyway, BS discussed the option of going back into surgery to have the axillary node dissection. We thoroughly discussed the pros and cons and of course the added risk of lymphedema and nerve damage. I decided not to have the surgery, since I think it is promising that the cancer was not found in the other node that was taken out, and I didn't think it was really necessary since the cancer cells are so tiny at this point. BS agreed and respected my decision. She told me if she felt that my life were threatened, she would have strongly recommended that I have the axillary node operation.
I have an appt to see a med onco next week to discuss options, and also with rad onco. I am going to get the Oncotype test, also. Of course, I was told I can always change my mind about the axillary node surgery. But apparently, chemo is a definite option, as are hormonal treatments and of course radiation, which is a given.
My questions are: Has anyone else ever been in this position? If so, what did you decide to do?
And exactly what sizes are considered to be "micromets?"
Thanks for any input any one may have. I truly appreciate it.
Posts 1 - 30 (56 total)
Jan 24, 2009 08:44PM - edited Apr 28, 2009 06:22PM by yellowrose
Jan 24, 2009 10:05PM Britt wrote:
Thanks, Yellowrose - I will definitely check out that website. I rather felt that my surgeon felt the same way about the micromets -
Did you get chemo - radiation - hormone therapy?
Thanks again and have a great evening!
Jan 24, 2009 10:13PM Lories wrote:
I was wondering if the mi could mean microcalcifications? But yet this is following the N or node desingation. Could it be as you are thinking that they are microscopic?
I also found a reference to microinvasion. It is noted in a section on sentinel node when a woman has DCIS - "a small number of cancer cells broke through the gland wall and invaded in what is called a microinvasion. The gland wall has been breached by an invasive ductal breast cancer measuring less than 2mm. That's smaller than a pin head." from Living through breast cancer, Kaelin.
not sure if that helps. Lori
Jan 24, 2009 10:28PM - edited Jan 24, 2009 10:31PM by Beesie
If you look at page 58 of the NCCN treatment guidelines, you can see micromets defined as "greater than 0.2 mm, none greater than 2.0 mm".
It also explains that "isolated tumor cells", or ITC, are single cells or clusters not greater than 0.2 mm. ITCs are considered equivalent to having no lymph node invasion (pN0+). Anything larger than an ITC but smaller than 2.0 mm is considered to be micromets (pN1mi) and anything larger than that is full metastasis to the nodes.
Jan 24, 2009 11:11PM Britt wrote:
Wow! What a lot of great information -
Lori - that may mean "microinvasion" - I am checking out my path report again and it did mention "Ductal Carcinoma In Situ, Comedo Type, High Nuclear Grade" along with The Lump so perhaps I had a little touch of DCIS also that they got out? Every time I read this four page report (includes addendums!) I discover something else. I am driving myself bonkers. It's time for a martini at this point! Thanks for the info - it did help a great deal! (although I also had microcalcifications, too!)
Beesie - Wow! What a compendium of info! I just checked out the addendum report re the biopsy of the sentinel node and it states: "Right Breast Sentinal Lymph Node, Excision. Cytokeratin immunostain positive for isolated tumor cells. Comment: Cytokeratin positive cells are present in a subcapsular and intranodal location. The intranodal location measures 0.2mm in greatest dimension and is identifiable on the routine H&E stains." I think the operative words here are "isolated tumor cells" - or as you refered to them, ITCs. So does this mean I am on the borderline - because I just noticed that you wrote that micromets are indictated as pN1mi, and that is what is indicated as part of my staging. It seems my report is a bit of a contradiction - they mentioned ITCs, then staged me as having micromets. Will definitely mention this to my onco next week.
Thanks again to you both - time for more research!
Jan 25, 2009 07:10AM - edited Apr 28, 2009 06:23PM by yellowrose
Jan 25, 2009 07:46AM LauraGTO wrote:
Maria - I had the same situation. But...even though my sent node only had micromets, my bs was adamant that I have an Ax node dissection. It wasn't presented as a choice. So I never questioned whether to have it or not. They removed 11 nodes and all were negative. I don't regret having it done, because I would have worried constantly that something was brewing. Decisions like these are tough. It's possible that if there are micromets in other nodes, the chemo and rads would kill it off. Best wishes to you with treatment and beyond.
Jan 25, 2009 08:05AM marejo wrote:
I had the exact same scenario happen to me and like you opted out of a complete axillary dissection. That freaked me out more (meaning the added risks...lymphedema etc) than the actual breast cancer at that time.
I had a 4.5 cm her2 positive tumor. I had a right breast mastectomy on July 28, 2005. Margins were clear and the initial "call" at surgery (after pathology took a look at the 2 sent. nodes removed) was that the nodes were negative. Ahhh, a huge sigh of relief (at that time) BUT when the pathology report came back the ending was different. Thankfully, my margins were clear but of the 2 sent. nodes, the first node had 1 micromet that measured .085 cm....very, very tiny. Second node negative. I, too, said NO WAY to going back in to remove more nodes. I felt confident that no other nodes would have cancer (as did my surgeon and oncologist) and aggressive chemo was part of my plan regardless (4 A/C + Taxol along with herceptin) all dose dense (bi-weekly). However, me and dh met with a well regarded radiation oncologist to discuss what she thought about radiation to that area and she felt because the one node did have a micromet and we did not go in to check if any other nodes were positive that I should have radiation also. (lumpectomy automatically would have radiation but I had mastectomy with clearn margins so radiation isn't typical in that situation) She said just because the second node was negative did not mean other nodes would not be affected. She did say though that it would be unlikely BUT when talking cancer the word unlikely isn't something you want to play around with. She felt since I was going through the full gammit of treatment the added benefit of radiation to that area (plus we did area of mast. sternum and back behind right breast) was something I should consider. Her call was "yes" I should go ahead with it. At that time I wasn't sure if I was going too..............geez, I was staring chemo and a year of herceptin in the face.......I couldn't think on that at that time.....BUT I did decide to go ahead with it. Just one more added assurance I guess.
The studies today are all pointing to not even calling us with micrometasis to the nodes "node positive" They aren't sure but it looks as if our threat of recurrence is no greater than those who are node negative (and I mean only with those with a micromet of metasis) However, the jury is still out on that.
Good luck to you Maria. I'll look forward to reading your update. My good news Maria..............To date, I am a 3 1/2 year survivor!!!!!!!!!!!!!!!!!!!!!! Yahoo and Praise God.
God Bless you with His peace and wisdom,
Jan 25, 2009 11:38AM Britt wrote:
Thank you ladies -
Again, thank you for sharing your information and your experiences. I am aware that there are two schools of thought re treatment and determination of micromets - will discuss all details with my onco next week.
Have a wonderful day and blessings to all and thanks for all of the good wishes and prayers -
Jan 25, 2009 12:50PM auriga wrote:
I also had micromets to one node. I just wanted to add one more thing to this discussion. My onco told me that sometimes the cancer cells get dislodged during the surgery and that is how the microscopic cells travel to the sentinel node. He is one of those that consider it node negative.
My surgeon did not even offer to remove any other nodes. But it bothered me enough that it helped me decide to go ahead with the chemo.
It will be interesting to see what your onco thinks.
Jan 25, 2009 12:58PM - edited Jan 25, 2009 12:59PM by Britt
Hi, Auriga, Fellow Floridian -
Thanks for sharing your experience with me. How big were your micromets? As you have read in my earlier post, mine is 0.2mm, which is borderline between isolated tumor cells (IDCs) and micromets. My surgeon also was not very concerned at all, but out of fairness wanted to give me the option for the axilliary. I am most anxious to meet with my onco to discuss. Your onco's opinion is quite encouraging. We shall see what mine says - and what kind of chemo did your onco recommend? Did you also have rads?
Thanks again and have a great day,
Jan 25, 2009 03:34PM roseg wrote:
A gal I work with had a similar situation, she was stage II. The SNB was initially negative but upon further review came back with micromets.
She had chemo and radiation. She told her Onc she wasn't having anything to do with tamoxifen, and didn't take that. She will be coming up on 5 years this summer. No further problems.
In her words, the chemo "chemoed" anything else that might have micro-metted and as far as she was concerned that plus the radiation was all the treatment she needed. I heard to whole story one day when I ran into her while she was on her way outside for a smoke
Jan 25, 2009 03:42PM - edited Jan 25, 2009 03:43PM by Britt
Hi, Rose -Thanks for relaying that to me - certainly sounds promising! But I would not balk at taking Tamoxifen - at least I don't think so - depends on my oncotype score and I am very "hormonally positive" and still premenopausal!. Love the fact that you ran into her while she was on her way out for a smoke break - since - I am ashamed to admit - I also smoke! Thanks again and have a great day!
Jan 25, 2009 03:56PM Jordianna wrote:
I was found to have no node involvement during surgery, but the final pathology report showed a micromet (1.5mm) to one of the three SN removed. I did opt for more nodes out (9) although my surgeon did NOT think it was necessary. She was confident that the rest would be clear. Fortunately, she was correct. But, for me I needed that peace of mind. I do not regret my decision.
I've been through chemo (ended 12/4). I started radiation and tamoxifen at the beginning of January. I'm 1/2 way through radation and after three weeks of tamox. doing just fine.
I hope that this helps. Good luck to you.
Jan 25, 2009 04:11PM Britt wrote:
Hi, Jordan -
Thanks for sharing your similar experience with me. I know, it's a tough call, and I think it is a very individual one - we all must do what we feel comfortable with - and it's important that you do not regret your decision. Wonderful that the rest of the nodes were clear!
What kind of chemo were you on? I meet with my onco this week, and I expect to be put on a chemo regime, then rads, then tamox. Although my micromets were tiny, I do want to nip them in the bud, but it was my decision not to go forward with the axillary node operation. It is also wonderful that your surgeon respected your decision. I am glad mine gave me a choice, and also respected my decision. It is really amazing how many of us have had micromets.
yes, indeed, your post helped a great deal, and thanks for your good wishes and I hope for continued success in your treatment.
Jan 25, 2009 04:33PM KathyAlex1960 wrote:
Hi everyone. I had mastec 12-29-08. Initial sentinel lymph nodes were negative. Came back 1 positive for micrometasis 3 days later. Had lymph nodes removed 1-19-09. Surgeon hoped all would be negative. 2 were positive.(out of 14) I am glad I had them removed! Peace of mind. Chemo to start in 3 to 4 weeks, once I am healed up. A whole new ball game ahead of me. Glad to have found this site. Will be checking in a couple of times a day. I am scared of the chemo. One day at a time as they say.
Jan 25, 2009 04:41PM Britt wrote:
Glad you are here! Were the other nodes that were taken out also micromets? I am curious about that. It is quite interesting that all of us have had similar yet different experiences depending upon which option we decided upon. As I mentioned earlier, I meet with my onco this week, and I am also not looking forward to chemo - but, we just have to soldier on and be Warrior Princesses! With my scenario, they found micromets in the sentinel node itself, but absolutely nothing in the other node that was taken out. Really, everyone's BC is indeed a unique and singular experience. Take care, rest well, and you are right, all we can do is live this one day at a time. Big (yet gentle - we are both still healing!) hugs, Maria
Jan 25, 2009 04:53PM peeps1111 wrote:
I also had a micromet after surgery. Since I was going to do chemo, rads and hormone therapy anyways, I did not see the point of the additional axillary surgery and although my surgeon wanted me to have it, I opted to radiate the axilla instead since I was having rads to the breast. I also was freaked out by the possibility of lymphedema.
My oncotype was 20, which meant a recurrence rate of 13%. I am in the middle of rads now and have had several sessions with a lymphedema-trained physical therapist to prevent lymphedema because radiation also increases the risk albeit less than the surgery.
When I posted a question here about that back in Aug. or Sept. to see if anyone with a micromet had additional nodes positive with followup axillary surgery, I think about 6 people answered me and all of them said no, but I am going by memory. You might want to use the search option.
Jan 25, 2009 06:28PM - edited Jan 25, 2009 06:30PM by BrittThanks, Peeps. My decision making process was just the same as yours. Of course, I don't know what my oncotype is yet (haven't even ordered it yet!) Interesting about the question you posted. I will do a search. Thanks again and continued good luck with rads. Maria
Jan 25, 2009 07:01PM KKing wrote:
I had a lumpectomy, clear margins last April. sentinel node came back with .6mm micomets and mammary node was clear. Surgeon recommended take out more which I wanted anyway just to be sure. 14 were taken out and clear.. Went through chemo which onc recommended because it did show in the lymph but I also had vascular invasion in the breast. Did radiation and am now on tamoxifen. So far so good. They don't do oncotype tests in Canada and I did think it was only for er/pr negative?? Am I wrong on that?? You have to make the decision that feels right for you for your health and for peace of mind. Let us know how it goes for you.
Jan 25, 2009 09:58PM auriga wrote:
My micromets was also 0.2mm. Right on the border with yours. My onco really was not bothered by it at all. My oncotype score though came back at 26, so I opted to do the chemo. I was really worried that maybe some cells had gone to more nodes. He recommended 4 rounds of TC. I have my second tx tomorrow morning. If you end up having chemo, so far for me it really isn't that bad.
Keep up posted on what you find out.
Jan 25, 2009 10:30PM Jasminn wrote:
I also had a .5mm micromet in my sentimal node. At the time of surgery, my BS also took 8 other nodes, all negative. Still waiting for my OncoType score, but so far, oncologist recommends 4 rounds of TC. Said if I was older, she wouldn't do chemo, but since I'm 43, she recommended it. Said to verift with the OncoType score though, and if it's really, really low, then she might change her mind to Tamox only.
Auriga - glad to hear that your chemo sin'g that bad so far. I think chemo scares me more than the bilat itself!
So far, I'm 2.5 weeks post-op and don't really have that much pain except in my arm where the lymph nodes were taken. Feels like it's on fire when anything touches it, including my jammies. I guess it's the nerve damage, and everyone says it will go away eventually. Does anyone else have this? I hate it! If it doesn't go away, I just might have to chop my arm off!
Jan 25, 2009 11:34PM KathyAlex1960 wrote:
Path report: microscopic deposits of metastatic carcinoma compatible with lobular carcinoma of the breast.....these foci range from a cluster of seven atypical cells to a 0.45 mm strand of atypical epithelial cells in subcapsular sinuses.
Micrometasis according to the surgeon. Still have caught this beast early, apparently. Seeing her tomorrow - will get more specific info then. Thanks for the hugs.......yes, still sore!!
Jan 26, 2009 04:33AM tibet wrote:
I had the same experience and first was negative and after path report came out they found 1 mm micro mets in one sentinal node. They advised me to have full node dissection. They removed in total 21 nodes and besides that one micro mets, all 20 nodes were clear.
I am on chemo right now and I don't know if I need to have rads as I had mast. also.
Jan 26, 2009 07:08AM hopefor30 wrote:
I was also in a similar situation -- but in my case, it's even more ambiguous. I had mastectomy with SNB biopsy -- was told by surgeon after surgery that she removed 2 nodes -- final pathology showed 6 nodes were removed and there were isolated tumor cells in 1 node. I freaked! My surgeon did not recommend axillary dissection because she had already removed a total of six nodes and aside from the 1 with isolated tumor cells, the others were clear.
What made my case even more confusing was that my initial tumor was a 3mm tubular -- was not suppopsed to be anything in the nodes. So, my pathology was re-looked at by several pathologist and the final concensus by the senior pathologist was that although isolated tumor cells could not be completely excluded, he favored benign displaced epithelim -- dislodged during a biopsy. That was a relief, but the ambiguity of the whole thing has always been something that has bothered me.
I had two opinions on chemo -- the first onc said she would only recommend chemo and only 4 rounds if my Oncotype was in the middle range or higher. The second onc said no chemo as well, but wanted to confirm with Oncotype score. I scored a 16, in the low range (but not as low as I would have liked) and the no chemo recommendation stayed.
I try not to second guess this and worry about it, but it does bother me sometimes. The stuff from San Antonio 2007 did confirm that isolated tumor cells are node negative, but the bottom line is that they are really not sure what the implications are. My breast surgeon told me she didn't like them -- and that the differences between isolated tumor cells, micometastasis and macrometastasis were arbitrary. Who knows? The Oncotype test did give me some piece of mind about the whole thing, but I would have preferred not to have to deal with this.
On the plus side, another onc told me that in the past, prior to SNB biopsy, there were lots of women staged as node negative who probably had micromets, but they just didn't find them. So, in a way, it's a good thing they now do. --
Good luck, Britt -- here's hoping for a low Oncotype score for you as well.
Jan 28, 2009 05:47PM Britt wrote:
Hi, everyone -
My life is beginning to resemble a situation comedy of errors - looks like I DO NOT have micromets.
My BS called today, quite upset. Said the hospital pathology report made a typographical error. I actually have 0.2cm in the sentinel node, not 0.2 mm. So she is adamant that I have the axillary node dissection, which is now scheduled for 2/10. I asked her if the other node is still clear and that they did not make a mistake with that - she assured me they did not. She is really very angry, as am I. It is almost two weeks after my surgery on 1/16 and it took them this long to discover this? Were it not for my BS calling today to do an additional follow-up, none of us would have ever known for a while. At least I already made my appt with radiation onco and medical onco for next Wed.
It could have been worse. They could have not discovered this error until it was too late.
Ladies who opted for the axillary with micromets, I salute you! At least I will have peace of mind afterwards - and most of the time the nodes they take out are negative. Just a hassle to have to deal with the lympedema threat - but there are so many of you who are doing so - so I am not alone!
Thanks for listening and thanks for sharing all of your experiences and information -
Jan 30, 2009 07:45AM Everlastpink wrote:
Wow, Maria, good luck! I'd be angry too. But like you said, at least they found out now. It sound like you are doing the right thing with the axiallary node dissection.
I am still waiting for my oncotype dx too. I hate waiting. I meet with my med onc again on 2/11 and she should have the results then, as well as a bunch of blood work she did to determine where I am menopausally-speaking, and some other things.
Looks like we are having another little "cold" front this weekend. Stay warm!
I know you will let us all know how everything goes.
Jan 30, 2009 07:55AM - edited Jan 30, 2009 07:57AM by Britt
Hi, Katherine -
Thanks for the good wishes! And 0.2cm equals 2mm, which are borderline micromets, so after a lot of thought and a long conversation with an oncological nurse as to pros and cons, I have decided to go through with it. "Cons" include massive doses the the "Big Guns" of chemo and radiation - the latter to both breasts and underarm areas - both for an extended period of time. "Pros" include a little down time with the operation, chance of nerve damage, threat of lymphedema, etc. My onco nurse friend (she is the mother of my sister's best friend in NJ and is recently retired - but did onco nursing for years and stays on top of all the latest treatments) also said there is a very good chance that the nodes they take out will be negative, since one of the two nodes they originally took out is negative.
So that's it. Still waiting to speak with BS to discuss with her. I also want to get the Oncotype test. We shall see. I know how impatient you must feel! Please keep me posted on your results.
Yes, it's very cold and damp right now - 58 and raining and very dreary and going to get even colder and rainer today and temp will plumment to mid-30s tonight. Great day to stay at home and read and watch movies!
Take care and I hope to hear from you soon - and you stay warm, also!
Jan 30, 2009 08:14AM LauraGTO wrote:
Whoa... thank goodness they discovered the boo-boo. Most likely, you will NOT have any mets to Ax Nodes - odds are in your favor. Best wishes to you. Keep us posted.
Jan 30, 2009 08:24AM Britt wrote:
Hi Laura -
Yes, thank goodness the Bad Boo-Boo wss discovered - as you have see from above, I have decided to go ahead with the surgery. Better safe than sorry. I realize the odds are in my favor, but this disease is so capricious and unpredicable I just want to be sure.
thanks so much for the good wishes - will keep everyone posted.