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Topic: if sentinal node cant be found-?

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

Posted on: May 13, 2019 07:37PM

HereToHelpMyMom wrote:

Hi Everyone,

Im posting on behalf of my mother. Here's her info: She is 80 and was just DX with IDC in her right breast (1.4cm, ER+/PR+, HER2-).

So we just spoke again with the surgeon, because a mastectomy is scheduled for next week. The Dr said that there is a risk, increased by my mothers age, that the sentinal nodes will not "light up" from the dye.

She said the gold-standard procedure for a young otherwise healthy person, would be to then take all of the axillary nodes. However, for an elderly person who has mobility person, she would not risk lymphedema. The complicating factor is that my mother is very mobile and in somewhat good health, but just learned she has severe osteoporosis. So my mom is somewhere in the middle of healthy/not healthy.

We cannot decide whether to be aggressive with the axillary nodes or not, in the case that a sentinal node cannot be identified. The Dr suggested we do a MODIFIED version, where she takes many nodes, but leaves the ones under her arms. Any thoughts?

Thank you!

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May 14, 2019 06:01AM Salamandra wrote:

My thoughts would be to get a second opinion from someone who has a lot of experience with patients your mother's age. Maybe a third opinion even.

I'd also want to know about the option of prophylactic radiation to the axillary nodes, which I believe has been shown to be comparable in efficacy to dissection.

I would want to ask about options for conservative treatment plans. Get the tumor out, check the genomic characteristics (oncotype). If it's aggressive, re-visit, but if it's low risk, consider that the whole picture (small HR+ tumor in a woman 80+) is likely to be not aggressive, and go with that.

TBH, I might even want to revisit the mastectomy part. Lumpectomy is much less invasive and lower recovery time than a mastectomy, and unless it's in an unusual location or there are other complicating factors, lumpectomy should be an option.

Second opinion from an NCI-designated facility! Worth the time and trouble.

Dx at 39. 1.8cm. Oncotype 9. Dx 9/19/2018, IDC, Right, 1cm, Stage IA, Grade 2, 0/3 nodes, ER+/PR+, HER2- (FISH) Surgery 10/18/2018 Lumpectomy; Lymph node removal: Sentinel Radiation Therapy 12/3/2018 Whole-breast: Breast Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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May 14, 2019 04:48PM HereToHelpMyMom wrote:

Hi Salamandra

Thanks for responding. The surgeon said that radiation on the nodes can also cause lymphedema, but Im sure a surgeon has a surgical bias! she said the gold standard was to remove all nodes when the sentinal cant be found.You make a good point though.

We are going with a mastectomy for a few reasons, although lumpectomy was an option. Although the mass is small, it's location is behind the nipple, which wouldnt be able to be conserved at all. Her breasts are quite small, so cosmetically, it's a draw. Also, my mother has dense breasts, so finding new growths can be difficult. Third, there is a second suspicious area that a biopsy found to be benign, but in my opinion, the biopsy itself may have had an inadequate tissue sample, and was rushed. We basically want to avoid another surgery, if possible. 2 surgeons said they leaned toward mastectomy, but agreed it wasnt mandatory . Thanks for the thoughtful and detailed response. A lot to think about.

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May 14, 2019 05:28PM Salamandra wrote:

Best of luck! Heart

Dx at 39. 1.8cm. Oncotype 9. Dx 9/19/2018, IDC, Right, 1cm, Stage IA, Grade 2, 0/3 nodes, ER+/PR+, HER2- (FISH) Surgery 10/18/2018 Lumpectomy; Lymph node removal: Sentinel Radiation Therapy 12/3/2018 Whole-breast: Breast Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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May 15, 2019 01:17PM HereToHelpMyMom wrote:

thanks :-) I thought more about what you said. How you mentioned looking at the tumor characteristics and then deciding how to proceed with lymph nodes. I'm also troubled by not ever KNOWING what is or isnt in those nodes. Once they are out, we could properly stage it, but at what cost? Very difficult choices.

Thank you again and I wish you the best.

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