Sentinal node or take em all

lynne502

I was diagnosed with stage III invasive ductal carcinoma in April '07 (I'm 44 years old). I began chemo two weeks later - 4 A/C and 12 Taxol and Herceptin (I still have 4 more to go). Surgery is scheduled for October. I'm planning on having a bilateral mastectomy with (maybe) reconstruction - I'm still on the fence about that. My surgeon wants to do a sentinal node biopsy - since chemo will be done he just wants to take a few lymph nodes. My oncologist, however, wants to take alot of lymph nodes out. If I've already had chemo, what difference does it make whether to take a few lymph nodes or a lot? And for that matter, if they find that cancer had once been in the lymph nodes, what does that mean for further treatment? I'll be picking up with the Herceptin again after surgery for I don't know how long.

chenheart

Tough call, for sure! Do your Drs. communicate with one another so that they are aware that they are each recommending a different course?
I had the "take em all out" method, and had 3 of 15 positive nodes. On the other hand, I had the surgery BEFORE the TAC chemo cocktail, so the point may be moot. I know this isn't much of a response to yur question, is it??? There are different reasons a physician would recommend one biopsy type over another~the multiple removal method is pretty tried and true. I suggest you have a serious discussion with both of your doctors and make sure everyone is on the same page, as it were. Bottom line is, you want the most agressive treatment plan and full confidence in that plan! We are a growing, and strong family of Survivors~welcome to our ranks!
Claudia

Kitty3571

I agree that the most agressive approach is the best - You also have to take your health decisions into your own hands and make sure YOU are getting the best possible treatment choices - Yes, listen to your doctors, of course but also trust your decisions from within and hopefully that will help - In the end I found that even while hitting this beast with all I could, it could still return. I assume you are Her2 because you mentioned Herceptin. That means it's aggressive. I also did the A/C, Taxol & 52 treatments of Herceptin along with 36 of Rads - Unless you experience mets, that is the longest you can remain on Herceptin (thank GOD for Herceptin) As least that is what my ONC told me - Couldn't finish all the Taxol though due to some problems...Plus if I had to do it all over again I might have opted for the mastecomy instead of just a lumpectomy. Now as I just finished treatment and had my port removed last week, I am now falling into the "worrying if it will come back catagory"!!! They took only 5 nodes from me during my sentinal node biopsy - It was very tender for a long time. All will get better with time and I will continue to have hope (that always helps) I wish you the best of luck with the rest of your treatments and will pray that your surgery, whatever you decide will go well
Kitty

newboobs

I had the sentinel node biopsy- where they inject a blue dye into the area where my tumor was. Then they use a special "black light" to see if the fluid flows to any nodes. If nodes light up, they remove them. I'm not well versed on all the technical info, but I hope this helps. All of my nodes didn't light up, but my surgeon took 9 nodes because they were swollen, biopsy showed they were negative.

Hugs lynne!

seof

seof here, I will be asking by Doctors a similar question in about a month. I have completed 8 of 12 weekly chemo treatments after which they will do all the tests over again and decide the next step...surgery, then chemo, then radiation....more chemo, then surgery, then radiation.....or what. Nodes looked suspicious in ultrasound before chemo was started, and the tissue in the area is enlarged, so chances are good that they have been involved. chemo is shrinking everything, so we will see what happens. The main thing I would say in your case is that you should be persistent in expecting the Doctors to communicate clearly with each other and with you. If you are getting conflicting messages, it is that much harder to be confident in the treatment you recieve. Insist that they explain themselves to you until you understand and feel as comfortable as possible with the decision, or consider finding a team that works better together.

I'll get off my soap box now, sorry. Keep on keeping on, and remember that you are in good company...you are a survivor!
seof

inkblot

Hey lynne,

I had Sentinel Node Bx. Healed quickly with no complications. (Yoga definitely helped with regaining range of motion)

It is my understanding that the advantage of SLND
is that it can spare more nodes while also reducing risk of lympedema. In my case, (lumpectomy) both a dye and radioactive tracer were injected prior to surgery. My surgeon used the light as well as a different device to trace the radioactive agent. Three nodes lit up and were removed for immediate preliminary pathology. My surgeon got the info back from the lab (while I was still under)that none of the 3 nodes showed evidence of cancer and so he didn't remove any additional nodes. I was pleased to learn that upon waking up from surgery. Not the end of the story however.

My nodes were pathologically investigated later, using a more sophisticated test, different from the preliminary tests. One of the 3 nodes taken (in my case the node determined to be the actual Sentinel Node) had precisely 7 micro (immature) cancer cells. I saw the slides and could actually count them. The other 2 nodes taken were clean and I remained happy with my decision to have SLND, as did my surgeon. (You have the right to have your path slides sent to any other examining facility you choose...or you can pick them up and take them with you, for 2nd opinions)

When I was going through second opinions, (re adjunctive treatment, as I'd already had surgery) the surgeon I consulted with said that she would have wanted to take more nodes, due to those 7 micro cells, even though it would have required an additional surgery. I, however, would not have wanted more nodes removed on that basis alone, due on my research, talk with other surgeons and my gut feeling) I saw a team at one of the 2nd opinion facilities (surgeon, radiation onc. and medial onc.) The medical onc there was also more aggressive-minded and his advice was more aggressive chemo, with more rounds and even a trial! I was Stage 1, one cm tumor. That felt way over the top to me. Just proves that not all great minds really do think alike! LOL Education, tempered with a bit of caution and taking a bit of time to get the info you need, is important. I ultimately had 2 second opinions before feeling prepared to make my best decisions.

If you've talked with your surgeon in detail about nodes, then you may already know that the nodes are inside what looks like a concave sponge. Axillary nodes are quite small. I know because my surgeon showed me some nodes. Some are embedded deeply into the dense, spongy tissue and naturally, the trauma of removing them can present more risk of nerve damage and future pain, etc.. Removing the entire sponge they are in, is simpler than poking about to locate and remove a few. For the surgeon, that is. Still, many women who have practically all their nodes removed, don't experience any complications.

Decision making about this can seem a bit over-whelming but my advice is in line with what the other ladies here have recommend: Research and get all the solid info you can prior to surgery. I strongly recommend at least one 2nd opinion. Then, make whatever decision feels most right and comfortable for you. We are all different. Our anatomy is different and our gut feelings are different. It's important to feel that we've made the most informed and best decisions for ourselves and have no regrets.

Re your question on what difference it makes anyway, if you've already had chemo, prior to surgery: I have no idea. My chemo was post surgery. I would venture to guess however, that chemo pre-surgery would be an entirely different scenario and that is an important question which should be addressed with your doctor(s). Getting answers to such questions is paramount to being able to make your most informed decisions. It is our doctors responsibility to answer all of our questions to the best of their ability. If they don't want to be bothered or cannot, then that's probably a red flag. Don't hesitate to see your doc, armed with your questions written down. Jot down the answers as you go. Or if your doc is comfortable with it, take a voice recorder along. Whatever works best, but don't make decisions without having your questions answered to your satisfaction and in language that you can understand. Anything less from a doctor is not, in my humble opinion, a good level of patient care.

Warm hugs and good wishes for getting the chemo behind you and having an uncomplicated, smooth surgery! You've found a good place for sharing information, concerns and issues. I hope that it will be as helpful you as it has been to myself and so many others.

Love, light & laughter,
Ink