Delayed Sentinel Node

Ask our Nurses your questions
1

I had a lumpectomy right breast 1.3 cm tumor removed plus two 1 mm microscopic areas removed, so it is multifocal. Grade 2, Invasive ductal carcinoma with lobular features, Stage 1. Oncotype score 15, Ki-67 6%, no cancer identified in lymph nodes during mri, ultrasound. EP+, HER2-, 53 years old

No sentinel node done during surgery, was offered the option to do more radiation instead of sentinel node. Now the surgeon recommends doing sentinel node because it is multifocal.

Do I need sentinel node or can I just do more radiation as originally discussed?

I would like to avoid the chance of getting lymphedema.

If I do sentinel node and there are some positive nodes, would the treatment me more radiation to the nodes?

If the nodes are negative, would it mean less radiation to the nodes?

If it is multifocal and the sentinel node is delayed, can they accurately find the sentinel mode since the lymphatic system may have changed due to the lumpectomy?

Aug. 7 was the original surgery and delayed Sentinel node scheduled for Sept. 18, so over 30 days, so should be enough time for the lymphatic system to be better?

Is there another safer alternative to the radiotracer and blue dye? Flourescent dye option?
Radiation can also cause lymphedema, so what is the best option to avoid lymphedema, sentinel node or radiation? Are both equal?

Is Proton therapy better in terms of avoiding lymphedema?

The role of hormone treatment in all this? I have hypothyroidism, high cholesterol and borderline high blood sugar. I don’t want to take drugs that cause more issues to the current condition. Also I am post menopausal.

2

Hello rosek

Thanks for your post. It’s natural to have questions about your treatment plan. Some of these can only be answered by your treatment team and we wonder if you have had the opportunity to discuss these with your breast care nurse or surgeon.

Its understandable you want to reduce the risk of developing lymphoedema. You can also order our publication about this which has more information

A delayed sentinel lymph node biopsy (SLNB) might be possible in some women with ductal carcinoma in situ (DCIS). As you have invasive cancer it’s likely that this is why the sentinel node biopsy is now being suggested. Your treatment team would be best placed to clarify this for you.

Surgery and radiotherapy can both cause lymphoedema to develop. Usually, the less lymph nodes that are removed the less likely it is that lymphoedema will develop.

If your sentinel node is negative, you will not need any further treatment to the lymph nodes. If your sentinel node biopsy is positive, depending on what the result is exactly will determine what the next steps would be. It should still be possible to identify your sentinel node after the surgery you have had.

We’re not sure what you mean by safer alternatives to the current dyes used in SLNB. It you have concerns about the dye and tracer used for a SLNB, do discuss this with your treatment team. Proton beam therapy is not used in breast cancer outside of a clinical trial setting

You mention being EP+. We wonder if this is oestrogen receptor positive. If so, then hormone therapy would be recommended to reduce the risk of your cancer coming back in the future. Its also understandable you don’t want to take any medication that may affect your other health conditions. Your treatment team will take your past and current medical history and any medication you are on into account when they plan your treatment for breast cancer.

It does sound as if it would help to talk this through with them.

We often find we can help people more by speaking to them on the phone. Do call our helpline if you would like to talk this through or have any further questions. The helpline team have time to listen, talk things through and signpost you to additional support and information if necessary. Your call will be confidential, and the number is free from UK landlines and all mobile networks.

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Best wishes

Jane

Breast Care Nurse

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