Hi all, I recently had my WLE and SLNB results. Im looking at a cavity shave and and Axillary clearance after unclear margins and 4mm of cancer in the sentinel node. Surgery in 1.5 weeks.
My question is - how many positive lymph nodes before they suggest chemo? I have grade 2 IDC with some dcis and er+ pr+ her2-. No oncotype is being done as I’m premenopausal and I have a positive node.
Dr said it would be a possibility but didnt like to speculate until axillary clearance results come in. Obviously I have to wait but results could be 7 weeks away and I need to prepare mentally.
Did anyone else have 4mm of cancer in lymph node but the rest were clear?
Hi Blue Satsuma I had clear margins when I had my lumpectomy but with one large positive node - I wasnt told the exact size. I then had full node clearance of 30 nodes - all were clear. However I still had chemotherapy because my tumour was grade 3. If you do have to have chemo just to reassure you I found it to be nowhere near as bad as I had thought- it was very doable.
Thanks @Bookie. That sounds positive about the chemo. I have 4mm in the node they removed which I believe counts as macrometastasis. Hopefully, like you, my other nodes will be clear. Just wondering whether I’d even be offered chemo with just one positive node. Thanks for your reply. Hope you are feeling well now x
I think in the UK many teams use the PREDICT tool, you can access it yourself on the internet. Ideally your oncologist should sit and go through it with you.
You enter all the tumour details and your details and it generates the improvement in outcomes with surgery, +/- chemo +/- radiotherapy.
I think if the improvement is less than 3% then they don’t offer chemotherapy
Every case is individual however.
It’s tricky as I very much wanted everything !but equally wasn’t aware of the long term possible effects of chemo.
At the end of the day for me I’m having chemotherapy and radiotherapy because the improvement was 8%, and the cancer triple neg.
But that’s how lots of teams decide.
Hi, I had 2/3 positive lymph nodes following SLNB. Following node clearance a further 17 were removed and they were all clear. I entered the Optima trial and was allocated to chemotherapy. I don’t know if I was in the control arm and received chemo or if my cancer was tested, found to be high risk and I received chemo. Hopefully this trial will help women in the future.
I hope the rest of your nodes are clear.
Hi @Vibby. I tried the predict tool but i dontbknow the ki67 part. But with 1 node it was a 3% improvement. I guess I’ll have to wait until the axillary clearance results. Maybe I’ll be lucky and it’ll just be that 1 node. Fingers crossed. Thanks for the advice x
Yes, you do need a lot of the final pathology details to fill it in completely. And although I totally agree that it should be in the public domain, it is best practice that your oncologist or surgeon goes through it with you x
I had 1 of 5 sentinel nodes, and 2 micro nodes in the axillary clearence. I kind of got the impression that after that 1st node chemotherapy was going to be suggested. It was, and I did 6 rounds. Wishing you all the best!
Hi @Cali. Thank you. I felt from my results appointment that chemo was on the cards but my husband said that he didn’t get that impression. I will ask at my surgery if the results will be 6 weeks like last time. Thanks for your reply and hope things are going well. X
Hi Bluesatsuma. I had a lumpectomy and full axillary clearance (I already knew I had at least one positive node) in 2017. Hormone positive breast cancer. I had 2 nodes positive plus 2 nodes micromets (visible under microscope). I consented to chemo and joined the Optima trial. I was assigned to the group that had their tumour tested and the results was no chemo needed and I went straight to radiotherapy. Michele x
Hi @bluesatsuma … i had 3.2 % …my onc said anything over 3% would indicate chemo in my case…but it is so individual…i was actaully glad …the belt and braces approach to throw everything at it gave me ( some ) piece of mind… because as we know , cancer can travel via the blood not just the nodes …and then we dont know for years to come …i think also its important not to put everything on statistics …because we are all so undividual and although your stats may be 3% …in reality they vould be 1% or 98% …thing is we just dont know…its all so hard…and i wish you well and whatever decision you come to is the very right for you …take good care
Using Predict my percentage increase if I had chemo was 10-11%. I was really worried and upset, but now I can say that while not fun, it was not as bad as I had been expecting. And now 5 months after it finished I’m doing pretty good. Hope you will be too soon.
Thank you @Cali, @cat15 and @Optimisticmz. Good to hear that chemo isn’t needed for every node positive patient and also that if I do have it, tht it is doable.
I think it is uncertainty that gets me down. I can deal with it once I know for sure. Hope youre all doing great x
It’s such a hard time waiting isn’t it! I have recently had 2 x tumours removed 1 x 21mm Invasive lobular and 1x 18mm ductual I also had a full node clearance 20 lymph nodes removed but only one positive for cancer both cancers are hormonal and are HERR2 negative. I’ve been told I’m in a grey area for chemo due to having the two different types of cancer and the lymph nodes involved. They have suggested that I have a pro signa test to see if chemo will be needed. Apparently it gives you a rate of your specific cancer returning. I am 50 and currently not menopausal. I’m am however slightly worried as a lot of this data is based in post menopausal women. We will wait and see! Let me know how you get on x
Hi @hc1973. This is my worry too. Im premenopausal but now my lymph nodes are involved, I know the subject of chemo is on the cards. Dr said it depended on the axillary clearance but was more likely as I’m younger and my sentinel node was a 4mm macrometastasis. She played down the size saying it doesn’t mean more are imvolved, but I know the size is important along with the number of nodes. I’ll wait and see but I just feel this huge cloud hovering over me. Some storms pass I guess. Hoping for blue skies. Good luck with your prosigna test. Let me know how you get on. X
Knowing the plan I think will make us all feel better, it’s the uncertainty that becomes stressful! I’ve decided to try and think that I’m going to have to have chemo so that I can deal with it. Then if the results say otherwise then it’s a bonus! I wasn’t told what size lymph node it was. Mine showed up on an ultrasound and she said was big and juicy looking! - nice! That’s why I had the biopsie before surgery and it was decided to do the node clearance. I’m glad they worked that out before and that I didn’t have to go back in for it. I hope you are OK and let’s keep each other updated Helen x
@hc1973 me too- I’m also preparing for chemo aa if it doesnt get on my plan, it will be super news. Fingers crossed that we both over prepare for that news and that ot doesnt happen. I’ll keep you posted x
Hi all
Just joining this thread as I am facing a similar dilemma. Started out with 2 very small tumours (10 & 5mm, (stringly ER+, HER2-) found via ultrasound. Then discovered I was BRAC2 positive so had a bilateral mastectomy, however the expected plan was still just hormone treatment and possibly radiotherapy, as was thought node involvement was unlikley, and BRAC not thought to increase recurrence risk. Then my histology showed 3 tumours, largest 2cm, plus large area of DCIS, and 2/9 positive nodes. From this point on I was told chemo was very likely - I was shocked at first but over time began to get used to the possibility. I had an axillary clearance which found just micro metastasis in 1 node, which I was told they basically consider ‘no further disease’ (plus all the nodes are now gone anyway!).
While awaiting my first oncology appointment I did a lot of research and felt it was likely chemo would be suggested, especially as I am 42 and pre-menopausal. Finally had my 1st oncology appointment today, where my doctor said I am borderline for chemo and offered me the OPTIMA trial - where your tumour is genomically tested and if low risk you are randomised into chemo or no chemo (if high risk you definitely get chemo). It was great to finally discuss it all with the oncologist, who was lovely, but I now really don’t know what to do! I too had read the hypothesis it could be the ovarian supression that is sometimes a side effect of chemo and/or given following chemo rather than the chemo itself that reduces recurrence risk for some hormone positive breast cancers, and having read about the trial it seems they are quite confident that tumours that are low risk may not benefit much from chemo - so the risks of chemo could outweigh the benefits. I am now wondering if I should just pay for the genomic test myself, because if I am low risk I can then choose not to have chemo (whereas via the trial I could get ransomised the chemo even if low risk). I know it’s super expensive so this may not be possible but just interested in what you guys did in the end @bluesatsuma@hc1973 xxx
@sap1981 I’ve just replied to you in another thread, but should have read this one first! Sorry you’re in this situation. I haven’t gone so far on journey yet. Only had my axillary clearance yesterday so 6 weeks until results. I’m fully expecting more lymph nodes to have cancer. I seem to have gone against the odds at every other stage so far. If I’m offered chemo I will take it but only if above 3% I think. X