mastectomy/ rads with only 2 nodes involved

I seem to have noted that several ladies on here have said that they are having/or had radiotherapy, folowing a mastectomy, when less than 4 nodes are involved.
I was told by onc and con that as I only had 2 nodes inolved, I would not need rads, as i had undergone a mastectomy.

If ladies have had rads with mastectomy and less than 4 nodes involved, why was that? Was it because you had a rather large tumour? Or was it once again a case of different authorities spending in different ways?

I am triple neg so do have limited treatment options. However, tumour was 2.7cm max

thankyou
Julia

Hi Julia,

I don’t know why your team has decided on this particular course of treatment for you.

I had ONE node involved, and three tiny tumours (which it took an MRI scan to find) in the breast itself. These tumours were 6.5 mm, 3.5 mm and 3 mm. Two were invasive ductal and one was in situ. One was oestrogen positive and the other HER2 positive. In fact the only sign I had bc at all was that I noticed a small lump in my armpit which turned out, at biopsy, to be an enlarged lymph node containing bc cells. This was the only node of 17 removed that was found to be involved.

I had axillary clearance, mastectomy, 4 x FEC and am on the 2nd of 4 Taxotere. This is to be followed by rads (to the chest wall I think), a year of Herceptin and 5 of Arimidex.

I must admit to having been suprised that I am receiving SO MUCH treatment when I only had a single node involved!

xx

I had a mastectomy, 3 nodes affected and am now having rads. Had chemo up front.

My tumor measured 5cm… I was under the impression that it was an extra security against spread having had the op. Mine is invasive lobular cancer.

Helen
xx

Hi Justme
Wow! Firing it all at you aren’t they. Your total mass measured just 13mm. Tiny, compared to lots of us here. Also, you are having 4 FEC + 4 TAX. Alot of us here are getting 3FEC + 3 TAX.

Although you are having a tough regime, you must feel secretly assured that you are not missing out on anything, rather the contrary. I am being treated in Essex/ London area and have no real reason to suspect we are behind the times, but can’t help wondering…Is it enough?

Jules

Hi Positvie thinker

I had 25 rads due to the size of my tumour even though I didnt have node involvement, I had 6 FEC and mastectomy…I was just told it was a precaution…

Pam
XXX

Hello Jules

I had 6 TAC chemo, am having a Masectomy and will then have 25 Rads because I had three 5cm tumours in total. dont know if this is because of where I live, Cornwall.

val

Hi Positive thinker

I had a 4cm tumour and one node involved out of ten removed in summer 2005. I had mastectomy plus EPI CMF chemo but no rads. I discussed with onc who said that radiotherapy would not add to benefit. There was a large benefit from chemo and from ongoing hormone therapy (tamoxifen) afterwards. I think it also depends on grade and stage - mine was grade 2 stage 2.

Best wishes

k

hi kmans,
i agree there, i think it depends a lot on the grade/ stage of the cancer.
I was dx with grade 2/3 lobular + IBC and although the ‘lump’ is just 1.8cm with no lymph nodes they are throwing everything at it. 6 x TAC neo-adjunct chemo, then mastectomy, then rads - don’t know yet what other treatment i may get.
I do know that everyone I’ve met are on different regimes, even with the same surgeon and oncologist, so I assume that the MDT meetings mean that treatment is tailored to us as individuals.

I had a whole discussion with the doc on the subject.
My tumor was 35 mm, full cleareance (8 nodes removed), one only positive. ER+, H+ weakly. The onc said she thought I would not need rads, but she wanted to discuss it with collegues to have more cases. It appears that the guidelines if less than 4 nodes are positive are mixed: sometimes they go by age, sometimes they let us decide. I read a whole bunch of articles, and it looks that rads improve the survival (minimally) to the BC, but lower survival in general… because rads to the chest seems to potentially weakens other systems. SO.

Anyway, my doc after review came back saying that all her collegues suggest I skip the rads. WOOPEE.

i had a 80mm lump, don’t no at this stage about my my nodes as they will be doing a full node clearance with my bilateral mastectomy. i’ve had 4 x FE and 4 x Taxol and to have radiotheropy after surgery/reconstruction. i have mixed feelings at the moment as upto last week i was to have the reconstruction 6 - 12 months after surgery using a strecher/implants, and now they have said that they want to do recon at the time of surgery using the back skin and muscle as i won’t be able to have implants due to the radiotherapy.

i have stayed positive all the way but i’m getting a bit concerned now as to what i will look like with all the scaring

Any way i see the nurse agin on thursday so maybe she will be able to put some light on things for me.

Karen x

Dear Positivethinker

Where abouts in Essex/London are you being treated? I am also in this area and have had wonderful treatment, just curious where you are being treated. I too was down to have chemo but through personal circumstances at home had Zoladex injections instead.

Hope you are all coping well.

Love K

I had a 2.7cm grade three tumour, with 3/16 nodes. I am ER+ and HER2 borderline. I have had mastectomy, 4 x FEC & 4 x Tax, then rads, tamoxifen & herceptin. My onc says that age comes into it. The younger you are, the more they throw at you - I was 44 at dx. I had a friend, 45 at dx, who had no node involvement but she still had chemo & rads.

As for the 4FEC & 4Tax or 3FEC & 3Tax, my hospital changed on June 1 from 4 to 3, but I understand that the dosage is higher with 3, so the overall dosage stays the same.

RR
xx

Does this mean that when you are older they just don’t bother or that they think you won’t be able to take it?

All I can say is I am aged 57 and also 10 years post menopause, and they are still throwing the lot at me (see my previous post on this thread)!

I am going to question my oncologist about whether or not rads would improve my prognosis by much, as I am concerned about damage to ribs/lungs etc. Also I have not made up my mind as to resconstructive surgery, and as I am very slim, I think my only option may be with the skin stretching and implant, which having rads may compromise.

Another thing to take into consideration re the necessity of radiation therapy could be how close to the chest wall the tumours were.

By the way, I was told that as only one lymph gland was involved, I wouldn’t need the lymphs above the collarbone irradiated.

xx

I am glad I started this thread!
Reading the replies it is not cut & dried as it is when there is either a large tumour or 4 nodes involved. Definately down to onc&con at their meetings. I had heard it depended on how close to chest wall is was too.

“crehensal” it doesn’t mean that if you are older they botther less, it just means that when you are younger it is likely to be more aggressive, so need to throw more at it.

“kelly100”. I am being treated at Queens.

I love my onc and con and have no reason to think that they dont judge individually. My consultant said that the risk of lymphodema and rib damage, potentially outweighed the benefit, but left it up to onc. The onc said it would not be usual to do rads on me but would talk to me about the ne “SUPREMO” trial, where they want to do a proper study to see if the benefits outweigh the risks, not sure how long they have been recruiting.

Personally, I dont want the rads as I have an implant from recon, but would be prepared to take the risk IF there was a definate benefit.

BTW. I sneaked a look at my notes and saw mt con wrote letter to GP saying"it is only 2.7cm and only 2 nodes involved". I really like the"only" part of it, especially as when con see me he would never use that word, far from it!

Jules

I was told if I had a mastectomy and lymph node sampling (4 taken and tested), I might avoid further treatment. Sadly this wasn’t the case. I needed an axillary clearance (total 3 out 7 nodes pos), apparently they could only find 7 nodes. I then had 6x fec, and 15 rads. Now 5 yrs of arimidex and bonefos.

Perhaps it’s not the quantity of nodes found but the percentage effected?

I would ask again for your team to be more specific why you personally wont be offered further treatment. BC can vary vastly between individuals and so you need to get them to focus on you and your prognosis, it is likely it is very different from some of us on here.

Irene

Hi all

It is all very confusing - I am 43 with a grade 3 IDC of 2cm and another of just 3mm with 12 nodes removed and only 1 node affected and it is hormone receptive. I was told I didn’t need rads because I have had a mastectomy and immediate recon. (still waiting for results from my mastectomy) I was told I would need chemo (not sure yet which one) because of my age and that it is hormone receptive and I haven’t gone through the menopause yet and because it is an aggressive little b****r will then have 5 years of tamoxifen. Hope I don’t need rads now as I have a small implant in with my LD flap recon - not sure if you can have rads with an implant. I suppose we should all be pleased that they tailor our treatment to our individual diagnosis - hope that costs never come into it (postcode stuff that you hear about).

Oh the joys!!!

Love Lenise XXX

Irene
I know the percentage of my node involvement. the first node was full of cancer. The second had a microscipic amount (4%). The surgeon felt confident he had taken enough tissue surrounding these to cater for overspill. He removed 9 altogether. i have read a post here once where a lady had scatterings in 4 and therfore had rads because she was in the 4 node involved category, so I think it is quantity involved as opposed to quantity per node. I rather think and hope that as an otherwise very healthy girl, the nodes did their job by catching the cance and filling the net completely before moving to the next one, but I may just be being optimistic.

Lenise
You can have rads with an implant, after all your health means more to them than your implant, but my surgeon said all patients with the implants eventually get a capsular contracture, even after 2 years, but it is easily rectified as a day op.
I am so pleased with my implant that I secret hope I do not have to have rads, but health first, I suppose. As i mentioned before like you it appears won’t be having it.

Love jules

Hi Positive Thinker

I am 53 my dx was dcis, had simple masectomy with snb results showed no node involvment, but consulatant said that as the was pre-cancerous but went very close to the chest muscle that I am to have five weeks of rads just to be on the safe side that he got everything. I live in the Exeter area. I opted not to have a reconstruction as I am very skinny although I was offered immediate reconstruction.

Heather

To go back to my previous posts on here, I spoke to my oncologist on Wednesday just prior to my 3rd out of 4 Taxotere, and asked why I was getting so much treatment (inc rads) when my 2 tumours were small with only 1 lymph affected.

He said that as my cancer was caught early (stages 1 and 2), I have a very good chance of the treatment being curative (no guarantees though as usual), and that is his aim.

I did question as to if it DID return would it reduce my options for further treatment…he said that I couldn’t have rads in the same area, but there are plenty of other options on the chemo/drug front if that situation should occur.

I actually think that it is more to do with your particular oncologist’s and your multi disciplinary team’s views and methods of treating your particular form of the disease that affects your treatment rather than postcode lotteries.

xxx