Node clearance, radiotherapy or nothing?

Hi all, first off, I’m not the patient I’m the husband!  Didn’t know where to post this so hope it’s OK here.


My wife was diagnosed with IDC 11th Oct, mastectomy was done on 31st Oct.  We got the lab results yesterday and we’re feeling a bit down. The surgery was successful, good margins etc.  There were two tumours, each 10mm, one grade 2 and one grade 3.  That part we were expecting as it was in line with the previous scan and biopsies.


The bit that floored us was finding 2.5mm of cancer in the sentinel node. The indications from ultrasound were that the nodes looked normal, so we were cautiously optimistic about the snetinel node result.  Looks like that optimism was misplaced.  We’re now getting to grips with the idea that we’re stage 2 rather than stage 1.


What’s really stressing us out is that the surgeon has left the next move entirely up to us - the positive node needs to be tackled and there are three possibilities; more surgery to clear all the nodes, radiotherapy to the nodes area or enter the POSNOC trial.  This trial is testing the theory that positive nodes don’t need specific treatment as the chemo will deal with them.  If we go on the trial, it would be 50-50 whether we get nodes treatment of not.


THe surgeon is saying that there is no clear evidence that any one of these approaches is  better than the others, so it’s up to us to choose!!


Here are the conflicting facts going through our minds …


more surgery would mean more delays in starting chemo, and now that we know that cancer may still be present in the nodes we really want to get chemo going asap


radiotherapy is said by some to have lower lymphoedema risk than surgery, but our surgeon said it’s fairly similar


choosing radio would mean chemo could start sooner as there would be no more surgery


surgery feels attractive in the sense that potentially cancerous nodes would be physically removed from the body


I could go on, but I think you get the general idea!


I feel we need input from oncology to help us decide what to do, but our oncology referral has only just started so we’re unlikely to see an oncologist for quite a few weeks.  Are all these delays normal? I just saw a NICE guideline about systemic therapy starting within 31 days of surgery, but I don’t imagine we’re close to achieving that.


Sorry for the long post but the last day and half has been very difficult and I’d welcome any advice.  Just hearing about other similar experiences would help - in these situations it’s tempting to think that we have been dealt an especially bad hand, where in reality there are probably loads of people having similar issues.  Thanks


Just wanted to send you and your wife a hug Nick - you are doing just the right thing in your support for her. I haven’t trodden the same path, but there are many people who have, and they will be along shortly to try and help.  This is a fantastic place for all and every kind of support, in the good and bad times, there is always someone who can help.  Wishing you good luck. xxx

Hi Nick, 


im so sorry that you and your wife find yourself here and pondering this dilemma. My own experience was very similar to your wife except I had a WLE ( lumpectomy) rather than a mastectomy.  And despite everything looking positive before surgery, I too had cancer in my sentinel node. Even the surgeon said she was shocked at this.

At my first meeting with the Oncologist I was left with a number of questions to ponder including the decision to have chemo or not as in my particular circumstances this only offered a four percent benefit and once the potential side effects were considered the net benefit was potentially less.


Anyway long story short, I did opt for chemo which then left me with the choice of entering the Posnoc trial. Initially I agreed to enter the trial. But the decision weighed very heavily in my mind. And in my experience my oncologist gave me relevant factors and benefits and risks but would not give me a steer in either direction. So I thought about this on a daily basis. And after much deliberation I decided to withdraw from the trial and have radiotherapy to my axilla. As I had a lumpectomy I was scheduled for radiotherapy anyway, so it simply meant that I would receive treatment to an additional area. And my reason for this choice? It was purely psychological. I just needed to know that I had thrown everything I could at this for my own peace of mind. That way if I get further reoccurrence or spread I will know that there was nothing further I could have done. But this is very personal choice and each individual will be different. My husband was very supportive and fully understood my decision and while he hadn’t said so previously finally admitted that he wanted me to take a belt and braces approach and do everything possible.


im now finished my chemo and start radiotherapy on Monday. Chemo wasn’t easy but it is doable. And your support to your wife will really help her get through this and make a decision that is right for you as a family. 


Good luck with whatever decision your wife makes about her treatment. I am sure that this will be right for you both. 


Im sure others will be along soon to offer you their perspective. Hopefully you will find this site am jnvaluable source if support. I’d have been lost without it! 





Hi Nick

Just like to say that it’s lovely that you are supporting your wife in this way. My circumstances are different - I had a lumpectomy in June, followed by chemo and am now having radiotherapy. I too was worried about the time delay between surgery and chemo (I think it was about 6 weeks) and had read that it should be a month. However my oncologist said that was perfectly fine. The body needs time to heal and then they need to make sure they are giving you the right treatment.

You have time to think things overI and be guided by what the consultants and the oncologists recommend.  

Best wishes

Sue x