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Micro-metastases in sentinal lymph node.

18 REPLIES 18
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Re: Micro-metastases in sentinal lymph node.

Thanks for the info, Poemsgalore. My problem is that I haven't seen an oncologist yet, so if I asked to see one it would delay proceedings even more. I hadn't heard that about radiotherapy so that's another question on my list!
I know I don't have to have the ANC, but if I refuse it without any stats to go on I'll always be worrying. And if I do have it and the nodes are clear, I'll regret that too - can't win!
Annie x
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Re: Micro-metastases in sentinal lymph node.

Annie, I always understood that if you had radiotherapy that would sterilise the area and that an ANC would not be necessary. That was what I was told by my team. Plus, they can't force you to have any treatment you don't want, only advise you as to what they think is best. I've already explained my position on whether to have rads or anc, or any of them, in another thread. Maybe you should ask what your chances of a recurrence are before making the decision. In my case, less than 20% in my chest and 50% in my lymph nodes. I'm not having rads, and won't have ANC unless it becomes necessary.
Good luck
Poemsgalore xx
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Re: Micro-metastases in sentinal lymph node.

Hi patty, I did what you suggested and had a long chat with one of the BC nurses, who went through the pathology report with me and gave me much more information than the consultant did last week. I now know the meaning of 'non-vascular invasion', for example!
There didn't seem to be any mention of the size of the cancer cells found in the two nodes they removed, so I'm none the wiser there, and it seems you don't get to see an Oncologist in this area until after all surgeries have been performed. The lovely surgeon who did my mx is back next week though, and the BC nurse said she could arrange for me to have a chat with him before my op date. so I'm very glad I phoned her.
Thank you for your sound advice, patty!
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Re: Micro-metastases in sentinal lymph node.

Hi Annie, you you could ring your breast care nurse and ask to see the oncologist before your op. My hospital gave me this option as my op is on 20th. I know everyone's cancer is individual to them, so it may be they are giving the best advice for you, but if you have any questions the BC nurse should be able to reassure you. Hope things get clearer for you, and get on that phone today !! X
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Re: Micro-metastases in sentinal lymph node.

Thanks for replying, pattyp, the problem is I haven't even seen an oncologist yet, just the consultant who did my op and, for the results, his colleague (as original consultant on holiday). That's the problem - I don't know who to ask, and I'm booked in for the op on the 28th June
Thanks for the hugs, much appreciated!
Annie
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Re: Micro-metastases in sentinal lymph node.

Hi Annie62, I think it maybe depends on if the sentinal nodes were found to have micro or macro mets, mine were micro but if they're macro I think you have to have the clearance, anyway that's my understanding of it, I maybe wrong, being new to this nightmare rollercoaster we seem to have been put on!!! I'm sure the lovely ladies on here will put me right. Maybe ask for chat with your oncologist as soon as poss to get things clear. Hope you can get some answers, sending you virtual hugs, partly x
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Re: Micro-metastases in sentinal lymph node.

Thank you, Jo - I think I'm reluctant to have the ANC procedure because of the probable side-effects. Wouldn't chemo kill off any cells in my remaining nodes? It's all very confusing....
Annid
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Re: Micro-metastases in sentinal lymph node.

Hi Annie62

Welcome to the BCC discussion forums, you've come to the right place for some good, honest support from the many informed users of this site.

Could I suggest that you give our helpline team a ring, calls are free, 0808 800 6000 lines open Mon-Fri 9-5 and Sat 10-2, they're here to support you through this.

Take care,

Jo, Facilitator

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Re: Micro-metastases in sentinal lymph node.

Hello, I am new here too and I would like some advice!
I was diagnosed with breast cancer on 14th May, had mx and sentinel node removal on 31st May and had the results last Wednesday. The consultant was not the one who did my surgery as he's on holiday, and all he told me was that cancer cells had been found in the two nodes they removed, so I'd have to have ANC plus RADS and Chemo.
I had felt so well after the mx - far better than I had for months before - and recovered so quickly from the surgery that I was driving after 10 days. I'd conviced myself that the cancer was all gone, and it hit me so hard that the nodes were affected that I didn't think to ask whether ANC was really necessary - no mention was made of how many cells etc. were found in the nodes.
I have to go for a CT and bone scan next week and am now sure they'll find all sorts of secondaries! I really need to talk to someone about the ANC, but my BCN just said it was standard procedure.....what would you suggest, please? I haven't seen an Onc Consultant yet.
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Re: Micro-metastases in sentinal lymph node.

Thank you to all you lovely ladies for your support, I have (finally) made up my mind and am keeping my nodes intact! I shall just get the rest of my lump removed. I am going with this to avoid any damage to my arm and after all, my oncologist is the expert and even said if it was his wife he wouldn't my recommend clearance of nodes in the same situation as me. So there we go, decision made and I feel relieved and actually want the op over with to go onto the next stage of treatment. Roll on 20th June!!
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Re: Micro-metastases in sentinal lymph node.

Hi Pattyp
In the same camp as PG above, I can't tell you which option to choose but I can tell you what happened to me.
Was dx in May 2006 whilst 30 weeks pregnant. ER- PR+, Her2+ and Grade 3. Just before surgery the surgeon told me that if any traces of cancer were found in the nodes then I would have to have a second op to remove them. After surgery I was told I had 2 micromets in my sentinel node. It was the surgeon's decision not to carry out an ANC, I really didn't have a say in it to be honest (whether that had anything to do with being pregnant at the time ie another quicky surgery I don't know as I have no medical background) so I had chemo and then rads followed by Herceptin and Tamoxifen. His advice completely contradicted what he had said on dx but I put my faith and life in his hands and trusted him.
At the time I was scouring the internet looking for information and came across various trials. I thought there would have been more advances/information available 7 years down the line though and I am amazed that this still appears to be a grey area.
I had no choice but to have chemo being Grade 3 but I remember my onc telling me that some oncs treat micromets as node negative whereas others will err on the side of caution and treat as node positive. Mine decided on the cautious approach and treated me as node positive which then enabled me to have Taxotere as part of my chemo protocol - not sure if it has changed since the passage of time but in 2006 Tax was only given if you were node positive.
If you dig about in the archives on this site I am sure you will come across various threads on micromets - some of the posts from me probably! I hope some of the information from other users helps in your decision making. Best wishes and keep us posted on how you are getting on. Love xxx

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Re: Micro-metastases in sentinal lymph node.

Hi, Can't help with your decision, but can tell you my circumstances.

I had 3cm tumour, grade 3, 100% ER positive, 70% PR positive, Stage 2b. Three nodes removed, one with cancer cells, but they didn't say how many. Nobody suggested that I had ANC, but I have had chemo and now know that I had vascular invasion too. I have refused RADS due to a lung disease and radiographer agreed it was best not to have rads. She told me I had a less than 20% risk of recurrence in chest (I had mx) and 50% chance in nodes. If that happens, then I would have to have ANC. But I'm not considering it until it becomes necessary. As Cybele says, lymphoedema is lifelong and can be an awful thing to suffer.

good luck with your decision. PG xx
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Re: Micro-metastases in sentinal lymph node.

Thanks for your replies ladies. I am still in a quandary, the oncologist did say I would have radiotherapy and hormone treatment, so I'm thinking that this will kill any that's left. He did say I would not need chemo, it seems that different hospitals offer differing advice. Lorry lordy lotus I still can't decide, aaarrgghh!!!!fc
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Re: Micro-metastases in sentinal lymph node.

I had a 2.8mm tumour, grade II IDC, and after the WLE they found one micromet in the sentinel lymph node. The surgeon said he wouldn't be happy if I didn't have further treatment of some kind, and was given the choice of EITHER chemo OR full node clearance OR radiotherapy to the armpit. His recommendation was the chemo, but I was give nthe choice.

After much agonising I chose chemo as the least bad option, because I am a swimmer and was very afraid of lymphoedema, which is a life-long risk, as opposed to the short term unpleasantness of chemo.

The other thing that convinced me was a study my surgeon showed me from Holland, on women with early stage invasive cancer who had micromets, where they compared those who had chemo to those who didn't - the 5 year disease free survival rate was signficantly higher for the women who had chemo. It was , however, only one study - they are still in the early days of research on micromets.

The more I read about lympoedema, the happier I am that I didn't go for the node clearance. There are no guarantees about the cancer not coming back, micromets or no micromets, whatever the size of tumour and grade of cancer.

It's a very difficult decision, and you can only do what feels right for you - good luck and best wishes xxx
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Re: Micro-metastases in sentinal lymph node.

I had one micromet in one lymph node. I was told that 2 micro mets or less were deemed non involvement. A friend in America her surgeon said that when I had all nodes removed it was a radical decision as it seems they have stats to show total clearance is not necessary. I had full clearance, had mx and chemo and now rads, I feel it's better to be safe than sorry. My surgeon said in years ahead they might not go with full clearance. I just wouldn't like to make a medical choice when I'm not medically equipped to be sure. I'm concerned that some women are left with personal choice and then question if they have made the right choice, we must be lead by these professionals. Secondly, I was always lead to believe that any lymph node involvement was a concern, as any pesky cell would have been in the bloodstream and then travel.... It's a minefield all this worry...
Hope you get to make the right decision for you
Maggie x
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Re: Micro-metastases in sentinal lymph node.

Hi Patty
i had a small grade 2 idc, highly ER+ 8/8, a micro metastasis was found on one node. My surgeon advised that research was taking place to assess the benefits and risks of a full clearance as opposed to not, he also told me about a trial in America for the same thing but they couldn't get enough women to participate as they were not prepared to take the risk. He said with a full clearance, although you are at risk of lymphodema, they know that it works for 10, 20, 30 years (they stop counting after that he said), at this stage they do not know the risks or benefit for leaving them in, and will be a few years until they do. I decided to have the full clearance, it's been nearly 18 months now and I'm fine. I also had chemo and radio.
Let us know what you decide.
Take care
Lydia x

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Re: Micro-metastases in sentinal lymph node.

Hi Pattyp

I was in much the same position although my surgeon said it was standard practice to do an ANC if the SNB showed lymph nodes affected. He did say that Sloane Kettering were doing research that showed that full clearance was not necessary. I had the ANC and have developed lymphoedema (the double procedure increases the risk to about 40%, I believe. Are you having chemotherapy? I wanted to avoid chemo so chose the ANC.
Good luck with deciding - ask your consultants lots of questions!
Moya xx

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Re: Micro-metastases in sentinal lymph node.

Hi Pattyp

Whilst you await replies please feel free to call our helpline to talk your concerns over, lines are open 9-5 weekdays and 10-2 Saturdays on 0808 800 6000

Take care

Lucy

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Micro-metastases in sentinal lymph node.

Hi, I had my lumpectomy and SNB 3 weeks ago, and have been told I need further surgery as the margins were not clear. However they also found in one of the two nodes removed, micro-metastases and have offered total clearance of my lymph nodes. After a consultation with an oncologist, he informed me that as my cancer was grade 2 and I am oestrogen receptive, there was no evidence to show that clearance of nodes was of any benefit, and could cause problems with lymphodema. My problem is that I am due for surgery next week and need to decide if I want them to remove the nodes at the same time as the 2nd lumpectomy. In my head it seems sensible not to have unnecessary surgery, but I'm still thinking should I just get rid of them anyway? If anyone who has had similar please let me know your decision, I know in the end it is up to me but making the decision is driving me crazy !! Any advice would be greatly appreciated.