Path ReportNode Involvement

marybeth · Posted: Tue Mar 08, 2005 10:36 am Post subject: Path ReportNode Involvement

this is how I understood my surgery: My surgeon explained to me that during my lumpectomy he tried 3 times for clear margins, unsuccessful. I later had a left mastectomy. When trying for the sentinel node on the lumpectomy, the "activity" had died down and difficulty identifying the sentinel so he removed 5 nodes. He said the report said 1-4 were clean, #5 had cancer. My oncologist called it 'microscopic cancer" in the node when I questioned the extent of cancer in that node.

the path report on my lumectomy indicates:
Lymph Node (1) designated left sentinel, excision: Negative for malignancy.
Then, further down the report, Lymph nodes (4) designated Left, excision: Metastatic ductal carcinoma in one of four identified lymph nodes (1/4)

Questions:
1) can cancer skip one thru 4 and get into 5? I thought cancer cells 'drained' in order of 1, 2, 3 etc - ? Or could the cancerouse node actually be #1 since it was hard to locate it during surgery and then 2-4 were clean?

2) does the path report indicate the extent of cancer in the node? it doesn't seem to. I'm wondering what made him think 'microscopic' all I see is "metastatic"

#)My concern is in removing only 5 nodes and cancer showing in #5, could there be more lymph nodes involved. My surgeon explained that my course of treatment (A/C 4 every other week, then Taxol same) would not change even with more node involvement and so they don't remove additional nodes in order to reduce the chance of lymphedema. Do you concur?

Thank you in advance for all your help. This forum helps me to know if I need to ask additional questions of my oncologist! MB
_________________
Dx 12/28/04 at age 51
DCIS and ductal carcinoma invasive
6mm tumor
lumpectomy 1/5/05 unsuccessful margins
left mastectomy 1/14/05
1 +/5 lymph nodes
Chemo started 3/15 AC, then Taxol
Herceptin 6 rounds/stopped b/c of low EF
Armimidex
right prophylactic mastectomy 2/17/06
Implants 1/07, final w/tatto 9/07

Kristen · Experienced user Joined: 01 Nov 2004 Posts: 60

Hi Marybeth,
I will let the doctors answer your question about lymph nodes beyond number 5 but I just wanted to share with you my experience.
I had the sentinel node removal of three nodes. The orginal path came back negative nodes. However, when they did the final path they found one node was indeed positive, unlike you it was the first node not the 5th node. But, regardless my surgeon took me back in (3rd surgery) for removal of more nodes. I had 13 more removed all back negative. Sure your risk of lymphdemia is increased the more nodes that are removed. But I think I would want to make sure there were no more node involvement especially it being in the 5th node. I had the same treatment you are having, 4 A/C and 4 Taxol dose dense.
It will be interesting to see what the doc's have to say.
If I can be of anymore help, just let me know...
Kristen

marybeth · Posted: Tue Mar 08, 2005 8:08 pm Post subject: Re: Path ReportNode Involvement

Hi Kristen - thanks for sharing your experience. I wondered myself about that additional lymph node removal. I do hope the Dr. can shed some light. Thanks again! MB
_________________
Dx 12/28/04 at age 51
DCIS and ductal carcinoma invasive
6mm tumor
lumpectomy 1/5/05 unsuccessful margins
left mastectomy 1/14/05
1 +/5 lymph nodes
Chemo started 3/15 AC, then Taxol
Herceptin 6 rounds/stopped b/c of low EF
Armimidex
right prophylactic mastectomy 2/17/06
Implants 1/07, final w/tatto 9/07

sgishelly · Posted: Tue Mar 08, 2005 10:31 pm Post subject: Re: Path ReportNode Involvement

MaryBeth,

Hi. I had a similar experience...sort of...I had 3+ lymph nodes on the right side and I thought all was clear on the left. Then My onco told me that they had done a 2nd test on the sentinal nodes on the left and that a microscopic tumor was found...but nothing showed up anywhere in the left breast. Today, when I went in for my 4th and final AC treatment, I questioned him about it again....as far as if I needed any other treatment other than what I was doing....AC (4 rounds - dose dense) , then Taxol and radiation....and he said no. Anyway, I don't know if this helps you or not, I just thought I'd share my experience. The chemo is doable just make sure to ask for different meds if nausea is a problem. I suffered through 2 days the first round before I called my doctor and I should have called right away. They adjusted my nausea meds and thins have been going much smoother since.
_________________
Shelly
Dx Nov 1, 2004 at 40 y/o
Right MRM, Left Simple Mast. - 12/9/04
Stage 2A IDC -
Primary tumor 1cm
3+ / 14 nodes, ER/PR+, HER2-
34 rads - finished 5/25
chemo - AC and Taxol FINISHED 7/6/05
beginning reconstruction 2/06
brain mets 4/06 - now stage 4

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