question for the Drs

sgishelly · Posted: Tue Feb 08, 2005 10:03 pm Post subject: question for the Drs

Just came from my 2nd chemo treatment. I also saw my oncologist and he brought up something that I'd not heard before and my brain was apparently on vacation so I didn't think to ask about it.

Here's the deal...I had MRM on the right and a simple mast with SN on the left. I was told that nothing showed up on the left side either in the breast or the SN. Today, my doctor said that there was another test run after the biopsy....said he wasn't sure why because it's not commonly done....anyway he said there was "staining" which indicated there were cancer cells there. He did say that they were not able to be seen with a microscope or they would have been picked up in the biopsy. So my question is...will the chemo take care of these cells or is there something else I should be doing? Should radiation be considered for this side as well? What exactly does this mean to me?

I'm going to dig out my path report and find out exactly what he is talking about...if I can figure the stupid thing out. Thanks for any info you can give me.
_________________
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

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

Hi Shelly,
It will be interesting to hear what the good doc's say. I just thought I would share something that happened to me...
I was in the Sental node biopsy study which was to show that they could pick up the first few nodes and have better results than first removing all the nodes (which was standard of care). I got on the arm that they would do the sental node and if any came back positive (discovered during the surgery) they would remove the rest right then and there.
Well my surgery went well with no positive nodes out of 3. Then a week later I get a call saying that when the lab was doing the permanent slides they discovered that one was POSITIVE.. so back in I went for more to be removed (I think 11 or 15) which all were negative..thank goodness!!
But, I can't help but wonder if other women gone through the sental node dissection with negative nodes, may have had positive nodes like me.
In your case are they talking about lymph nodes which came back postive the second time around like me???
Kristen

sgishelly · Posted: Mon Feb 14, 2005 12:34 pm Post subject: Re: question for the Drs

This is what my path report says...

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Left Side Lymph Node Diagnosis
Sentinal Lymph Node #1: Free Of metastatic disease ; immunostains for LMW cytokeratin done on block (s) B to rule out micrometastatic carcinoma, were negative; 0/1
Sentinal Lymph Node #2: Cytokeratin positive isolated tumor cluster ; immunostains for LMW cytokeratin done on block (s) B to rule out micrometastatic carcinoma show an isolated tumor cluster. No corresponding cells are noted on the H&E stained section; 0/1
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

It sounds like the report contradicts itself. I just don't know what to think.
_________________
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

ann hollis vail · Posted: Mon Feb 14, 2005 7:34 pm Post subject: Re: question for the Drs

Shelly,
Call the office tomorrow so they can put your mind at ease. Your oncologist will call you and should go over what this means. I would think the chemo would get it on that side. Let me know what the doc says. hollis

hhmv73a · Experienced user Joined: 16 Jan 2005 Posts: 95

Dear Shelly,
Sorry I cannot provide you with any recommendations since we need to perform medical history and physical examinations before recommending any treatment.
Usually, radiation can be used for patients with 4 or more axillary lymph nodes or with other unfavorable prognostic factors. There is no definite recommenation for radiating the chest wall or not, but radiation may decrease local recurrence or even improve survival for certain patients with less than 4 nodes in the ipsilateral axilla.
Chemotherapy is usually recommended for patients with locally advanced (3 nodes is not that advanced) and/or poorly differentiated breast ca.
Now for your case, I highly recommend you to talk to the medical oncologist again. You may want to ask him whether radiation is indicated or not and why. If you are not happy with the answer, ask for an consultation after chemotherpy is completed. RT is usually given after chemo unless the surgical margins were positive or close.
Good luck,
Dr. Jay Lu

Muttsmom · Posted: Mon Feb 14, 2005 9:55 pm Post subject: Re: question for the Drs

I'm just curious. Why does everyone sound like people like myself with many positive nodes, don't have much of a chance? I know it's better not to have them, but there are many ladies that are many years out with alot of node involvement. I guess it's hard to hear over and over again about "poor prognosis". I just became officially 3 years NED with Stage III and I think I'm doing good as does my onco.
_________________
Nancy
2/14/02 ILC 43 - 5.5 cm 9+/16 nodes
Stage IIIA er/pr+ Her2-
2/02 MRM
FECx6 radsx33
Tamoxifen - Arimidex (chemo induced menopause)
4/03 SM w/bilat. recon.
9/03 expanders removed
5/04 repair reconst. disaster
10/04 Actonel for bone/joint pain from Arimidex
NED - 5 years
3/07 Diabetes
In memory of Kim 12/1/04

penelopez · Senior User Joined: 11 Oct 2004 Posts: 165

Nancy ~ I don't think that because we all know this is a very sneaky disease.

One ladie's doctor told her that even if it is in the nodes that it does not mean that it has actually travelled from the nodes and survived somewhere in the body to set up shop. And, if it did travel, your immune system possibly could kill those cells. Or, they could lie dormant for many, many years and never wake up. We all hear stories of women with lots of positive nodes doing GREAT many years later and women with no positive nodes and other "good" prognostic factors who have a recurrence at a later date.

ENJOY YOUR NED!

Hugs,

Margie

leo · Site Admin Joined: 23 Sep 2004 Posts: 1574

Hello

This is an interesting report. But it can happen, as the stains are done on different "cuts" from the tissue. So the cells can be seen in one section but not in the other.

So As Dr. Lu suggested, you should talk to your oncologist to see if you need more surgery/chemo or even radiation.

best regards,
Leo
_________________
Leonardo F - Webmaster Cancer Forums
Disclaimer: this information is for informational purposes only. It is not medical advice.

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