Member Comments are provided by individuals and reflect their personal opinions only. Under NO circumstances should you act on any advice or opinion posted in this forum. ALWAYS check with your personal physician before taking any action regarding your health! MedHelp International and our partners, sponsors and affiliates have no obligation to monitor any comments posted on this site, or the content and/or accuracy of such exchanges. MedHelp International does not endorse the views of any user.
Breast Cancer (Expert Forum)
Advise about what surgery option to choose
Questions posted in the Breast Cancer Forum are answered by medical professionals from The Cleveland Clinic. Topics include Breast Biopsy, Chemotherapy, Hormone Therapy, Lumps, Lumpectomy, Lymph node dissection, Lymphedema, Mammograms, Mastectomy, Radiation Therapy, Reconstruction, Self Breast Exam, and Surgery.
Advise about what surgery option to choose
by mta_img, Jul 07, 2002 12:00AM
Hi,
I had four cycles of AC and four cycles of Texotere. Just had last treatment on July 5th. Surgery is scheduled for July 31st.
My Tumor was large initially that surgeon was going to perform Mastectomy. Also, three lymph nodes were positive (only three lymph nodes were taken and all were positive).
Now, after the treatment, clinically there is no tumor. I'll have mammogram during next couple of weeks. Ultrasound did not show any sign of tumor also.
Logic says that if my tumor is gone, then any cells in lymph or any other place should be gone also??
I was prepared for mastectomy. I thought this would avoid the radiation afterwards. Surgeon is proposing Lumpectomy and says: mastectomy will not bear any effect on deciding about radiation.
He also wants to remove a lot of lymph nodes.
The question now is:
1) Should any lymph nodes be taken out? If so, to what level. I think he wants to do level three. I’m not convinced on this.
2) Should we do lumpectomy first and see the pathology of the tissue.
3) If I go for mastectomy, should I take radiation?
Anything else should I consider. Any comments would be helpful. This is big decision for me, especially lymph nodes.
Thanks and God Bless!
Anna
I had four cycles of AC and four cycles of Texotere. Just had last treatment on July 5th. Surgery is scheduled for July 31st.
My Tumor was large initially that surgeon was going to perform Mastectomy. Also, three lymph nodes were positive (only three lymph nodes were taken and all were positive).
Now, after the treatment, clinically there is no tumor. I'll have mammogram during next couple of weeks. Ultrasound did not show any sign of tumor also.
Logic says that if my tumor is gone, then any cells in lymph or any other place should be gone also??
I was prepared for mastectomy. I thought this would avoid the radiation afterwards. Surgeon is proposing Lumpectomy and says: mastectomy will not bear any effect on deciding about radiation.
He also wants to remove a lot of lymph nodes.
The question now is:
1) Should any lymph nodes be taken out? If so, to what level. I think he wants to do level three. I’m not convinced on this.
2) Should we do lumpectomy first and see the pathology of the tissue.
3) If I go for mastectomy, should I take radiation?
Anything else should I consider. Any comments would be helpful. This is big decision for me, especially lymph nodes.
Thanks and God Bless!
Anna
Doctor's Answer
by CCF-RN,MSN-JS, Jul 08, 2002 12:00AM
Dear Anna, At this time the decision to be made is what needs to be done regarding treatment of the local disease. There is not a standard direction regarding treatment of local disease after systemic chemotherapy, as to what the most beneficial route will be, based on research, is continuing to be investigated.
The reason for treatment of the breast itself and axillary lymph nodes (or local disease) is to decrease the chances of local recurrence of the cancer. The chemotherapy being done first (neoadjuvant therapy) was to shrink the tumor as well as to treat any microscopic spread of the cancer.
The decision whether or not to do mastectomy or lumpectomy is based on individual factors such as cosmetic result, or preference regarding radiation or not. If lumpectomy is decided on follow up radiation to the breast would be recommended. However, if there is no evidence of tumor remaining then there is no “lump” to remove, so I’m not sure what is being removed unless the area shows up on the mammogram.
The lymph nodes that are removed are the ones in the fat pad under the arm. The number of nodes found in this fat pad vary from one person to another. Radiation could be done to these lymph nodes, and there is data showing that radiating negative nodes works as well as removing them in terms of preventing the cancer from coming back in the nodes. Since you did have positive nodes and have had systemic treatment, radiating the remaining nodes rather than removing them could be a possibility, however, you would not know for sure if there was any cancer present in the lymph nodes now after chemotherapy.
The reason for treatment of the breast itself and axillary lymph nodes (or local disease) is to decrease the chances of local recurrence of the cancer. The chemotherapy being done first (neoadjuvant therapy) was to shrink the tumor as well as to treat any microscopic spread of the cancer.
The decision whether or not to do mastectomy or lumpectomy is based on individual factors such as cosmetic result, or preference regarding radiation or not. If lumpectomy is decided on follow up radiation to the breast would be recommended. However, if there is no evidence of tumor remaining then there is no “lump” to remove, so I’m not sure what is being removed unless the area shows up on the mammogram.
The lymph nodes that are removed are the ones in the fat pad under the arm. The number of nodes found in this fat pad vary from one person to another. Radiation could be done to these lymph nodes, and there is data showing that radiating negative nodes works as well as removing them in terms of preventing the cancer from coming back in the nodes. Since you did have positive nodes and have had systemic treatment, radiating the remaining nodes rather than removing them could be a possibility, however, you would not know for sure if there was any cancer present in the lymph nodes now after chemotherapy.
