Further Lymph node removal

Dear doctors,

I was diagnosed with stage IIIA breast cancer, ER- and HER2--3 this February. My surgeon suggested to remove only the lymph nodes close to my breast when she did mestectomy. She removed 8 lymph nodes and all of them positive. Right now, I am under chemo treatments AC+T and will follow by radiation treatment at my breast and underarm.

My question is: shall I request further surgery to remove more lymphnodes in case more positive ones left? Would chemotheropy and radiation treatment kill all the positive lymph nodes left? Thank you very much and I really appreciate your help.

[CCF-RN,MSN-rf]

Dear oceanlover:  Since you have already begun chemotherapy, there would be no reason to remove more lymph nodes.  It would not change the stage or the treatment so it would only be a surgical disruption of care.  Chemotherapy is designed to "attack" any and all disease, anywhere in the body.  Radiation is for local control of disease where it is targeted and would be given in situations where there are many positive nodes.  Whether to go back and remove more lymph nodes before chemotherapy is controversial.  There is no real scientific evidence to support one technique over the other.

[surgeon]

that is a good question, for which, unfortunately, there's not a clear answer. Controversy remains as to whether it's clearly necessary to go back and take the rest; in other words, is it therapeutic as well as diagnositic to remove nodes which have tumor in them. It's only really been addressed since the era of sentinal node biopsy. Initially it was standard to go back and remove the rest of the nodes when the sentinal nodes were positive. The length of time necessary to really know for sure has not yet passed, in terms of evaluating long-term studies with large enough groups of people in them.

[seven7]

After my mastectomy April 2002 I wondered ,just like you,if there were more nodes positive that were not taken out.
15 were removed during the mastectomy and 14 were positive.  I was  a  III.  I asked both of my oncologists about it, and they said if some positive ones were left , the chemo and radiation would take care of them.   When I had all my 2 year tests in April this year,  no sign of cancer was found anywhere in my body, and I am feeling good.   Best Wishes to you!   Seven

[bshort]

Wow!  I really love this connection.  I too had the same question and didn't really like my doctors' answer.  On my second surgery, she performed a re-excision biopsy with axillary dissection.  5 positive nodes and 5 negative nodes.  She said she was very comfortable that she had gotten all involved nodes.  4 weeks later I had a bilateral mastectomy that removed 2 addt'l nodes that were also positive.  Chemo starts July 8th, and now I feel much more comfortable about my node status.  Thank you.