Lymph Node

When I first went to get my clinical exam there were several doctors who felt my lump and they believed the cancer was in the lymph node (this was only stated in the reports never to me).  I had a FNA which said I had breast cancer.  The next day I had a core biopsy that said I had grade 2 invasive ductal carcinoma.  The following week I had lumpectomy with 15 nodes removed, the path said grade 3 that there was some consistencies with lymph node invovlement however clinical evaluation was required.  I asked my surgeon some 10 months later and he stated that they could not be definite that the cancer was not in the lymph nodes so they said I did not have it in the lymph nodes (0 for 15 to be exact).

Should doctors air on the side of conservatism when there initial dignosis as well as the mammo and the path show that there is a potential for lymph node involment?  I gave this info to my onc (different doc) and he said from what he saw (which he did not exam me prior to my lumpectomy) is consistent with the no nodal involement.   What should I do?  Does this happen often?  Should I have my tumor reviewed somewhere else?

MissyMouse

[CCF-RN,MSN-rf]

Dear MissyMouse:  The most conclusive test is the pathology report.  If the pathology report indicates that there is no metastasis, then there is no lymph node involvement.  If you are concerned that the pathology report could be incorrect, you can have the slides reviewed.  Whether or not the lymph nodes are positive should be pretty straight forward.

[MissyMouse]

The path report stated that clinical evaluation is required.

[surgeon]

I'd guess that if there was mention of possible lymph node involvement on the original path report, before lymph nodes were tested, it was because they saw some invasion of tumor into lymph channels. It's not really useful or meaningful to say, in that report, that that's consistent with possible lymph node involvement, because that's true by defintion: invasive cancer invades various structures, and has the possibility to spread to lymph nodes or elsewhere. So, in having said "possible lymph node involvement" the pathologist was stating the obvious. When there's invasive cancer, lymph nodes are checked no matter whether the report says "clinical evaluation required" or not. That's how you tell if there's involvement. In your case, there wasn't, which is good news. The only problem with your report was a pathologist who thinks he/she needs to guide therapy; but the therapy would have been carried out exactly as it was if he/she had stuck to the facts: you had invasive breast cancer which was managed properly.