Sentinel Node Biopsy after RT therapy?

[CGTMHI]

Good afternoon,

As luck would have it, I was just diagnosed with breast cancer AGAIN - and in the same breast!  10 years ago, I had a 2.1cm tumor removed via lumpectomy, 10 lymph nodes removed (all negative) and 7 weeks of radiation therapy. I found this new tumor myself during self-exam and had a biopsy last week.  The tumor is 1.15cm and the surgeon I saw is suggesting I have a sentinel node biopsy and a mastectomy.

Question 1) Everything I've read about this procedure tells me that because of my previous radiation therapy, I am not a candidate for the sentinel node biopsy.  I confess that the majority of the information I've found is about 2 years old and I wonder if a sentinel node is now appropriate?  

Question 2) Given my history, what would the Cleveland Clinic offer me in the way of treatment options?  

Question 3) Is there a suggested "timeline" for treatment, i.e., mammogram - biopsy - surgery - chemo, etc.?

Question 4) Is it possible for me to have more radiation therapy?

Question 5) Is it likely that I will need chemotherapy?

I'm really desperate for help as I'm wondering why this surgeon is suggesting a sentinel node biopsy, when everything I've read says otherwise.

Thank you SOOOOO much for your help and this wonderful site!

CM

[CCF-RN,MSN-rf]

Dear CM:  Q1 and Q2) Given the length of time that has transpired from your original diagnosis, treatment at Cleveland Clinic may be a mastectomy.  We would do sentinal lymph node mapping but we would remove a small sample of lymph nodes - not just the sentinel nodes.  This is because there is evidence of "skip" metastasis in sentinel nodes.  In other words, the first node or two may be negative and a subsequent node or nodes positive.  Obviously, the exact treatment could not be determined without evaluating your situation specifically.  Q3)  There is no specific timeline, although you would not want to wait months to address the problem.  Q4)  Likely, you have received your "lifetime maximum dose" of radiation to the affected breast.  Q5)  Without more information, it is impossible to tell for certain what additional treatment will be needed.  However, it is likely that you may need chemotherapy.  It never is a bad idea to get a second opinion if you are uncomfortable.

[surgeon]

sentinal node biopsy after already having had lymph node surgery there is probably less reliable than the first time around. Many surgeons would recommend removing the remaining nodes (or a portion of them) rather than doing just a sentinal node sampling. Likewise, with recurrance after lumpectomy/radiation, the only choice is mastectomy. Reconstruction can be done simultaneously or later, or not at all depending on preference.