Significance of tumor location?

[Elle53]

My tumor was located in the upper inner quadrant of my breast.  I recently read that, compared to outer quadrant cancers, there is a higher chance for the inner quadrant cancers to spread cancer cells through the lymphatic system to the "intramammary" (between the ribs and the breastbone) lymph  nodes.  It also said outer quadrant cancers most often send cancer cells to "axillary" lymph nodes and sometimes, up into "supraclavicular" region.  My concern:  I only had a sentinel node test done, which was negative.  But am I considered "safe" having had an inner quadrant cancer?  What are the chances of spread through the "intramammary" lymph nodes if the sentinel node was clean?  This is the first time I've seen this mentioned.

Thanks very much for this site.  You all do a wonderful job.  

Elle53

[CCF-RN,MSN-rf]

Dear Elle53:  Your question is a good one but the answer at this point is not known.  It is not easy to get to the intramammary nodes so it has not been the practice to do this sort of assessment.  The presence of positive lymph nodes does influence the decision to do chemotherapy but so does the size of the tumor, histology, and HER 2 status.  If you were going to have chemotherapy, then you are probably as safe as you can be.  If not, then you should discuss your concerns with your oncologist.

[surgeon]

The short answer to your excellent question is, "it's unknown." Studies to look into that have not been done. The significance of the intrmammary nodes is also unknown. In the days of radical mastectomy, and even more recently, there were some that argued for "super-radical mastectomy," meaning taking those nodes as well, especially for inner-located tumors. It's been pretty well shown that doing so adds a lot of morbidity but does not enhance cure rate. The only way to test the intramammary nodes is basically to open the chest; so such studies aren't done very much. The bottom line is that at the present time, treatment decisions regarding chemo are made based on the tumor characteristics such as size, etc., and on axillary lymph nodes status, but not on location. It well could be that staging for inner-located tumors would be enhanced by routinely testing the intrmammary nodes; but it's not done --  for the reasons above, namely the significantly bigger deal involved in getting to them. If you are getting some form of chemo anyway, then it's basically moot; if you are not, you could consider discussing your concerns with your oncologist.

[Elle53]

Thanks for your speedy answer, which was very interesting!

I have had chemo (4 A/C) so I will consider myself "safe."

[Twocapes]

My situation sounds just like yours.  My tumor was right side, upper inner quadrant.  Sentinel node biopsy (two nodes taken) was negative and I had 4 A/C treatments and now have only 5 of 33 radiation treatments left.  Because of my age (57) and size of tumor (2.5 cm), this was the recommended treatment. I've already started on Arimidex.  Feel free to write me at ***@****.   Sheryl

[ritavv]

My cancer was also in the right upper inner quadrant.  I did NOT have chemo and when I read about the other nodes a couple of years ago I panicked.  From my research I found there has been a study in France where they supposedly have developed a less invasive method of getting to the internal mammary nodes.  They found that a significant number of women who were node negative with the axillary nodes, did have a positive internal mammary node.  They felt that it explains why some women with node negative (axillary) cancers get recurrences soon after treatment.  

I wrote a letter to the department in the hospital that did my radioactive trace for the sentinel node biopsy.  I asked if they would have mentioned in their report an internal node if they saw one since the surgeon wouldn't be going for it anyway. I got a call from the doctor in charge and she said she reviewed my films and no internal mammary nodes showed up.  However, she qualified that because the injection of the radioactive stuff was so close to the area of the internal nodes, she couldn't be sure that one wasn't obscured.  So I felt a little better, but that has always been a concern of mine.

Since you had chemo, it sounds like you are protected either way.

[Elle53]

Thank you, ladies, for taking the time to comment.  I really appreciate it.

Elle53