axillary discection or no

[paranoidpartner]

My partner was diagnosed on with IDC on Sept 25.  She had a biopsy that showed a 1.5 cm tumor on the upper right quadrant of her right breast.  It was rated 6/9 on the nottingham, is er+ 90% pr+ 75%, her2nue neg.  Nov 13 had a lumpectomy and SNB.  The Dr only took one node feeling there was no reason to take additional with what she saw during the surger.  The node was + with tumor measuring 3mm.  Also came back with one section of the margins questionable.  Because of the questionable margin, less than 1mm clean the Dr wants to go back in to clean that up, if possible.  It may be too close to the chest wall.  The doctor has also advised going back for axillary dissection.  This is what is bothering me I have heard many nagative things about the axillary dissection and wondered if 3rd beam radiation was a better option if one at all.  Is the dissection just prognostic or is it actually theraputic.  Please help, we are having a difficult time in making decisions.  Thank you

[Irishgal2]

Oh that's a nice thought, can I come too!  Only joking, but a break will do you both the world of good.  I went to Sweden for 4 days before my axilia clearance, so I don't know about flying afterwards.  I somehow think it may be 6 weeks, as that was the time scale given to me to get my movement back to near normal, thankfully I was quicker.  Why not ring one of the Breast Cancer Nurses in the hospital your partner is attending on the quiet what her advise is, she would have a very good idea.  At least then you will know if you can book that holiday for her birthday.  If you cannot fly, you can still take a lovely romantic and relaxing break somewhere in driving distance.  I would not suggest a spa because you are very limited to the treatments you can take post op.  Best of luck on 11th.

[paranoidpartner]

Hello and thank you.  I was wondering about recovery time from the ALND.  Her birthday is the 16th of January, I was trying to make plans.  I know your recovery was remarkably quick as far as the healing, do you have any ideas about the amount of time required prior to flying?  I would like to take the opportunity to "get away" before the chemo and radiaton treatment begins.

Thank you so much for all your support.  I will continue to keep you updated, her surgery is this Tuesday the 11th.  

Have a wonderful Christmas and New Year

[Irishgal2]

Your partner sounds very strong which is great, I'm sure she will do just fine as too will you.

Chemo is definitely recommended because of node involvement as well as her age and menopausal status.  Whether it is 1 node or more I think the chemo regime may be the same but I am not sure.  She will most likely have 6 or 8 cycles of treatment.  In Ireland it was customary to have a CT scan, chest xrays and bone scan whether you have any node involvement or not.  It is important that she has all these tests to give her a full and clear picture.  

The next steps are removal of the nodes to see if any more are infected, scans etc to ensure cancer has not spread anywhere else and then start the appropriate chemo regime followed by radiotherapy and hormone therapy.  Yes it is a long road, but you will all get to the end of it sooner than you think.  I wish you and your partner the very best of luck and I hope you have a nice Christmas.

[paranoidpartner]

I have been away from the sight and was unaware that my latest comments were not posted.  Thank you for your input concerning the ALND.  I have just been very curious having done so much research concerning the dissection and whether it is pronostic or actually beneficial in the therapy of the cancer.  My partner had already come to the decision to go through chemo (most aggresive as possibe, as she is adopted, only 41 and premenopausal).  And radiation is a must having had the lumpectomy.   My question is probably more being devil's advocate and  whether or not the the dissection would actually provide information for her treatment.  Her original tumor was measured at 1.5 cm and the tumor size in the lymph node was 3mm.  Just wondered, as are the doctors, about the benefits versus the risks of the procedure.  The doctor took only one node believing there was no reason to take additonal.  I realize that if there are a number of addition nodes involved (god forbid) that scans will probably be advised to check for distant metastasis.  But really, does the chemo treatment change?  Really just my curiousity as the decision has been made.  My partner is incredible, the most positive individual you will ever meets so I feel as if I have to play the devil's advocate and look  down all paths of this whole mess, .  As for hair loss and chemo, she says she is not bothered.  I have talked about wigs and she is happy with hats simply to keep her warm.

Thank you for all your input, it is wonderful to have others to talk to.  Good luck to both of you in your continued success in this battle.

[Irishgal2]

Like lizziecee I too think your partner has made the right decision.  One of the most important things in the whole scary BC situation is to know the extent of the cancer and focus on getting it all removed.  The reality is that without the dissection of the axilia your partner would still be in limbo and wondering if any more nodes were involved.  It is hard enough coping with the diagnosis of BC and the subsequent treatments without having that added worry.

I had 4 cycles of AC Chemo therapy.  I had a cycle every 21 days, so all in all took about 3 months.  Although I had no cancer in my lymph nodes I was only 39, pre menopausal and the cancer was a grade III, hence the reason my Oncologist advised me to go for the chemo.  If any of my nodes were involved, chemo would have been a must and 6 or 8 cycles rather than 4.  It would have been most likely FAC or TAC chemo regimes.  TAC is the same of AC for the first 4 cycles and then another drug called Taxotere for the remaining cycles.

I'll be honest with you, chemo is most likely going to be strongly recommended for your partner.  However, she will still have a choice, the final decision will be hers.  Ok so chemo is ****, for me the worst part of the whole BC situation, I think for most people it is.  Every woman is different as there are many different chemo regimes that can be used for treatment of BC.  There are side effects associated with all of them, differing slightly depending on the regime you are on and all they cycles may be different e.g. every 10 days etc....  Some people cope reasonably well with Chemo, I was one of the lucky ones although I did have the common and expected side effects, but I could still look after my two young boys most days, went to work some days and enjoyed a good few nights out.  However that was me and I was very lucky that the chemo did not affected me really badly.  Unfortunately there is a flip side to the coin and you will see on this website that many woman had a really bad time with chemo, through no fault of their own.  The docs and nurses cannot predict in advance who will reaction which way to each chemo, it really is a lottery. Additional pain is not normally associated with chemo as far as I can remember.  The most common sides effects are hair loss, nausea (can be prescribed anti nausea medicine which worked for me) and effects to your blood and so your immune system.

Most chemo's have the side effect of total hair loss.  This was the most upsetting part for me by far.  My husband tried to understand, but I guess he just did "not get it".  The good news is that your hair does grow back although mine is a different colour.  I don't know your partner, but just to give you a heads up, this may be a very tramatic experience for her and all you can do is support her, you cannot make it better, just be there for her as you are now.  You will also see on the forum that there are some braver women that me who coped with hair loss very well.  Really every woman has a different story.  I know you want to stop the pain for your partner, but I'm sorry there is nothing you can do there, she will have to go through the treatments herself and make the best decisions for her future survival.  All you can do is be there for her, listen, find out as much information as you can and support her decisions.

I too was ER and PR + and Her2 -.  I am now on Tamoxifen for 5 years and hope I am as lucky as Liz to be writing on this forum in 5 years time.  Liz is right when she says ER/PR+ and Her2- is a good prognosis.

Good luck with supporting your partner.

[lizziecee]

I was dx with a 2 cm invasive ductal carcinoma Jan 2003. Had lumpectomy and 8 sample nodes. 3 were malignant. I went back for total axillary removal a month later, as I got a haematoma where the lumpectomy was carried out, then an infection.  Sentinel node biopsy was not done at my hospital in England then, but is now.  My surgeon said I had no choice but to have total axillary clearance, and he was right as another node was found malignant, 4/18.  I think your partner has made the right decision, even if no other lymph nodes are malignant, at least she will have peace of mind. Usually if there is spread to any lymph node, chemo will be advised, followed by radiotherapy, and hormone therapy as she is er/pr+.  Being Her2- and ER+ is a good prognosis. I was also ER+,HER2-, and being post menopausal, am on Arimidex. Tamoxifen will usually be prescribed if pre-menopausal.
I have never heard of axillary radiation being a substitute for axillary clearance, as this will not detect if further lymph nodes are involved.

As my cancer had spread to 4 lymph nodes, I had a body scan, chest x-ray and liver scan, but thankfully there was no spread to other organs. My surgeon and Oncologist said that having chemo and rads, dramatically reduced the chances of microscopic cancer cells spreading further, or if they had, the chemo and rads would sort them out.

Every case of breast cancer is different as there are so many factors to take into account and your partner should be guided by her bc surgeon and oncologist. We can only really relate our own experiences and of course, do our research.

Nearly 5 yrs on, I am doing fine, with no recurrence.

You sound a wonderful partner....keep it p
Liz.

[paranoidpartner]

Thank you for your input, it is so difficult being on the outside and feeling as if I can do nothing.  I have heard so many different stories with ALND and am so afraid my partner's quality of life will be drastically changed.  I have heard that axillary radiation my be a substitute for the dissection, all is purely academic now since she has decided to have the dissection.  While having the dissection the doctor will also go back into the original tumor site to clear the bit of margin that was not completely clean after the initial lumpectomy.  We have had many hours of discussion and she feels a very definite need to know the extent of the nodes affected as well as the knowledge that the cancer has been removed from her body. I know that the most important factor here is that she feel 100% positive about her decision and my job is to help with that.  Sometimes, though, it is so difficult.  One last question...did you have chemo and if so was there any additional pain experienced from the chemo in combination with the node dissection?  Thank you again for your support.

[sonu78]

hi,
Feel sorry about your partner.
A case of infiltrating carcinoma with histopathology report suggesting doubtful clearance and positive node mandates revision mastectomy with axillary lymph node dissection. This should be followed by postoperative tamoxifen therapy with or without chemotherapy. Now if your partner is felt unattended at this time, she has a very high  rate of recurrence.

[Irishgal2]

Trust me you are not paranoid, in fact you are very supportive the fact that you are even on this forum.  I was diagnoised with IDC on 19th March this year.  I had a lumpectomy and my results were a 2cm tumour, grade 111 cancer, PR and ER+, Her2 neg.  My margins were clear as my surgeon took 1.5cm of tissues around the lump rather than the standard 1cm, thankfully for me it worked.  However I did not have any lymph nodes removed at that time because the initial result of my biopsy prior to surgery was DCIS (in situ i.e. pre cancerous).  However the Surgeon was concerned with this result as DCIS does not normally present in a lump.  I decided to play a wait and see game, my decision.  So when the pathology report came back on my cancer status, the biggest factor regarding lymph node involvement was the fact that the cancer was a Grade 111 (fast growing and active and very common amoung younger women, I was 39 when diagnoised).  Because of this, I decided along with the breast cancer team (Surgeon, Oncologist and Breast Cancer Nurses) to get all level one and two lymph nodes removed rather than going for a sentenial node procedure.  17 were removed.  Thankfully all mine were clear.  

However your partners story is different as one node has already proved positive.  You need some more facts like what grade the cancer in the tumour and infected lymph node was.

I have to say that I was either very lucky, had a wonderful and skillful surgeon or a combination of both, but I found the lymph node removeable procedure easier than the lumpectomy as I had a lot of swelling and bruising following that surgery.  I was expecting extremely restricted movement in my arm and considerable pain.  Well I needed very little pain medication afterwards, no bruising or swelling and 1 hour post op I was lifting up a cup a tea in the affected arm.  I was surprised and thrilled.  Not everyone has a bad experience, thankfully I was lucky.  I was back driving in 8 days against doctors orders of course and had excellent movement.  I was a good girl and constantly did my exercises that I was given, besides the fact that I had two young boys swinging out of me anyway.  I have had no side effects from this surgery to day and the scar has healed nicely.  However it was painful getting the stitches removed as they have to sewn at an akward angle and quite tight.  The nurse and myself told the surgeon we were going to send him to embroidery classes to improve his technique!.

Nobody can tell you what to do, just get as much information as possible from all concerned.  The whole BC situation is not without risks and we are constantly being asked to make decision and it is very scary hoping you are making the right decision.  Everyone has a different experience, some very good, indifferent or horrible, nobody can tell you how you partner will respond to each area of treatment.

All I can say is to wish you the best of luck and as it is, your partner is winning the battle with a very loving and supportive partner, believe me, that is key, my husband was great too.