lump vs. mastect, other questions

[Lynna34]

We met with the surgeon on Tuesday about my mother's (70yrs old)
6.1 mm lump (origin) and also an enlarged 3.4 lymph node
in same breast. Path reports indicate ductal carcinoma in situ for small lump, papillary
carcinoma for lymph node lump, grade 2 for both lumps.  Path
report says to check for invasiveness of lump.

She was all set to have her breast removed but the surgeon said he didn't
think it was necessary because research shows that there is no difference
between lumpect. and mast.  as far as results go.  Is this really true?  Also isn't having two lumps a reason for mastect?
Also, is radiation really dangerous to have? I know it can contribute to lymphedema.

The surgeon is recommending the removal
of the two lumps, along with the lymph nodes under arm. He believes that
the lymph node would be the sentinal node.  Then chemo and radiation.
Of course, we have to see what the tests show on the day of the surgery
and also meet with the oncologist and radiologist, etc.

  She has had blood tests
and chest xray which came out clear.  r. said he will do whatever she wants as far
as breast removal or lump removal and that she can change her mind between
now and the date of surgery.  My neighbor works in the med field and said that the more you keep going in you can cause more trouble and that it would be
best, in her opinion, to take the breast.  Any thoughts? Is there less
of a chance for cancer to return if you remove the breast?

Dr's rationale was that there is no family history of BC and both
precedures provide same results.  Both of my mother's parents had colon
cancer but Dr. said there is no relation at all between the
two.  

If you can provide any  advice, I would really appreciate it.

Thanks for all your advice.
Lynn

[CCF-RN,MSN-rf]

Dear Lynn:  Technically speaking, the survival rates between lumpectomy + radiation and mastectomy is equivalent.  There are issues, though, that may make a person lean more toward one procedure than the other.  If there is more than one focus of breast cancer within the breast, some might lean more toward mastectomy.  If this second lump is a lymph node, that is not considered a second focus but, rather, metastatic disease (disease that has involved the lymph nodes).  In this case, a lumpectomy with a lymph node dissection is an option as long as it is followed by radiation therapy.  If this is your mother’s situation, then it really boils down to her choice.  Just because the surgeon believes he can do breast conservation surgery, doesn’t mean it is the right option for your mother.  Although survival is equivalent for both procedures, the mastectomy may reduce the incidence of a local (in the remaining breast tissue) recurrence.  Radiation, required in the case of lumpectomy, is safe (relatively speaking).  Care should be taken to select a center that is accredited and has state-of-the art machinery.  Good technique has minimized serious complications of radiation therapy, although that possibility is never eliminated entirely.  Finally, there is no way to be certain a node is a sentinel node without using dye and a radioactive isotope to track the drainage back to the first (sentinel) node.  Since there appears to be evidence of disease in one node, a sentinel biopsy would not be indicated and a lymph node dissection would be the procedure of choice.  In summary, whether to do a lumpectomy + radiation or a mastectomy is probably your mother’s choice as long as either procedure includes a lymph node dissection.