positive lymph nodes after chemo

I had chemo before mastectomy due to a very large tumor and IBC, and this was followed by radiation and now I take Tamoxifen as well. Before surgery, no enlarged lymph nodes could be felt by examination, and no positive for cancer lymphnodes were detected by Ultrasound and/or MRI either. My surgeon was suspicious though, and it only came out during the operation that about 16 out od 22 lymph nodes were positive for cancer and this following 6 treatments with chemotherapy. The chemo did well on the breast but not on the nodes. Of course, the surgeon removed as much as he could and many had spread to adjacent fat tissue and stuck to nerves as well. could you tell me what that means in terms of prognosis. As I said, I did have radiation after surgery. I would appreciate any information as my oncologist seemed a little hesitant to be specific and my surgeon moved to a different state right after my surgery. (not because of it, though..LOL) Thanks.

[PaulMD]

Hi there.

It is entirely possible that lymph nodes cannot be palpated before any surgery. If your primary tumor shrank after the pre-operative chemotherapy, then it is hard to believe that the lymph nodes did not respond to this treatment.  It is possible, that there could have been more lymph nodes involved before the chemotherapy, and the chemotherapy has already decreased the number of lymph nodes involved (though still plenty remains).

Lymph node status is a major determinant of prognosis, and having 16 lymph nodes puts you in a higher stage (I believe stage IIIC).  The radiation would aim to lessen the risk for recurrence, but it is still best for you to have regular surveillance follow ups.

Regards.

[katarina777]

Thank you, Dr. Paul. What happened is that the chemo had killed, or worked on quite a few lymph nodes but during the time between finishing chemo and the surgery, and which was about six weeks, the cancer came back. And I felt it, but the surgeon did not change the date of surgery. Obviously, it was not my place to counsel him about this. This cancer is so aggressive, in one week it produced a tumor the size of a large baked potato. Thank you very much for your response. kat