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Intramammary Node vs. Sentinel Node, course of therapy and prognosis

My mom had a mastectomy on her Right breast last week and I am a bit confused by the findings. It was a 1cm mass, grade 3 tumor and they took 16 lymph nodes for dissection. The sentinel node and all but 1 lymph node came back with no cancer cells. There was an intramammary lymph node in the general location of the tumor that came back showing some cancer cells. I am trying to figure out what this means in terms of her treatment that will be needed (ie: chemo regimen) and her overall prognosis (ie: are folks able to survive this and live for a long time afterwards? how long?). While I know that biopsies aren't supposed to spread cancer cells, her biopsy caused a very large hematoma which lasted for 10 days until the mastectormy. I am hoping that (maybe) the intramammary node was positive for cancer because it picked up cells from the hematoma as a result of the biopsy and that the mastectomy effectively got rid of all cancer. (her bone scan and CT scan came back clean). My questions are:
1.) how do you interpret the finding of the lymph node situation as described above? (ie: i know there is about 5% false negative for sentinel node and about 20% incidence of a postive intramammary node)
2.) what chemo regimen will they likely prescribe (length and type?)
3.) how hopeful can our family be at this point that mom will be around for the next 5, 10, 15 ,20 years to see the grandkids grow up?
Sorry for all the questions, but as you can see, I have been Googling like crazy for the last 2 weeks and not sleeping much. Thanks and God Bless. This is a great website.
157 Responses
242527 tn?1292452740
Dear concernedson#1:  Hematomas are a complication of a procedure, they do not spread cancer cells.  There is no evidence that breast biopsies spread cancer cells.  Sentinel lymph node biopsies are done because it is believed that as cancer cells migrate, there is a higher chance that the first or second node will be positive than nodes that are further down the chain.  Experience shows that it is not uncommon for there to be “skip” metastasis, where a node beyond the sentinel node is positive.  It is also possible for an intramammary node to be positive.  In any case, the information that is important is the number of lymph nodes that are positive, the size of the tumor and several other factors about the tumor that will be analyzed by pathology.  This information, as well as your mother’s health, will help to determine the chemotherapy regimen.  Her doctor will be best equipped to discuss the specific regimens that will be recommended as well as the duration.  He/she will also be best qualified to discuss prognosis as it relates specifically to her situation.
127512 tn?1193745816
Not the doctor here but just trying to give you some info to help. Where was the 1cm mass (Lobular or ductual) (close to the chest wall)? Do you have a copy of the 1st biopsy report, masectomy report and the I node report? I would send all samples of biopsy, masectomy and node for a second opinion? Most insurance companies pay for this. How was the test performed FISH or? They usually perform a masectomy and only a sentinel node biopsy then if something is found in the sentinel nodes they do further node testing. They normally take as few nodes as possible due to infections. Also, normally if there is no lymph node involvement and the mass is 1cm and under no chemo is usually recommended but radiation is. It is sometimes left up to the patient. Is she going to a credible breast cancer center? Do you know her ER, PR and HER2 status? Is she post or pre menopausal? An oncotype test would also be beneficial in determining her need for chemo. It is good her scans were negative. Depending on her er, pr and her2 stauts meds are given to remove the estrogen from our bodies to prevent it from feeding the cancer. There are some many new drugs on the market now to keep cancer under control I would think your moms prognosis is very good. Gather your reports, post back here or you can get important info at breastcancer.org. You can click on community support and speak to many other ladies that can help with advice to guide your mother on this journey. Scan down and post in the appropriate forums. I hope this info helps and I wish your mother well.
Avatar universal
Just wanted to quickly post you for an update on your reconstruction surgery? Any decisions yet? I hope you are well. I think of you and Montana every day. You guys are always in my prayers. The other post was a bit clogged-I hope you see this.
Avatar universal
When is your appointment? I enjoy the blogs and the people on the other thread but I just can't keep up with them anymore. There are not enough hours in the day. Plus, they have formed their own close-knit support group which is really neat.
Avatar universal
I am supposed to have my mammo in October. I haven't had the nerve to make the appointment. I have been trying to get this rapid heartbeat thing resolved. I cannot imagine what my heartrate is while I am sitting and waiting for the radiologist to tell me  my results. Aren't you due for your mammo in October?
I agree with your comment about the group network on the other thread. I am glad that they have such bonds. That is how I feel about you and Boninclyde but like you said, there are not enough hours in the day for all of the posts. I hope that both of you know that I keep you in my prayers (without the daily reminder).
127512 tn?1193745816
Ziggy I am supposed to go October 19th. I switch hour by hour chickening out but I think I will make it to the surgery and through it. Have to be there 5:30am. Surgery at 7:30. Let me know about your mamo. I am preparing for surgery and have brain fog.
Avatar universal
Let's use this thread to stay connected. Boninclyde, I'm glad you set the date. You will make it through the surgery I have no doubt. I'm praying for your anxiety and Ziggy's rapid heartbeat. I don't want to make you more anxious by bringing it up all the time, so please let us know when you want to talk about it. Or, let us know if it's ok if we keep asking you about it.  I know you want this and have thoroughly research your options to make sure you're doing the right thing. It is going to be ok!

My mammo is scheduled for Oct. 18.I always schedule it well in advance so I can pick my time.  I forgot to ask if Dr. Anderson would be around to read the mammo so I don't have to go through the mess I had the last 2 times. I suppose I should call back and check. I feel good about the mammo, knowing there's a very good chance that everything will be ok, but I'm always anxious to get the results.

Ziggy, I pray that your appointment goes as well as it did the last time. Let us know when the appointment is.
127512 tn?1193745816
Ok we'll use this thread. Sounds great.

I have set a date but I feel like I am being so selfish. If something were to happen my kids may hate me for not being there for them. Probaly goes back to my own childhood. I am sorry I can't explain it. All I can say is I just fell like they would fall apart without me. Or maybe have a party. No just kidding. Anyway like I said I can't help but feeling selfish all because I want a boob.

I do hope ziggy's heart gets regulated. Ziggy's not that old I dont' believe.

And Montana, I hope the best for you on your next mamo. The day before my surgery. Once again we find ourselves on this journey together. Take care. I'll keep you posted.
Avatar universal
Do you know how long it takes to recover from this kind of reconstruction? I know it will be hard for you to not be available for your girls while you recover, but that's temporary. I know you worry about something happening to you, but that's highly unlikely. Is it selfish to want to feel normal? I don't think so. I'm sure your girls want you to be happy. If they know  this is important to you, I think they will feel it's important and want you to do this.

Thanks for your good wishes, too.
Avatar universal
boninclyde-did I miss something???What surgery??Is this your reconstruction??I am glad that we switched to this thread because I was so confused by all of the postings on the other thread! You are not being selfish for wanting this surgery. We are entitled to feel good about ourselves and if this is what you need, I so DO IT!!!
My cardiologist feels that my rapid heartrate is all anxiety related. I have not been able to do a regular stress test because I get too nervous before I have to get on the stupid treadmill!!! He gave me a scrip for 5 xanax so I could try it to see if it would calm me down enough for the test. I think that I am going to save them to take before my mammo-which I have to schedule for October.
I cannot believe that we are all on the same schedules...it is a little weird. I sometimes think about some of the others that I remember from last year, Under Forty Pam and Avid Hiker. Have you seen  any posts from them? There was another woman, I think she had a name referring to being a grandmother. Do you remember her?
Montana-Like you I will request an appointment on the day when the radiologist who spotted my DCIS is working. I agree that having the same person look makes a difference. I get nervous just writing about this. Sorry to be such a baby!
Avatar universal
Avatar universal
Today I rescheduled my mammo for Oct. 17 due to a conflict on the 18th. I asked if Dr. Anderson would be reading mammos that day and they couldn't tell me, but they did say they would make a note saying I requested he read mine. We'll see...

I wish we'd hear from the other gals, too. I think they come back on occasion, but I don't have the same connection with them that I have with you two.
127512 tn?1193745816
I to tried to keep up on the other thread but couldn't. They got a really good support system going on over there and thats important. As far as UFP and AH they post on the breastcancer.org forum. Doing well. They don't post often. Good to see them doing well and moving on. Me and grandma (her name was naim, we keep in touch for quite some time through e-mail. I have Mitro valve prolaspe and anxiety. When my heart acts up I don't really know if it is MVP or anxiety. Guess it don't matter I just take a pill and wait for it to pass. Montana and I was talking about my reconstruction surgery. I know I can do this. Like you I am a baby. A much, much bigger baby. I'll be glad when all this is behind me. I had a death in the family. She has been fighting pancreatis and ovarian cancr for 27 months and lost her battle Thursday evening.
127512 tn?1193745816
I lost a dear family member this weekend to pancreatic and ovarian cancer. What a trooper she was. She was ready to go home. Such a wonderful person. You could not have asked for a better person. Her love for God goes beyond all imagination. She will be truly missed. I also lost and friend to breast cancer that had spread to her brain. She also was a wonderful person. She left behind a 2, 3 & 5 year old. It is so hard on the family.  I wish God didn't need so many angels, I would like to keep some here with me. May they laugh when we laugh, may they cry when we cry and may they hold our hand when we are lonely and scared. I can truly say this has been the worst time of my life since my diagnosis. I feel crushed.
Avatar universal
I'm sorry to hear about your losses. I understand why you feel crushed. The weight on you is awfully heavy right now. I'll pray for God to lighten your load.

I didn't realize you have MVP but I'm glad you have medicine that helps. I don't feel either you or Ziggy are babies. I think women are more emotional and you've both had plenty of stress in this past year to be emotional about.

Thanks for the update on UFP, AH and Naim. Glad to hear they're doing well.
Avatar universal
Glad I could find you. The other post suspicious abnormalities on mammogram is full I guess. How do I get in contact with snowtree, and others. Do they have to do something on their end? or do I have to do something on my end to clear, make room to post?
Boninclyde - sorry to hear about your losses. Life can be overwhelming sometimes. It is hard to understand and put it all together. I pray for God to strengthen you. I am so sorry. Truly.
My surgery is scheduled for October 12th. Everytime I read these posts and am amazed how 1 in 8 women will get breast cancer and then I just realized how many have to go through biopsies, mri's etc. and find out they are benign. It seems to me that breast cancer whether benign or not will probably effect every woman one way or another. That is sad.
God bless you on this thread. Your burdens seem heavy, so glad you can support each other.
Avatar universal
In the past threads were always closed after about 30 posts, so I don't know why that thread was left open so long. When the others find the thread closed I think they'll look around for familiar names and post there, so hopefully, they'll find you. There's nothing you can do once a thread is full. I've been conversing with these 2 ladies for over a year now, and we just "hijack" a different thread when a previous one fills up.

I'm glad you posted your surgery date.  Are you having a partial or full masectomy? The women on this thread are a great support, too, and both of them found out they had cancer last year.How are you feeling about the upcoming surgery? You're in my prayers daily, along with labhusky, mistyb and tamknit.
Avatar universal
full masectomy - left breast. I am anxious about the surgery. Not sure what to expect. I mean they went over things, but I am unsure what to expect. The doctor feels I will be up and around in a matter of days. I know most of the women who post except for tammy all had lumpectomies. I think I should expect different results. I know no driving for a week but how long to heal after that. This outpatient so I need my family to understand that for 3 days mom will be on the couch with the remote or will it be longer than that. The doctors said it is up to me and how I feel but after reading misty's post with a lumpectomy I'm thinking it may take longer. She advised not lifting a shampoo bottle etc. no driving for a week, etc. I am trying to be positive and I want to be prepared.
Avatar universal
Well, I have my appointment for my mammogram set up for next Wednesday the 10th. I made sure that I would have the same radiologist reading my tests. Please keep good thought for me.
Boninclyde-please know how very sorry I am for your loss. I will keep your friend and her family in my prayers.
Avatar universal
I had a mastectomy in August.  I was kept overnight, standard procedure.  I needed heavy duty pain killers for total of 3 days (incuding surgery day) and 800mg Motrin and/or icepacks for about 4 additional days.  
There is a good pamphlet from ACS that discusses mastectomy recovery, exercises etc..  I didn't feel like doing much of anything for  that first week. Staples came out on day seven but I still didn't have the dexterity to  manuver my car in some situations so I didn't drive for about 2 weeks.  Both my surgeon and my oncologist were very pleased with my quick recovery so I think I did better than most.
    NO lifting over 5 lbs for a couple of weeks,  A gallon of milk weighs 8.  We bought half gallon containers for awhile.  Wet laundry is heavy, be careful.  I made a couple of dumb moves on laundry day and had to use Motrin and ice.
    I couldn't lift my arm above shoulder level for over 2 weeks.  Move frequently used top shelf items before the surgery.  
   I precooked for a couple of days and then my friends supplied meals for several days.  My niece came over and helped in the kitchen because most stuff was too heavy to carry/lift.
    I am a health walker and the doctor wouldn't let me try walking until the 8th day.  I barely made it to the end of the block on the first try and it took me almost 7 weeks to get back up to 3.5 miles daily.
    I slept sitting up in a recliner the first week because laying down wasn't comfortable.  I laid claim to all the spare pillows in the house to prop the arm on the surgery side and put behind my back.
    If ACS Reach to Recovery doesn't give you one, get a small really soft throw pillow to use in the car (between you and the shoulder harness) the first week or so. Have it with you when going to the hospital for your surgery.
     I returned to work at 3/4 time the 3rd week and full time the fourth week but my job is mostly at a desk and I had co-workers who mothered me for about 3 weeks.
     I am someone who always pushes the envelope on limitations so I tried to recover as quickly as possible.  LISTEN to your body, it will speak loudly. Respect what it says as you heal.  I will be praying for your recovery.  God Bless
Avatar universal
I can understand why you're anxious about the surgery and the recovery. You've got a good attitude, though. Will you have the help you need when you get home? I hope the people around you understand what your limitations will be.

Last night I went to "My Inbox" at the top of the forum page and typed in maa64 to contact you. Maybe you can try doing that to contact the others and let them know you're on a new thread. I know how important the support of others is to you, especially right now before your mastectomy.
Avatar universal
I'm glad you made your appointment. I'm praying for good results.
Avatar universal
My instructions weren't complete. I went to "My Inbox" at the top of the page, clicked on "Compose" and typed maa64 in the address box to contact you. I hope it works for the others.
Avatar universal
I am so glad I found you!  Has anyone heard from the other girls?  
Maa, I am sure your surgery will go well.  Recovery time varies.  If your shampoo bottle is small or not full, I am sure you will be able to lift it.  When I mentioned the shampoo, I meant it as an example of items that may be heavy when full and when combined with other like items, can make a shopping cart hard to push right after surgery.  Probably a good idea to stock up on those type of items before surgery. :)
Well, guess what I just found out.  All this time I have been saying I had a lumpectomy, I have been using incorrect terminology.  Apparently a lumpectomy is only if the abnormality removed is cancerous.  Even though the pathologist said the surgeon removed a mass the size of a golf ball, because it was benign, it is called an open excisional surgical biopsy.  While the surgeries are basically the same, the wording is quite important when dealing with your insurance company.  The pathologist also mentioned that the surgeon should not have removed such a large mass and should have just stuck with the original plan of biopsying the microcalcification.  The pathologist just happens to have a daughter who goes to school with my son and I bumped into him the day we had parent/teacher conferences.  His wife was the radiologist who placed the wire in my breast.  They both specialize in breast cancer.  Well, this news is interesting considering how much discomfort I have had since the surgery.  I have experienced shortness of breath and swelling and pain along my rib cage, around to the edge of my shoulder blade and above my clavicle and up my neck.  I also have all the typical tingly, numbing, and sometimes needle poking sensations in my arm.  My mom, who has had a lumpectomy, kept telling me that what I am experiencing is not normal.  After getting to the point where I just can not take another day of constant discomfort, I called my drs. office and spoke to the nurse.  I have an appointment tomorrow.  Hopefully, there is something that will relieve this quickly.        

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