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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
MEDICAL PROFESSIONAL
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.
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