Breast Cancer - one node positive, decision to make

I met with my consultant yesterday to discuss the results of my recent lumpectomy and sentinel node biopsy.

Good news - they got a clear margin on the tumour.  Bad news - whilst the sentinel bode and second node were clear, the third node was positive for cancer.  

Consultant said she would bet money on the other nodes being clear, but that conventional practice in the UK would be to undertake a full clearance just in case.  In the US, conventional practice would be to NOT remove the other nodes as it was only present in one. Their research shows that rads can be as effective as removal.

So I now have to decide what to do.  She said I'd probably have chemo either way, and maybe radio too. 

I'm only 39, so I'm really worried about the potential life-long effects of the full node clearance.  My friend (who had BC previously) said to have the clearance to make sure it's all out. 

I have requested an appointment with the oncologist to see what her opinion is.  But either way it's going to come back to me to decide.  Feeling quite overwhelmed and not sure that I'll have total peace with either decision.

And now I'm receiving loads of messages from people wanting to know how i got on - so grateful for the love and support but it also feels a little bit overwhelming  i don't want to have to talk about it.

Thanks for reading if you got this far!

  • Hi Embop, 

    I just wanted to tell you about my Mum, who had breast cancer 16 years ago and had to have a mastectomy with full node clearance on the one side. 
    The full node clearance left her with lymphodema in her arm. This arm was then permanently larger than the other due to swelling, but it isn't noticeable unless you know what you're looking for. 
    The lymphodema hasn't affected Mum's day to day life and she still does everything with that arm that she used to before the node clearance (despite us reminding her to take it easy!). She has a checkup maybe once a year at the Lymphodema clinic where they monitor the swelling and provide her with compression sleeves and gloves (that the majority of the time do not have to be used). In the past 16 years, she has only had 2 instances where her arm did swell more due to an injury (one was a burn and one was a scrape) and this was treated with antibiotics with no further side effects. 
    My mum was relieved to have a full node clearance as, like your friend said, it had got it all out. I just wanted to pass on my mums success story of her full node clearance as it hasn't really affected her quality or way of life. 
     

    good luck with your decision and if there are any questions you have, my mum and I would be happy to answer them for you. 
    xxx

  • Hello Embop

    Its good news that you don't need anymore surgery following clear margins. I had my lumpectomy Oct 4th and with clear margins, clear sentinel node, and 1 out of 3 nodes positive,  so very similar.  I think its fair to say that practice does vary and it was never suggested that I a axillary node clearance. It may depend on where the positive node was, did  they tell you. 

    In relation to the chemo,  practice around this also varies depending if yours is esrogoen, progresterone positive or HER2 negative, sorry but i don't know what yours was.  Locally where i live in the south east the main nhs trusts use something called Oncotype DX test which looks to see if the tumours would respond to chemo or not. I had this test done and it showed clearly that I would not benefit from Chemo. Saying that I still felt a bit uneasy with the result and although i didn't want chemo at the same time I didn't want to have the uncertaintly that it may have spread. I am now waiting to start the radio, hopefully before xmas.

    The oncotoype test was dealth with by the oncologist so that may be something they discuss with you, good luck with your appointment

    xk

  • Hi, 

    My mum has breast cancer, she had a lumpectomy and a sentinal lymph node biopsy which was positive (1/1). It was a difficult decision to make but we decided to do the axillary clearance for 2 main reasons:

    1) Peace of mind - knowing we've done everything we can 

    2) To help guide future treatment decisions

     

    Like you, we were fairly confident that the other nodes would be clear so we did the axillary clearance but level 1 and 2 lymph nodes only - it's worth asking your consultant about this (our consultant orignally said no and that all 3 levels were neccessary but our surgeon on the day said level 1 and 2 only was possible and that he would actually recommend it) - the risk of lymphodema reduces with this, althought there is still a risk. 

     

    Luckily, the rest of my mums nodes were clear (0/9), this gave us the peace of mind that we needed but also meant that my mum didn't need chemo (if we didn't do the axiallary clearance, then chemo most likely would have been recommended). It does depend on the charecteristics of your tumour however e.g. Her2+ or - etc.

     

    It's defo worth reading more about this - in our family we have a medical student and someone who works in the pharamaceutical industry who helped massively. Here are some links that might help:

    www.ncbi.nlm.nih.gov/.../28898379

    www.thelancet.com/.../fulltext

     

    I wish you the best of luck!

  • Hi Embop.

    The answer to this question is not always black and white.

    I am not a medic, but I think if I was in your shoes I would ask the oncologists what the chances are of a recurrence with, and without, node clearance. The Consultant says she will bet money on it. You need more information in the form of percentages.

    You can then balance that out against the chances of possible side effects (the oncologist can give you statistics for that as well) and whether they may be permanent. As I said I am not a medic, but know that the chances of getting lyphodaema, as other people are mentioned in their posts, are important to bear in mind.

    Armed with this information, you can then make your own decision. 

     

  • Hi, I know this post is a year old but my mum is in literally exactly the same position as you were and unsure what to do. Lumpectomy and one node out of three positive. How did you get on? And did you have chemo? Really hope you're well x

  • Embob

    Hi  Embo. I had three nodes involved  and had all lymoth nodes removed from under my right arm .i did get a seroma, its a build up.of fluids as the nodes aren't there to drain awsy fluid.  It doesn't happen to everyone ,but after having it drained twice  and one infection there its healed up well .it just is your decision to make, but yes do talk to your oncologist, I did mine as was offerd chemotherapy  and radiotherapy as a precautionary measure, I struggled making that decision, but after carefully thinking about it ,I decided to go ahead with it, as my way of thinking was...there is no guarantees if I have chemotherapy  and radiotherapy  that it will  or wont return ,but having it  if it did return I could honestly say I'd done all I could  to try to prevent it coming back, but if I didnt go ahead with it  id always be thinking if it did return, maybe if id have had chemotherapy and radiotherapy it wouldn't off come back. 

    Ive just finished my chemotherapy on Monday 14th December, but not yet had the Radiotherapy, but it won't be long coming i guess,don't know how many times or for how long yet .Good luck with your decision. X