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Advice on Sentinel Node Biopsy or ??

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koala55 View Drop Down
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    Posted: Jan 29 2016 at 8:45pm
Hi,
Have been reading the forum but this is my first post. Have completed 12 weeks of chemotherapy (4 cycles with carboplatin each 3 weeks along with Taxol weekly). Tumor has reduced from around 3 x 4 cm to 1 x 0.9cm. Biopsy at beginning of process (October) showed cancer cells in lymph nodes (2, I think). It is TNBC - Grade 3 and Stage 2-3. I have surgery - lumpectomy next week and am trying to make decision re how many lymph nodes should be removed. At this point I am having a Sentinel Node Biopsy and hope to retain as many lymph nodes as possible but wonder if I am better to take the most conservative approach and just have all 3 layers removed. From what I gathered from my Oncologist I will be having more chemo after surgery but I guess he will wait for all pathology results are in. I am in Singapore where perhaps they may take the more aggressive approach?? Any thoughts or advice would be appreciated. 
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gordon15 View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote gordon15 Quote  Post ReplyReply Direct Link To This Post Posted: Jan 30 2016 at 9:37am
koala55- you have a similar dx to my wife, who had carbo/gemzar and had much the same partial response in tumor but a complete response in 3-4 lymph nodes which were almost certainly cancerous although a needle biopsy was negative, node biopsies are sometimes wrong(it slips around or may not all be cancerous) and the radiologist even said further investigation was needed. Nodes lit up on PET/CT, abnormal on MRI/US/ surgeon, onco and radio-oncologist felt enlarged in exam, the radiologist-oncologist felt 4 enlarged. Good to have 3 opinions.
 
There are several recent (last couple yrs, I read them) studies that confirm NOT to excise all nodes, as it increases likelihood of lymphedema, which my wife got in her other arm after non-TNBC surgery in 2008.

found it> http://www2.mdanderson.org/depts/oncolog/articles/13/10-oct/10-13-1.html


Her surgeon and oncologist told her this time "if the first sentinel nodes looks suspicious, we will remove them all, just the first line, so they took out 5. They do what they call a quick test during the operation to check for cancer on the ones that are shown via nuclear targeting, I even saw the image clearly showing 2 nodes first in line from the breast in preop, her surgeon showed us.
She had 4 nodes abnormal size and without the fatty outside (often a clear sign of carcinoma), were talking about over a centimeter instead of 3-5 mm normal size, anyway the chemo killed the cancer in the nodes so they said stage 3A since nodes were considered free of disease. She had single masectomy and the tissue was sent for genetic testing (6 genes all were negative for mutations) Hope this helps.


Edited by gordon15 - Jan 30 2016 at 10:12am
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Dporter Quote  Post ReplyReply Direct Link To This Post Posted: Feb 22 2016 at 10:43pm
Hi Koala55,
I wondered how your sursery went and if you got your pathology back. Your case is similar to mine. I just had my lumpectomy on Thursday and go back this Friday for the pathology report. Waiting to see what will be recommended after report. I like to be prepared with questions before going if you don't mind sharing your experience.
Thanks,
Debbie
Dx TNBC 7/15; age 52; stage 2, grade 3, BRCA negative; Taxol weekly x 12, DD AC x4 completed 1/19/16
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Post Options Post Options   Thanks (0) Thanks(0)   Quote koala55 Quote  Post ReplyReply Direct Link To This Post Posted: Feb 23 2016 at 4:36pm
Hi Debbie
My pathology following surgery showed no trace of cancer in tumour or lymph nodes. The first layer of lymph nodes was removed (?17- which seems a lot). So a pathological complete response to chemotherapy prior to surgery. I go back to oncologist on Monday. He has suggested 'standard treatment' of 4 cycles of AC but said it could be good to add 2 more cycles of the first treatment I had which was carboplatin and taxol. This would be done first then the AC. My chemotherapy before surgery was 4 cycles of carboplatn and taxol - weekly over 3 months. Will get a second opinion on Friday to guide me with this decision. Hope you get good pathology results. Would be interesting to know what your next steps will be. So far my recovery seems ok after surgery and I have not had problems with drainage but might seek some physio to be sure. Best wishes.
Mez
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Post Options Post Options   Thanks (0) Thanks(0)   Quote koala55 Quote  Post ReplyReply Direct Link To This Post Posted: Feb 23 2016 at 4:38pm
Hi Gordon,
Thanks so much for your information re your wife. Only just figured out how to reply so if you wish read my reply to Debbie (below).
Best wishes.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Dporter Quote  Post ReplyReply Direct Link To This Post Posted: Feb 23 2016 at 9:47pm
Hi Mez,
Are you brca+? I am brca- so they did not give the carboplatin. I have taken the weekly taxol and the AC. I have heard of the surgery being between the chemo as yours seems to be. All my chemo was up front. I am still waiting for my pathology report on the lumpectomy. They only took the one sentinal node in my surgery but I was dtermined to have no node involvement with my first diagnoses. I am recovering well from the surgery. Will let you know what I find out.
Thanks,
Debbie
Dx TNBC 7/15; age 52; stage 2, grade 3, BRCA negative; Taxol weekly x 12, DD AC x4 completed 1/19/16
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Post Options Post Options   Thanks (0) Thanks(0)   Quote koala55 Quote  Post ReplyReply Direct Link To This Post Posted: Feb 23 2016 at 11:22pm
Hi
I have not had the testing for BRAC but am following up now. Did ask early in the piece but the oncologist did not seem to think it necessary.
Best wishes
Mez
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