Venting Grrrrrrrrrrrrr

[Patty F]

Hi Ladies. AGAIN I need your help. Here is the situation:
October 15th I had 2 lymph nodes removed from the axilla area that were cancer. January 30th I had a modified radical mastectomy. After surgery the surgeon told my family that he removed 70% of the lymph nodes in the axilla. After surgery I picked up my pathology report and it said nothing in it about the lymph nodes. I asked the surgeon about it and he said he would check on it. In the mean time I had a PET scan and it showed a lymph node in the axilla that was bad. Today I had an appointment with the surgeon and he said that pathology said there were NO lymh nodes in the specimen and now he wants to go in there AGAIN and remove this one lymph node.

Are lymph nodes hard to find?

Do I trust him to go in there again and remove the nodes or is he trying to do surgery again because he didn't remove them in January?

HELP

[AlaskaAngel]

Patty, I don't know what you might have said in an earlier post so have to ask,

Are you saying that you have a pathology report for the first surgery that says that 2 lymph nodes were removed and were cancerous,

and then you picked up a different pathology report from the second surgery (the one the family heard him say that he took out 70% of the nodes) and there were no nodes noted as removed on that path report?

AlaskaAngel

[Patty F]

That is correct

[AlaskaAngel]

We all differ as to how many nodes each one of us has. Obviously some have many, others have very few. If doing sentinel node biopsy they try to track and find either by dye and/or by radiologic response (as in geiger counter) the first node or nodes with the dye and/or rads response for removal. If clear, then likely no others need to be removed. We are all generally anatomically fairly alike but not everyone is.

Not all surgeons have lots of experience with removal of lymph nodes. It is possible but less likely for those who have done lots of lymph node removals to miss a node.

Is your surgeon a breast cancer specialist?

If he thought he "removed 70% of the nodes" during the second surgery and he wasn't speaking about the original surgery, then I don't think I'd be comfortable about it.

AlaskaAngel

[Patty F]

I don't have a surgeon that is a breast cancer specialist on my insurance.

[AlaskaAngel]

A surgeon doesn't have to be a "breast cancer specialist" to be taking out nodes successfully but if not then you are likely to get more accurate results if the surgeon did a fair number of them under supervision of a surgeon who has done a lot of them before doing them independently, and who has done a fair number after that.

I would want to know more precisely what the surgeon was referring to when he said he removed 70% of the nodes. For example, how much tissue was actually removed during each surgery?

[CLTann]

I just don't feel comfortable to hear 70% removal report. Why didn't he remove 100%? As we well know, partial removal is asking for trouble at a later date, since cancer can grow from a very few number of cells, nevermind a hunk of 30% mass. I suspect that the surgeon was lying to you, trying to cover up his imcompetence. Find a better surgeon, if it is possible.

[DonnaD]

Hi Patty,
I am confused. Did the surgeon remove 2 lymph nodes or 2 levels of nodes, getting 70 % of the nodes?

I had a level two node disection, and had 9 nodes, one of which had cancer. Angel Alaska is right we all have a different number of nodes.

Is it possible to take reports and get a second opinion? I am sure that would give you peace of mind. Any good surgeon welcomes second opinions.

I am sorry you are dealing with this stress. Hoping others will chime in.

The Her2+ gals from N. IL are getting together on Sunday, our second outing. I know it is a long drive for you but we would love to have you join us. Are you interested in details?

Donna
Donna

[Patty F]

Donna
The 2 lymph nodes that were removed were from the 1st surgery. When I was first diagnosed I had went to the Dr. because I had a lump in my axilla. And those are the two that were removed. I don't think he removed any at the time of the mastectomy.

[Hopeful]

Patty,

It used to be that a mastectomy included a level 3 axillary dissection, which means that all of the nodes are removed. Lymph nodes are not hard to find, but the surgery for them is not terribly specific - it generally involves excising a wedge of fat from under the arm. You would most likely have a second incision and be rather sore from it.

A sentinel node biopsy involves using either a radioactive tracer or a dye to see which node is the first site of drainage from the breast, then removing only that node and testing it for cancer. The thought is if there is no cancer in the first node, the rest are most likely cancer free and do not require excision. Did you have this procedure last fall? Doctors sometimes remove 2 or three nodes instead of just one with that test.

As to why you did not have nodes removed with your mastectomy when the doctor said he did it is a very disturbing question. I agree with the others here that you should get a new surgeon if at all possible. If this one told your family he did a procedure he obviously did not do, he is not behaving in an ethical manner, and you are well within your rights to seek another physician.

Hopeful

[Patty F]

I do believe you are all correct and I should seek a second opinion. I am not comfortable with him going in again to remove a lymph node that showed up on the pet scan 2 weeks ago.
Donna.......I can't make this months meeting (babysitting the grandson) but please let me know about the next one.