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Steph,
I apologize. it was my understanding that you DID insist on a mastectomy. From a closer examination of your post however, I believe the only thing you had to gain by getting the mastectomy originally, was a reduced chance of LOCAL recurrence, as you indicated that you already had axillary involvement. My Mom's tumor was right up against the chest wall, and I knew then it was going to be trouble. My mistake with Mom was not being forceful in seeing to it that the surgeon did a sentinel node biopsy. That would most likely have shown the micrometastes in her axilla, that went on to develop into a 12/20 node involvement over the following months, requiring her to go through a level II axillary dissection, rather than a radiotherapy approach to the axillary micromets. The surgeon took one enlarged node at the time of the original surgery, and found it to be free of malignant cells, giving all involved a false sense of well being regarding axillary spread. When she subsequently discovered that the cell type was not estrogen sensitive, as she virtually assured me it would be earlier, the poop hit the fan. The lumpectomy was suggested based on the suppostion that the tumor was ER+ and would be easily managed even without rads, but Tamoxifen alone. Her plan was to deal with any local recurrence through additional surgery later. So much for pre-surgical assumptions without biopsy.
Debbie,
My understanding of this disease, is that lymphatic spread is the most likely first route of the cancer, followed by vascular invasion. Surgical biopsy either prior to or during surgery, can be a crap shoot with respect to identifying metastatic prognosis. If you don't happen to find an invaded lymph duct or blood vessel in the slice being studied, you can't conclude that there is neither type of spread happening at the tumor bed site. Of course, as you mentioned, the lymph node studies, whether via sentinel node biopsy or extensive dissection, are the primary indicator used to determine risk of metastasis. I feel that the examination of the surgical margins is but one of a series of what amount to "clues" to metastatic risk, rather than a very accurate marker of such risk, and that the surgical margin taken predicts only the odds of local recurrence, if even that. It has been shown of course, that even women with extensive identified distant metastases prior to any surgery, benefit from attempts to remove as much of the primary tumor as possible, as this reduces the tumor overall tumor load, and improves the effectiveness of subsequent chemotherapy of any kind. If anyone has seen, heard, or read anything different than what I have described, by all means, please correct me.
Tom
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