Sentinel Nodes for Everyone?

[jsattaw]

One of my friends was recently diagnosed via mammogram, sonogram, MRI & needle biopsy. She just saw her surgeon who told her she would only need a lumpectomy and that she would NOT be doing a sentinel node biopsy.

This surgeon is highly regarded in our community and recently performed my mastectomy with SNB.

I'm very surprised she will not be checking lymph nodes. What are your thoughts?

Thanks.

Jill

[Tom]

Dear Jill,

My personal opinion is that she absolutely should have a SNB. How else in the world will she have an accurate staging without taking a look at the axillary nodes? in case you never read about my Mom, I will justify my position on the matter. Mom's surgeon did not even do a needle biopsy before the surgery. There was also no SNB, because the surgeon was POSITIVE they knew what cell type they would find, and that Tamoxifen would be the answer after a lumpectomy. One enlarged node was taken, and it was found to be disease free. But there was no assurance it was one of the sentinel nodes.

Well guess what! The cancer turned out to be HER2+++, ER-, PR-. Then, eight months later her axillary nodes blew up over a period of a week. Biopsy of them confirmed more cancer, and not just a little bit. The following axillary dissection revealed a horrifying 12 of 20 nodes positive for disease. I was sick at my stomach. So Mom went through the radiation all over again, trying to contain the cancer to the lymph nodes. Had she known in the beginning that there was disease in her axillary nodes, it might have been stopped cold right there with a larger radiation field. Now we are into Herceptin, and as many helpful supplements as we can find, as Mom is older and cannot tolerate standard chemotherapies. I know that people are sick of hearing our particular tale of woe, but I just want people to remember that it is what you DON'T know that can really hurt you. Anything less than the maximum possible information that can be obtained, is just plain stupid. I believe that the current treatment protocols are recommending SNB in all cases, but you'll have to check.

Good Luck,
Tom

[AlaskaAngel]

http://www.nccn.org/patients/patient.../3_work-up.asp

[karenann]

Maybe she just has DCIS. My mom had a lumpectomy for DCIS, 10 years ago and did not need any lymph nodes removed, which is usually the case.

Same with my Mom at 67: "SNB won't change treatment". Well....not having it would certainly have made it hard to know what options to consider. After a hand delivered note to the surgeon suggesting that if he wanted to deviate from American Cancer Society accepted standard of care he would have to explain why, next meeting he was singing a different tune. Second opinions after surgery consistently leaned on info from SNB. Mom has had no side effects from the SNB...but even if she did, she would rather have the information. I would add that I have read many times that the procedure is not for beginners and the more the surgeon has done, the more likely it will be accurate.

[Nicola]

I am 37 years old and was diagnosed in March 2004 with DCIS stage 0, I underwent a lumpectomy with NO lymph nodes removed, they removed the microcalcifications and they even went in a second time a month later to re-check the margins by removing more breast tissue, it came back clean. I underwent radiation everyday for eight weeks and continued to have check-ups and mammograms every six months. I received no chemo, or any adjuvant therapy. I thought I was doing great and felt so blessed and fortunate to have caught it so early as I had lost my mother and mother in-law to breast cancer. On Decemeber 1, 2005 I went in for surgery to have my gall bladder removed as I had had a bad gall bladder attack. When my onc went in to remove it he was shocked to find extensive cancer in my liver in both lobes, he immediately did a biopsy of the liver that came back cancerous HER2++++ I also have cancer in my spine. The only thing my onc's can figure is that there must have been some invasive cells in the breast that were not found in the original biopsy. I am now undergoing chemo with Lapatinib, Herceptin and Taxol with no end in sight. Please make sure you get a second opinion and really weigh out the decision of whether or not to have the sentinel nodes checked.

I wish you all the very best.

Big Hugs,
Nicola

[Marlys]

I really am not sure I know what I am talking about but my primary care physician made arrangements for me to have my lumpectomy and sentinel node biopsy. It was Spring vacation time and she really had a hard time finding a surgeon to do the procedure because so few are qualified (or trained) to do the SNB and most of them were on vacation with their families. When I sniveled to her that I felt it was really wrong that I had to wait 5 weeks from dx to surgery she agreed and said it was a shame that more surgeons were not qualified to do the procedure.
Marlys

[jsattaw]

Thanks for all of your replies. I will pass on the info to my friend and urge her to discuss this important issue with the surgeon.