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Help me to understand and make friends with my lymph nodes :)
I am in the middle of 15 sessions radiation treatment (post-lumpectomy) for my first-timer BC. My deets: Age 63, IDC stage 1 grade 2, 16-18mm, ER+ PR- HER2-, clear margins (though one was just 0.5mm), oncotype high at 32, no BRCAs, refused chemo. Healthy, active, plant-heavy diet, transitioned from a high-stress life to a low-stress life about 5 years ago.
I had a sentinel node removal & biopsy and it was clear.
So...what exactly does that mean? Specifically,
Does it mean that there's a likelihood my breast cancer hasn't spread anywhere else?
Does it mean that it likely didn't spread TO my breast from somewhere else?
There's a ton of conflicting stuff online and I was wondering if you can help me to understand.
AIs are recommended for me and I plan to give them a try just to see.
But my questions above don't seem to be ones that my medical team are willing to discuss in any detail. Liability issues, maybe? Unsure.
What are your thoughts or learnings about this, Mayo fam? Or what should I be searching for, in terms of credible studies?
Love to all.
(edited to add stage and grade)
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Good questions--and here is what I know from being a patient.
Does it mean that there's a likelihood my breast cancer hasn't spread anywhere else?
No spread to lymph nodes is a good sign, but there is really no way of knowing with total certainty when/if breast cancer will spread.
Does it mean that it likely didn't spread TO my breast from somewhere else?
That would be unusual, and if so, it would not be breast cancer but a cancer from its place of origin. Did anyone imply that might be the case? I think your oncologist could give this a direct answer.
AIs are recommended for me and I plan to give them a try just to see.
My own experience with letrozole (an AI) has been good. I also didn't have chemo, due to kidney disease and other co-morbities. My diagnosis was 3 years ago, when I was 68, and I have no side effects from letrozole.
All best going forward. It can be hard to sort through decisions--I know from experience!
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2 ReactionsGood questions!
I’ll try answering your first one based on my experience and what my doctors told me. I’ve had breast cancer twice. The first was about 10 years ago when I was 42. Super low grade, hormone positive, left breast only. No BRCA or family history. Had a double mastectomy, clear margins and a sentinel node biopsy that was clear. No radiation or chemo was recommended, but I was prescribed Tamoxifen. I researched Tamoxifen and became concerned that other health concerns could develop from it—especially ones that ran in my family. At the time, I was told that I had a 6% chance of the BC returning. I rolled the dice and declined Tamoxifen.
Fast forward 8 years—the breast cancer returned. Same stuff, left axilla (arm pit area) slightly higher grade (as is typical, I’m told), all in the lymph nodes. Because the cancer came back in my lymph nodes, it was recommended that I under go chemo, then radiation and take an AI. I did all that and have continued with the AI.
When I asked my doctors about the mechanism of reoccurrence (Why did the BC return when I had no breasts and when my sentinel node was clear?), I was told that it was impossible to know precisely what happened. But one doctor told me what was possible. She said that one cell from BC #1 could have traveled past the sentinel node and lay dormant for years. BC #2 happened when the cell decided to wake up and start multiplying. It just takes one cell.
I think it is logical to conclude that if you have clear sentinel nodes that you are less likely for reoccurrence. But it’s not a guarantee. As another doctor told me, cancer doesn’t follow logic. We can observe patterns of its behavior and that can help determine treatment.
Wishing you the best of health as you complete your radiation treatments!
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