Prognosis when cancer still in 1 lymph gland after chemotherapy??

Hi,

My mother was diagnosed with cancer at the end of August of last
year. After the biopsy she was told that she had grade 1 cancer which
is a low growth grade. However when she had a lumpectomy a month
later, she had 5 lymph nodes removed and 4 out of the 5 nodes were
cancerous. So she was then told that she had Grade 2 cancer.

Six weeks later she started chemotherapy and April 16th of this year
she had a masectomy. During the operation 17 residue lymph nodes were
removed and one of those nodes was cancerous.

My question is, does this mean that the chemotherapy was not
successful and that the prognosis is not good. Also, why did they not
give her the masectomy as soon as they found out she had grade 2
cancer and then give her the chemotherapy afterwards?

Also, residue nodes, does this mean all of my mother's lymph nodes
have now been removed or could there still be some inside her
containing cancer.

One more question, sorry, but she didn't start radiotherapy until 8
weeks after the Masectomy, should it have been started earlier?

I would be really grateful for any advise, I have been given advice
and support from this board last year when my mother's diagnosis was
first made and it did help to explain things to me and to her.


Kind Regards.....Denise

> weeks after the Masectomy, should it have been started earlier?
>
> I would be really grateful for any advise, I have been given advice
> and support from this board last year when my mother's diagnosis was
> first made and it did help to explain things to me and to her.
>
>
> Kind Regards.....Denise
>

Sorry to hear about your Mom, I am unclear why they finally did the
mastectomy. Stage 2 is still considered early breast cancer.

Alex

Hi, Denise,

Comments/questions interspersed below.

"Denise" <denise528@hotmail.com> wrote in message
news:1181683809.083878.139620@o11g2000prd.googlegr oups.com...
> My mother was diagnosed with cancer at the end of August of last
> year. After the biopsy she was told that she had grade 1 cancer which
> is a low growth grade. However when she had a lumpectomy a month
> later, she had 5 lymph nodes removed and 4 out of the 5 nodes were
> cancerous. So she was then told that she had Grade 2 cancer.

Grade 2 (as in aggressiveness), or Stage 2 (extent of spread, more-or-less)?

> Six weeks later she started chemotherapy and April 16th of this year
> she had a masectomy. During the operation 17 residue lymph nodes were
> removed and one of those nodes was cancerous.
>
> My question is, does this mean that the chemotherapy was not
> successful and that the prognosis is not good.

It doesn't necessarily mean the chemo was not successful. I'm sure it does
influence the prognosis in a negative direction. I have a friend who had
neoadjuvant (before surgery) chemo, and still had multiple positive nodes
after chemo . . . that was nine and a half years ago. Clinically, they did
observe her high-grade (growth/aggressiveness) primary tumor shrink
dramatically. (She was Stage III).

Prognosis is influenced by *many* factors - grade, stage, responsiveness to
chemo, various details of tumor pathology, various aspects of patient (age,
other health factors, ....). And prognosis is only a statistical estimate,
not a crystal-ball insight. My friend's prognosis wasn't super-duper, but
she's here & NED today. My prognosis was 60% to 80% depending on which
doctor was doing the estimating, and I'm not 60% or 80% alive today, AFAIK
<g>.

I'm not a medical professional, but my novice understanding is that doctors
think in terms of what a particular treatment is supposed to control. The
breast cancer spread may be local (breast only), regional (axillary lymph
nodes) or systemic (elsewhere in the body). Systemic spread could be
metastatic (Stage IV), i.e., actually be active & growing breast cancer
tumors in (typically) bones, liver, lungs or brain. Or, systemic spread
could be individual cancer cells roaming around the body, trying to become
metastatic disease but not having become established tumors yet. (There's
no good way to detect the latter via scans & such.)

Lumpectomy or mastectomy surgery is for local control. The axillary node
removal (as I understand it) is usually more for diagnostic purposes (to
determine whether there's regional spread) than for local control.

Radiation is for local or regional control. It's pretty much always done
with lumpectomy, and may be done with more advanced (regional spread or
advanced local or near-to-chest-wall local spread) BC with mastectomy. (I
had radiation with mastectomy six and a half years ago, after Stage III
diagnosis.) Radiation fields vary, and can include the axillary area (to
kill off cancer cells remaining in axillary lymph nodes) or areas such as
supraclavicular or mediastinal lymph nodes, which are usually not biopsied.

Chemotherapy is mainly for systemic control. In stage III or lower (i.e.,
no known established metastatic disease), it's trying to kill off
circulating cells (if there happen to be any) or undectectable tiny
metastases, and prevent the BC from becoming truly metastatic. In stage IV,
it's used mainly when there seems to be a chance of extending life without
undue sacrifice of quality of life.

> Also, why did they not
> give her the masectomy as soon as they found out she had grade 2
> cancer and then give her the chemotherapy afterwards?

I don't know that, and can't think of a guess.

I think that usually lumpectomy vs. mastectomy is not a grade
(aggressiveness) issue, but a tumor size/location (which is loosely related
to stage) issue. Very large or multiple breast tumors may require
mastectomy, because there's enough tumor material that one couldn't get a
reasonable cosmetic result with lumpectomy (and the point of lumpectomy is
basically cosmetic - preserving the breast for appearance or
self-image/psycho-social reasons).

Sometimes mastectomy is done because they can't get "clear margins" --
remove a big enough area of non-tumor material between the tumor and the
remaining breast tissue during the lumpectomy.

Sometimes mastectomy is done because the patient wants it, for peace of mind
(lower risk of additional future breast tumors).

None of those typical reasons that I know of, seem to explain what happened
in your mother's case.

Were there any mammograms done during or after her chemo that showed
additional suspicious or cancerous areas in the breast? Did she ask for
the mastectomy? Was her chemo started so soon after the lumpectomy that
they didn't have pathology about the margins of the lump, and found out
about the insufficient margins after chemo started (unlikely)?

> Also, residue nodes, does this mean all of my mother's lymph nodes
> have now been removed or could there still be some inside her
> containing cancer.

They don't usually remove all the nodes any more. You might want to read
Dr. Susan Love's Breast Book (highly recommended, and available widely) to
get more details about this and other aspects. My dim recollection is that
the axillary lymph nodes are in groups or layers, and they may remove one or
more of these layers -- assuming they go beyond the "sentinel node" sampling
process at all. The more lymph nodes are removed, the greater the risk of
lymphedema later, and that's a bad thing, too. Remember that radiation can
be used to try to kill cancer cells in the lymph nodes, also.

> One more question, sorry, but she didn't start radiotherapy until 8
> weeks after the Masectomy, should it have been started earlier?

You have to be healed from surgery before you start chemo or radiation. I
had to wait about a month after mastectomy before starting chemo. I'm not
sure how long women wait between lumpectomy and radiation if they're not
having chemo. I've read that (in more typical cases than your mom's)
waiting more than 3 months between surgery and any other treatment (chemo or
radiation) is a bad idea in terms of outcome statistics. I suspect that a
longer wait might be a worse idea if you have high grade (aggressive) BC,
expecially if it's also a higher stage, but that's just a guess.

The wait between surgery & other treatment is sometimes longer because of
post-surgical problems (such as infections). In your mom's case, since the
mastectomy followed chemo, she might have healed somewhat more slowly from
the surgery due to residual effects of the chemo.

> I would be really grateful for any advise, I have been given advice
> and support from this board last year when my mother's diagnosis was
> first made and it did help to explain things to me and to her.
>

Get & read Dr. Love's book, if you haven't already. It will help!

Best wishes to you & your mom for positive outcomes.

Ann T.
Remove 'dontsendspam' from address to reply by email

Denise wrote:
> Hi,
>
> My mother was diagnosed with cancer at the end of August of last
> year. After the biopsy she was told that she had grade 1 cancer which
> is a low growth grade. However when she had a lumpectomy a month
> later, she had 5 lymph nodes removed and 4 out of the 5 nodes were
> cancerous. So she was then told that she had Grade 2 cancer.
>
> Six weeks later she started chemotherapy and April 16th of this year
> she had a masectomy. During the operation 17 residue lymph nodes were
> removed and one of those nodes was cancerous.
>
> My question is, does this mean that the chemotherapy was not
> successful and that the prognosis is not good. Also, why did they not
> give her the masectomy as soon as they found out she had grade 2
> cancer and then give her the chemotherapy afterwards?
>
> Also, residue nodes, does this mean all of my mother's lymph nodes
> have now been removed or could there still be some inside her
> containing cancer.
>
> One more question, sorry, but she didn't start radiotherapy until 8
> weeks after the Masectomy, should it have been started earlier?
>
> I would be really grateful for any advise, I have been given advice
> and support from this board last year when my mother's diagnosis was
> first made and it did help to explain things to me and to her.
>
>
> Kind Regards.....Denise
>

I'm guessing and reading between the lines a bit, but I think you are
describing the following scenario.

Your mum had a diagnosis of stage I at the biopsy, proceeded to
lumpectomy and node dissection, which found 4 positive nodes and revised
the diagnosis to stage II. Chemotherapy was prescribed as would be
expected.

She then suffered a local recurrence and returned to surgery for a
mastectomy and further removal of nodes. This found one more positive
node. Radiotherapy was also prescribed.

If that is a fair description then I don't think there is anything
wrong, and her prognosis remains as it was after the original tumour was
removed, that would I think be something in the order of 40% risk of
metastasis (depending on detailed diagnosis). But do ask the
oncologist. I'm not a doctor, and I don't know the details anyway.

Local recurrences after lumpectomy are not particularly uncommon, the
standard treatment would be mastectomy, and it is not considered to have
much impact on prognosis.

I imagine that the radiotherapy was prescribed after the lumpectomy, to
be administered after the chemotherapy, but the additional surgery
delayed it. I doubt if the delay made much difference.

I imagine they removed all the lymph nodes they could find. But asking
whether there might be more inside her containing cancer is not really
the right question. The lymph nodes are not a source of spread of
cancer, they are a trap preventing it from spreading. So the important
question is whether the cancer has spread beyond the lymph nodes. If
they removed the great majority of nodes, then if any that remained
undiscovered were invaded (which in all likelihood they were *not*),
that would make it pretty likely that the cancer had already spread
further, and that it didn't matter whether they found it or not.


Tim Jackson

On Jun 13, 5:44 pm, Tim Jackson <t...@tim-jackson.co.uk> wrote:
> Denise wrote:
> > Hi,
>
> > My mother was diagnosed with cancer at the end of August of last
> > year. After the biopsy she was told that she had grade 1 cancer which
> > is a low growth grade. However when she had a lumpectomy a month
> > later, she had 5 lymph nodes removed and 4 out of the 5 nodes were
> > cancerous. So she was then told that she had Grade 2 cancer.
>
> > Six weeks later she started chemotherapy and April 16th of this year
> > she had a masectomy. During the operation 17 residue lymph nodes were
> > removed and one of those nodes was cancerous.
>
> > My question is, does this mean that the chemotherapy was not
> > successful and that the prognosis is not good. Also, why did they not
> > give her the masectomy as soon as they found out she had grade 2
> > cancer and then give her the chemotherapy afterwards?
>
> > Also, residue nodes, does this mean all of my mother's lymph nodes
> > have now been removed or could there still be some inside her
> > containing cancer.
>
> > One more question, sorry, but she didn't start radiotherapy until 8
> > weeks after the Masectomy, should it have been started earlier?
>
> > I would be really grateful for any advise, I have been given advice
> > and support from this board last year when my mother's diagnosis was
> > first made and it did help to explain things to me and to her.
>
> > Kind Regards.....Denise
>
> I'm guessing and reading between the lines a bit, but I think you are
> describing the following scenario.
>
> Your mum had a diagnosis of stage I at the biopsy, proceeded to
> lumpectomy and node dissection, which found 4 positive nodes and revised
> the diagnosis to stage II. Chemotherapy was prescribed as would be
> expected.
>
> She then suffered a local recurrence and returned to surgery for a
> mastectomy and further removal of nodes. This found one more positive
> node. Radiotherapy was also prescribed.
>
> If that is a fair description then I don't think there is anything
> wrong, and her prognosis remains as it was after the original tumour was
> removed, that would I think be something in the order of 40% risk of
> metastasis (depending on detailed diagnosis). But do ask the
> oncologist. I'm not a doctor, and I don't know the details anyway.
>
> Local recurrences after lumpectomy are not particularly uncommon, the
> standard treatment would be mastectomy, and it is not considered to have
> much impact on prognosis.
>
> I imagine that the radiotherapy was prescribed after the lumpectomy, to
> be administered after the chemotherapy, but the additional surgery
> delayed it. I doubt if the delay made much difference.
>
> I imagine they removed all the lymph nodes they could find. But asking
> whether there might be more inside her containing cancer is not really
> the right question. The lymph nodes are not a source of spread of
> cancer, they are a trap preventing it from spreading. So the important
> question is whether the cancer has spread beyond the lymph nodes. If
> they removed the great majority of nodes, then if any that remained
> undiscovered were invaded (which in all likelihood they were *not*),
> that would make it pretty likely that the cancer had already spread
> further, and that it didn't matter whether they found it or not.
>
> Tim Jackson- Hide quoted text -
>
> - Show quoted text -

I just wanted to respond to everyone who bothered to respond to my
message it has been very informative and sorry it has taken me so long
to get back. Also, thanks for the book recommendation, I'll order
it. As far as my mum's cancer is concerned, I think it was stage 2
and grade 2 and you are right in saying they discovered it was that
grade after doing the lumpectomy, prior to doing the lumpectomy they
had wrongly thought it was Grade I/Stage I.

They then decided to give my mother chemotherapy followed by a
masectomy but I don't understand why they didn't decided to do it the
other way around, does it make a difference???

Thanks..........Denise

As far as my mum's cancer

Denise wrote:
>> Denise wrote:
>>> Hi,
>>> My mother was diagnosed with cancer at the end of August of last
>>> year. After the biopsy she was told that she had grade 1 cancer which
>>> is a low growth grade. However when she had a lumpectomy a month
>>> later, she had 5 lymph nodes removed and 4 out of the 5 nodes were
>>> cancerous. So she was then told that she had Grade 2 cancer.
>>> Six weeks later she started chemotherapy and April 16th of this year
>>> she had a masectomy. During the operation 17 residue lymph nodes were
>>> removed and one of those nodes was cancerous. ....

> They then decided to give my mother chemotherapy followed by a
> masectomy but I don't understand why they didn't decided to do it the
> other way around, does it make a difference???
>

Not really. It does seem a bit unusual. It was most likely just a
matter of administrative convenience. Perhaps they didn't want to delay
the chemotherapy while waiting for the second operation, perhaps there
was some sort of delay or queue. I think you'd have to ask the surgeon
to know for sure the reasons why. I don't think it is important.

Tim