Lymph node clearance or radiotherapy for breast cancer

[Temporarynameforthisone]

Hello,

I was diagnosed with breast cancer in July last year and I’m under the care of the NHS and they’ve been amazing up until now. I had a lump and one positive lymph node.

I completed 5 out of 6 rounds of chemotherapy, was due to have my 6th n December but I had the flu and two scans showed I’d had a total response, I couldn’t have been happier. My oncologist wanted to push on with surgery. I had my surgery in February, a lumpectomy and four lymph nodes removed, surgery went well, really tidy scars and a great recovery.

I went along to my follow up appointment and I’ve been told the biopsy of lymph node 1 showed some live cancer cells were still present. Lymph nodes 2,3 and 4 were clear.

My consultant said the next step is return to surgery for lymph node clearance, remove the remaining lymph nodes in that arm pit. I asked what are the chances of cells skipping lymph nodes 2,3 and 4 and swelling further along and she said it was unlikely but, current NHS guidelines dictate they have to recommend lymph node clearance. She went on to say there is a lot of research currently taking place in to this procedure but the results aren’t available yet and if we were sitting here in 5 years time she wouldn’t be recommending this procedure. It would be considered unnecessary and radiotherapy would be recommended instead. She told me it is patient preference whether I have clearance or radiotherapy but restated the current NHS guidelines recommend clearance. I felt she was encouraging me to opt for radiotherapy but couldn’t say that as it would go against NHS guidelines which obviously she can’t do.

Has anyone else been in this position and had to choose between lymph node clearance and radiotherapy?

Lymph node clearance carries health risks for the future, lymphoedema and should the breast cancer return it’s easier for it to spread around the body to the major organs. I asked if the procedure is overkill as none of my remaining lymph nodes have shown there to be cancer present and my consultant said yes but cancer scares people and can kill you. She reiterated in five years time research won’t recommend this procedure but NHS guidelines do at the moment.

I’m leaning towards radiotherapy but scared it the wrong choice.

Hi there, I have just been through an almost identical situation to you (only difference being a mastectomy rather than lumpectomy). I too was told that the current protocol in this situation was to go back to the operating theatre for a full clearance. After lots of discussion with my oncologist (and her saying that the data was showing that radiotherapy gave the same results as surgery) I decided not to have a full clearance and went ahead with radiotherapy (which I’m currently undergoing).
Hope this helps. All the decisions you have to make are so difficult.

Hi and well done on getting through your treatment so far. I had stage 3 triple negative BC a few years ago. I had a mastectomy which showed that one lymph node was affected. I then had chemo, a full clearance and radiotherapy. I was very worried about having the clearance but I healed quickly with no later issues. After the procedure I did feel immense relief that no further spread was found. Hope that helps and that the rest of your treatment goes well xx

I can’t advise you what to do (no medical expertise) but my experience was that I had a sentinel node biopsy which came back with all three nodes having cancer cells so I had the recommended full node clearance and it turned out that none of the others were affected (I then also had chemo & radiotherapy). Haven’t had any issues with lymphoedema. I wasn’t aware that having a full clearance made it easier for the cancer to spread: funnily enough nobody explained this to me at the time (but with three positive nodes it felt like a no brainer to check the others). I think in your shoes I’d be inclined to skip a second operation, keep the rest of the nodes & blast any remaining pesky little bastard cancer cells with radiotherapy.