- Joined
- Dec 17, 2007
- Messages
- 3,653
- Reaction score
- 5,052
Invasive lobular breast cancer on the left side pT1c pN0 (sn), received BCS und adjuvant RT to the breast (50 Gy to the breast + 10 Gy boost) in 2002, she was in der 40s back then. ER+ PR+ Her2-
She remained in remission for 20 years, underwent adjuvant endocrine therapy for 5 years.
Now, in her 60s, she presents with a large recurrent tumor (8cm) in the left breast and one possible axillary node. PET-CT negative for futher disease. Biopsy shows the exact same biology as 20 years ago.
Mastectomy and ALND is performed. pT3 pN1 (2/4) R0. Macrometastatic nodes, no ECE, some L1 in the ALND-sample however. I have no idea why the pathologists only found 4 nodes in total. The ALND specimen is adequately big, this was not a TAS (8 x 4 x 2 cm). No reconstruction planned.
I am going to treat chest wall and lymphatics (IM and the supraclavicular fossa.), my only question is:
Do I treat the axillary nodes too?
I would have not treated it, if there were a few more negative nodes, but 2/4 + L1 worries me.
On the other hand, she has had dose there from the breast tangent 20 years ago and combined with the two surgeries she has had in the axilla, her risk for complications (edema and possibly plexopathy) will be quite high.
She remained in remission for 20 years, underwent adjuvant endocrine therapy for 5 years.
Now, in her 60s, she presents with a large recurrent tumor (8cm) in the left breast and one possible axillary node. PET-CT negative for futher disease. Biopsy shows the exact same biology as 20 years ago.
Mastectomy and ALND is performed. pT3 pN1 (2/4) R0. Macrometastatic nodes, no ECE, some L1 in the ALND-sample however. I have no idea why the pathologists only found 4 nodes in total. The ALND specimen is adequately big, this was not a TAS (8 x 4 x 2 cm). No reconstruction planned.
I am going to treat chest wall and lymphatics (IM and the supraclavicular fossa.), my only question is:
Do I treat the axillary nodes too?
I would have not treated it, if there were a few more negative nodes, but 2/4 + L1 worries me.
On the other hand, she has had dose there from the breast tangent 20 years ago and combined with the two surgeries she has had in the axilla, her risk for complications (edema and possibly plexopathy) will be quite high.