Hi Guys and Gals-
Sorry
for the delay in writing but there was lot to do after I left the
doctor's office and it was a long wait once we arrived. Our doctor is
very conscientious and does not rush through any of the needed
explanations and you can imagine that I had asked quite a few very good
questions as the good doctor pointed out. It turns out that I will be
needing chemotherapy after-all. Once the chemotherapy is done- I will
take a break and go on my 60th birthday celebration on a 14 day
Caribbean Cruise, When I return- I will then start radiation therapy.
(For
my work buddies- I told her I understood why I needed both kinds of
follow treatments- one works like a seat belt and the other works like
an air bag- very differently but BOTH there to save me) She loved it!
The
surgeon extracted 3 lymph nodes and the first one- also know as the
gate keeper was dirty (positive for cancer) and the 2 right behind it-
were clean (negative) and I had other lymph nodes floating in my breast
tissue that were also dirty with cancer.
So
in other words--- I am a N1- my Lymph Node is Positive because only the
first one was Positive and the other 2 were Negative. Sometimes
referred to a 1/3 (took out 3, one is positive ) Below is an article for
those of you interested in the staging etc..... Also, because I did
have some cancer filled floating lymph nodes in the actual breast
tissue, perfectly clean margins were not likely achieved at tumor site.
I will be receiving 4 doses of Adjuvant therapy. It is given to kill cancer cells that remain after surgery.
I
already did lots of the things they recommend before starting chemo- my
teeth are being cleaned on Friday, already had my annual Pap test last
month-stopped all my vitamins- will see my hair dresser who was treated
for breast cancer 4 years ago and she will coach me on my hair loss and
options- Do not think I am into having a wig- likely will scarf it .
My
lovely daughter Madison is still living at home and will step up to
help me manage but I also know that many of you have offered to help in
any way. My sister Janet is right behind me- my friend Harold is near by
and so is my niece Beth-
So that is it for
now folks- I am looking at this an as inconvenience in my life because I
have dealt with far worse situations over the years. I am not in harms
way and alone. In fact, I am in great hands and have all of you to love
and care for me. Yes, Inconvenient but not tragic.
good night and sweet dreams to all of you- I love you dearly.
with all that I am,
Nancy
"Ask for help around the house. The
most common side effect of chemotherapy is fatigue/feeling tired. Ask
someone close to you to help organize the chores you normally do, such
as cleaning, grocery shopping, cooking, and carpooling. It can be hard
to ask for and accept help from others, but in most cases your loved
ones will be happy to do something that helps you in your fight against
breast cancer."
Talk
to your doctor about maintaining your routine while on
chemotherapy. How much of your regular routine you can keep up while on
chemotherapy will be different for every person and depend on your
unique situation. Some people continue to work while others need to take
time off. Your doctor and oncology nurse can help you figure out how
you're going to feel and how much you may or may not be able to do based
on your regimen and health history. It can help to mark all your
treatment days and any follow-up appointments or lab tests on a
calendar. For example, if you're having treatment every 3 weeks:
- The first week after treatment, you may not have much of an appetite. If possible, try to avoid business lunches or big dinners.
- At some point in the first 2 weeks after chemotherapy, you may feel tired and you may be more susceptible to infections. Try to avoid large groups of people (including business meetings), hotels, airplanes, and other crowded places. Be extra careful about washing your hands and watching for any signs of infection or fever.
- The third week after chemotherapy you'll likely feel pretty good. This is the best time to plan business meetings or travel.
Once you go through the first treatment cycle, you'll have a better idea of how to plan.
Lymph Node Rating
| Lymph Node Rating | Meaning of Rating |
| N0 | Negative or clear - contains no cancer and no micrometastasis |
| N1, 2, 3: Positive (involved) lymph nodes | |
| N1 | Cancer is found in 1-3 lymph nodes under the arm or lymph nodes within the breast |
| N2 | Cancer is found in 4-9 lymph nodes under the arm or lymph nodes within the breast |
| N3 | Cancer is found in 10 or more lymph nodes under the arm, or has spread under or over the collarbone. It may have been found in the underarm nodes as well as lymph nodes within the breast |
Dr. Diane R. Gillum, |
Specializes in Breast Surgery • Female • Age 62
The importance of the axillary lymph nodes: A discussion on diagnosis and staging workup from UpToDate
"One of the first sites of breast cancer spread is to the lymph nodes located in the armpit (axilla). These nodes (referred to as axillary lymph nodes) can become enlarged and can sometimes be felt during a breast examination. However, even if the lymph nodes are enlarged, the only way to determine if they truly contain cancer is to examine a sample of the tissue under the microscope.
The presence or absence of lymph node involvement is one of the most important factors in determining the long-term outcome of the cancer (prognosis), and it often guides decisions about treatment."
Why Are Lymph Nodes Important?
Breast cancer starts
out with just a few cells, which group together in your breast tissue.
They may be camping out in the system where breast milk is produced: your ducts and lobes. As these cells grow and divide, they may also invade nearby tissue. A growing tumor may shed a cell, or a clump of cells.
This
independent cancer cell can use your blood or lymph system like a
network of highways so it can travel throughout your body. Your lymph
system works with your circulating blood to provide nutrients to all
your cells, as well as remove cellular waste products. The lymph nodes are the "pit stops" on this highway system, where lymphatic fluid is filtered, mixed with immune cells (lymphocytes),
and passed back into your circulating lymph fluid. So, if a loose
cancer cell makes it to your lymph nodes, it's also possible that the
cancer could get sent along to other parts of your body. If you get an
infection, your lymph nodes near the affected area may swell because
they have collected germs. And if you develop breast cancer, the lymph
nodes in your armpit (axillary lymph nodes) is the most common place
that cancer cells would lodge, causing those nodes to swell.
Why Do I Need a Lymph Node Biopsy?
Breast tissue itself contains some lymph nodes, which process lymphatic fluid and pass it along. Breast tumors tend to drain towards your axilla, or underarm area. Checking the underarm lymph node location should be part of a clinical breast exam, as well as your breast self-exam. Swollen lymph nodes might be evidence that cancer has spread beyond your breast, but the only way to know for sure is to have them removed and tested. There are two procedures for lymph node biopsy: sentinel node biopsy and axillary lymph node dissection (removal of all the nodes). The pathology report about these lymph nodes gives you your lymph node status.
Breast tissue itself contains some lymph nodes, which process lymphatic fluid and pass it along. Breast tumors tend to drain towards your axilla, or underarm area. Checking the underarm lymph node location should be part of a clinical breast exam, as well as your breast self-exam. Swollen lymph nodes might be evidence that cancer has spread beyond your breast, but the only way to know for sure is to have them removed and tested. There are two procedures for lymph node biopsy: sentinel node biopsy and axillary lymph node dissection (removal of all the nodes). The pathology report about these lymph nodes gives you your lymph node status.
How Does My Lymph Node Status Affect My Treatment Options?
Your lymph nodes may be clear of cancer, and if so, your lymph node status is negative, and rated N0. If you have a small tumor and clear nodes, it is less likely that you will need to have chemotherapy. That is not a guarantee, however, because your doctor will also consider your tumor grade, tumor size, hormone receptor status and how effective surgery can be for you. If your lymph nodes do contain cancer, they are consideredpositive, or involved, and are rated N1, N2, or N3 depending on the number affected and the location. Having involved lymph nodes suggests that the cancer has demonstrated an ability to spread beyond your breast, and you will be advised to have adjuvant systemic therapy, such as chemotherapy, after surgery to kill any additional cancer cells that persist in your body.
Your lymph nodes may be clear of cancer, and if so, your lymph node status is negative, and rated N0. If you have a small tumor and clear nodes, it is less likely that you will need to have chemotherapy. That is not a guarantee, however, because your doctor will also consider your tumor grade, tumor size, hormone receptor status and how effective surgery can be for you. If your lymph nodes do contain cancer, they are consideredpositive, or involved, and are rated N1, N2, or N3 depending on the number affected and the location. Having involved lymph nodes suggests that the cancer has demonstrated an ability to spread beyond your breast, and you will be advised to have adjuvant systemic therapy, such as chemotherapy, after surgery to kill any additional cancer cells that persist in your body.
What Does All This Mean For My Prognosis?
Prognosis, also called outlook, is one way a doctor talks about how the odds for survival stack up for you, after you've completed treatment. Remember, having just one cancer cell in your body is one too many. Treatment is designed to kill off as many, if not all, of your cancer cells as possible. If you had clear lymph nodes and a small, low-grade tumor, your prognosis after treatment is pretty good. On the other end of the spectrum, if you had 10 or more involved lymph nodes and a larger tumor, your treatment will likely be more aggressive, and your outlook will be harder to determine, until after you've finished all treatments. No matter where your diagnosis fits on that scale, please know that survival rates are improving, treatments are becoming more efficient and effective, and even metastatic breast cancer can be managed like a chronic disease.
Prognosis, also called outlook, is one way a doctor talks about how the odds for survival stack up for you, after you've completed treatment. Remember, having just one cancer cell in your body is one too many. Treatment is designed to kill off as many, if not all, of your cancer cells as possible. If you had clear lymph nodes and a small, low-grade tumor, your prognosis after treatment is pretty good. On the other end of the spectrum, if you had 10 or more involved lymph nodes and a larger tumor, your treatment will likely be more aggressive, and your outlook will be harder to determine, until after you've finished all treatments. No matter where your diagnosis fits on that scale, please know that survival rates are improving, treatments are becoming more efficient and effective, and even metastatic breast cancer can be managed like a chronic disease.
Want to learn more? See UpToDate's topic, "Patient information: Breast cancer guide to diagnosis and treatment: The importance of the axillary lymph nodes,"
for additional in-depth, current and unbiased medical information on
breast cancer, including expert physician recommendations.
Lymph Node Rating
| Lymph Node Rating | Meaning of Rating |
| N0 | Negative or clear - contains no cancer and no micrometastasis |
| N1, 2, 3: Positive (involved) lymph nodes | |
| N1 | Cancer is found in 1-3 lymph nodes under the arm or lymph nodes within the breast |
| N2 | Cancer is found in 4-9 lymph nodes under the arm or lymph nodes within the breast |
| N3 | Cancer is found in 10 or more lymph nodes under the arm, or has spread under or over the collarbone. It may have been found in the underarm nodes as well as lymph nodes within the breast |
Definition: Chemotherapy
Chemotherapy is the use of medications to kill cancer cells or make them less active.
Chemotherapy
medications work by killing rapidly dividing cells. Since cancer cells
divide more rapidly than most cells, they are particularly susceptible
to treatment. Other cells that divide rapidly, such as hair follicles
and the bone marrow cells that make blood cells, can also be affected;
they account for many of the side effects of chemotherapy.
Chemotherapy
is considered a "systemic" treatment, meaning that it works to kill
cancer cells anywhere in the body. This differs from "local" treatments,
such as surgery and
Adjuvant therapy is a treatment given along with or after surgery for cancer to reduce the chances that it will come back.
Adjuvant therapy is given to kill cancer cells that remain after surgery but cannot be detected by means such as scanning.
- As an adjuvant therapy, used along with a treatment such as surgery to treat any spread of the cancer (micrometastases) that are too small to be detected on screening tests such as CT and MRI
