|
Sentinel Node Biopsy
I was diagnosed with breast cancer in
November 12. My first reaction to this was shock and disbelief
as there was no previous history in my family.
Nancy - Aged 42
My name is Nancy. I am 42, married to a wonderful and supportive
husband with two beautiful sons aged 10 and 12. I was diagnosed
with breast cancer in November 12. My first reaction to this
was shock and disbelief as there was no previous history in
my family. I later learnt most breast cancers detected are
not hereditary.
My treatment options were to have either a lumpectomy or
mastectomy and axillary dissection, possibly followed by radiation
therapy, chemotherapy and/or hormonal treatment depending
on the outcome. My greatest fear was having the axilla dissected
and the possible side effects of lymphoedema. I was resolved
to having surgery to the breast but felt I needed more information
about lymph node removal. This may appear a minor issue compared
to having a life threatening disease but I am right-handed
and my right arm would be affected.
I found a surgical oncologist who performs sentinel node
biopsy, a procedure that identifies and removes the first
lymph node to which the breast cancer cells might spread.
The surgeon provided lots of information to read about sentinel
node biopsy. I decided to proceed with it. Unfortunately my
sentinel node contained some cancer cells and the recommended
treatment was axillary dissection. I still felt uncomfortable
with this and found there was another option for me, to enter
a clinical trial being conducted at Peter MacCallum Cancer
Institute. This trial was part of an international study by
the American College of Surgeons Oncology Group - a randomised
trial of axillary node dissection in women with a certain
clinical breast cancer who have a positive sentinel node.
I was a possible candidate.
My husband and I discussed the options. One was to have an
axillary dissection, the other to take the risk against medical
advice and not remove any more lymph nodes, the third to enter
the trial. If I entered the trial and was chosen not to have
the axilla dissected I would have the advantage of being closely
monitored. This would be the same if I had the axilla dissected.
I had to feel comfortable with someone else (a computer!)
making the choice for me.
After careful consideration I decided to participate. I signed
up, my details were entered into the computer and within seconds
the decision was made to have the axilla dissected. It was
only then I knew I had made the right decision. I had my surgery
and found I had no other lymph node involvement. Of the 20
removed there was only one lymph node involved. With hindsight
I would not have needed to have further surgery.
I believe this justifies my participation in the study. Peter
Mac is hoping to recruit 15 Australian participants for this
trial. I was only the second. I hope that very soon the Australian
Standard for every woman with early stage breast cancer is
to undergo sentinel node biopsy.
Back to top
In hindsight I might have chosen the sentinel
node biopsy. You should at least consider it.
Russ had a choice of sentinel node biopsy. She decided to
have all her lymph glands removed. They were all clear.
I was offered the sentinel node biopsy. Put very simply it
is a procedure where a dye is injected into the lesion(s)
and some time later is viewed under a scan (as it is radio-active)
It is thought that the dye will track to its corresponding
axillary node if the cancer has spread to the axillary glands.
This is a pre-operative procedure, that is, on the day of
the breast surgery, prior to the removal of the breast cancer.
Depending on the results of this procedure the glands in
the armpit may not be removed at this time. However, some
days later a second operation may be necessary to remove these
glands if the more detailed pathology shows the sentinel node
is malignant . This then requires another anaesthetic and
the extra surgery for the removal of the glands.
After a lot of consideration I chose to have all the glands
removed at the time of the removal of the two malignant lesions.
Why I am relating this experience is to say that I need not
have had the glands removed as they all were free of cancer
– in hindsight I had made the wrong decision. I do not
have regrets at this decision, as having an extra anaesthetic
was an important point is my decision and other factors came
into it also.
It is a procedure not adopted yet by the Royal College of
Surgeons. As part of a trial, surgeons are removing all the
glands and the data is being collected for a time and numbers
assessed to see if Australian doctors will offer it to us
here in Australia. It is being, and has been used overseas
for some time. Some opinion is that we, here in Australia
adopt a more aggressive role in removing all axillary glands
when an unknown number of breast cancers do not require this
removal of the axillary nodes.
One of the side effects of breast surgery with removal of
these glands, can be lymphodema, with varying degrees of severity.
So to get an opinion from a surgeon who offers this alternative
–if it is appropriate to your particular breast cancer,
I feel is worth knowing. My first surgeon I saw and whom I
chose to do my surgery did not mention it to me- I found out
about it from another information source. I did tell him I
had seen the other doctor, had considered the other information
in coming to my decision to have him do the surgery. Without
being conversationally confronting he gathered I would have
been pleased to have him tell me that there were other doctors,
who do feel women should be informed of this alternative practice.
One last thing I have learnt from this cancer experience
– but not everyone is the same as I,- is that we cannot
have too much information in making what is the best decision
for us. But everyone who attended a workshop conducted recently
by the NSW cancer Council –20 to 30 odd people who had
experienced various cancers, all emphasized the necessity
of getting copies of all pathology results and keeping them
forever with all your treasured possessions. Cancer science
and treatment is forever changing and hopefully progressing
with better outcomes for people with cancer and you need to
know as much as possible in the detail of your particular
cancer. I hope sharing “ my story” may be helpful
to someone out there and that you too may find a person to
walk with you during your cancer experience. I consider myself
so fortunate in having my friend to support and share it with
me.
Back to top
I chose Sentinel Node Surgery to maximise
my chances of maintaining my preferred lifestyle after treatment.
Caroline - Aged 38
Caroline had just moved into a new home with her newly found
partner. "The home was a "renovators delight"
that backed onto bushland near the river. We were so excited
about landscaping, building and canoeing on the river. We
both love the outdoors. News of the cancer was shock enough
without learning of the possibility of lymphodema as a side
effect of treatment. If I had to avoid camping, insect bites
and exposure to the sun, then we would probably have to move
and our planned future lifestyle together would have to be
dramatically altered".
Caroline was fortunate to have been referred to Dr Paul Crea
who had just completed trials on the Sentinel Node Procedure.
"While the risks were slightly higher that the full axilla
clearance technique, it made a lot of sense to me. If it turns
out the nodes are not likely to be affected - why remove them
all and face the possible resultant side effects".
Caroline was very lucky. The sentinel node biopsy was clear
and so surgery was minimal. "Within a week or two I had
full movement in my affected arm and now I am back to canoeing,
camping and travelling with work without concern. The cancer
diagnosis, surgery, chemotherapy and radiotherapy all have
a huge impact on your life as it is, and it's a fantastic
breakthrough to have new procedures like this that improve
your options and reduces the side effects".
Back to top
|
