Radiation after mastectomy

[JosieNJ]

Bad surprise - after  mastectomy full dissection and chemo the rad onc is weakly suggesting rads.
I had multifocal with 3 tumors, largest 2.1 all in upper outer quadrant, 1 positive node, grade 2-3 depending on the path dept. no lymphovasc invastion. no extracapsular node extension, age >55.
How much do rads increase my risk of lymphedema?
why after a sentinel node positive did they do a dissection if they wanted to do rads either way?  
I feel betrayed.

[carme]

My mother had radical mastectomy 1976 and again 1989. No chemo, no radiation.  The lymphedema showed up in her left arm 15 years after that mastectomy.  I had bilateral mastectomies with only sentinal nodes and no chemo or radiation.  So far, so good.  My grandmother nor my aunt nor my cousin ever developed lymphedema.  They all had extensive chemo and radiation.  Who knows?  Only God!

[lizziecee]

Hi Josie - the nurse doesn't unfortunately answer follow-up questions, you  need to make a new post.

I had a 2 cm invasive ducal cancer, stage and grade 2, with 4/18 lymph nodes affected. I had a lumpectomy and sample node removal (8 - 3 of which were cancerous) so I went back for total dissection, when one more node was +.  

At my hospital in England they strongly recommend chemo for tumours over 1 cm, and certainly if lymph nodes are +.  I had 6 x FEC ,also had 25 rads to the chest wall and armpit. I did my exercises religiously, and have had no lymphedema. I was advised total resection of lymph nodes can cause lymphedema, but no-one mentioned it being caused by rads.

Take care, Liz.

[JosieNJ]

I have read rads to the chest wall and supraclav does increase lymphedema.
Bottom line is there was NO reason for the dissection if they want RADS anyway.
Do these people talk?  What a horrible surprise this was for me.
The rad onc told me to stop reading, can you beat that? I know enough.
I probably will get a 2nd opinion, but this is pushing me to want to dump both these incompetents for not figuring this out 4 months ago.
The only reason rad onc recommends is if you add the tumors together you get 4.7. I thought they took the size of the biggest one.  Is there agreement in any area of this field? Somehow I don't get the feeling heart patients have so much ambiguity.  

[Cleveland Clinic]

Dear JosieNJ:  There are several possible reasons why radiation could be recommended and we cannot be sure in your case.   When a sentinel LN is positive, in general a completion of lymph node dissection is recommended to remove as much cancer in the arm pit as possible. However, some cancer cells may be left behind, and therefore, radiation is sometimes recommended to kill any cancer cells that the surgeon was unable to remove.  Radiation to the breast area would not necessarily have any impact on development of lymphedema.  Radiation to the axilla may increase the risk but it is difficult to quantify the level of risk without evaluation.  You may benefit from directing your questions to your oncologist and radiation oncologist as communication with them may relieve your sense of betryal.  If you do not feel comfortable, consider a second opinion from another oncologist and/or radiation oncologist.