Positive Brachial Lymph node

[Meghanat]

Hello,

My Mother completed 3-FAC and 12 weekly Nab Paclitaxel Neoadjuvant Chemotherapy.

PET CT was performed 3 weeks after the last weekly Nab-Paclitaxel. It says Brachial Lymph node SUV: NIL, previous 6. Doctor said Brachial Lymph node metastasis is very rare. Does this worsen the prognosis? There is no distant metastasis neither in first PET CT not in the latest one. The clinical staging confirmed by Tata Online opinion (Navya) was Stage 3C. I had uploaded the first PET CT scan CD for review from Tata memorial center.

PET CT after Neoadjuvant chemo says only one lymph node measuring 1.6cm X 1.1cm with SUV of 2.4. All other lymph nodes does not show any uptake in PET CT.

There were non hypermetabolic 5mm lung nodules. This PET CT says the lung nodules are stable. Please let me know if this confirms that there is no metastasis to lungs

Surgical oncologist says he will try to get as many lymph nodes as possible including Supraclavicular and brachial Lymph nodes. Is it safe to remove so many nodes?

Thank you very much!

Meghanath

[sumeet_shah Administrator]

1. Brachial Node Mets are very rare. I haven’t seen one till date. Difficult to comment more on that, without deliberation.

2. If lung modules are stable and have always been small, it neither confirms nor refutes the cancer. Different docs will have different protocols in case of such small nodules.

3. Removal of supraclavicular nodes is not a problem, no worries there.

[Meghanat in reply to sumeet_shah]

Thank you very much Sir. Surgeon here says he will remove brachial nodes too. I read online that it is one of the most important draining node. Is it OK to take that out? Cant that be left and then radiated?

[roxboxfox RadiationOncologist]

This is complex Clinical scenario and not something that we do routinely. One needs to discuss this in Multi-disciplinary Tumour Board MDT.

One carefully looks at each and every fine aspect of the clinical + biological and pathological features of the tumour.

Experienced Oncosurgeons and experienced Radiation Oncologists sit with Experienced Radiologists and discuss the pros and cons of the available therapeutic options and carefully dicsuss and present them to you.

It would be extremely difficult to given and open opinion of YES , No , Maybe without knowing these aspects.

Your Oncology team must have done all this behind the scenes and perhaps are trying the best what they can. But no one can really predict whether

its Modi or No Modi in 2019

what will Trump do in 4-6 months time.

when will next terrorist attack happen.

Only time will teach us all and enrich our experience.

All the very best