Stage 3a, questions

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9/2/2011 9:19pm
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Replies: 11

Hi. I am stage 3a, had microscopic cells in sentinel node, had 6 more nodes removed that were all clear. I was given a very good prognosis by my oncologist, he said it is most likely that I am cured but he can't tell me one hundred percent, because it did get to the one node. He said there is that small chance that cells could bypass the nodes or that cells could have been in lymph vessels in between the primary and the lymph nodes. I don't feel that worried about the nodes, I think it most likely stopped at the sentinel. i do worry alittle more about the other, because I did have a high mitotic rate. My breslow was not real deep, 1.57mm. Does anyone have information about how often this happens? In the reading I have done, I have not read any examples of  a recurrence in the lymph nodes after having a dissection.  If it did, would it go to my remaining nodes that are there? Thanks, I appreciate any feedback

MariaH - (9/3/2011 - 7:57am)

Hi Becky,

I'm so sorry you have to be here, but also very glad you found this board.  The people who come here are very compassionate and knowledgeable, so feel free to post any questions - chances are, somebody can help you with the answer.

Given your question about the lymph nodes - if you had 6 removed, I would check to see how many "levels" of nodes were removed.  When my husband had a "complete right axillary lymph node dissection", they took out levels 1, 2, and 3 - a total of 16 nodes.  I believe (but please look into this, I am not positive) that there are "levels", meaning how far out they go from the sentinel node.  Since everybody's body is different, the number of nodes removed will vary.  They may have opted to do only level one for you, since the sentinel only showed micromets.  My husband had 3 nodes show micromets,  therefore the complete dissection.  It is important, no matter if they took all the regional nodes or not, to palpate the area on a periodic basis to check for lumps/masses.  Even those who have had all of them removed can occasionally have a recurrance in that area.

It is possible that the mel could spread via the bloodstream.  Staying vigilant (but not paranoid) and knowing your body is the best approach.

Best wishes to staying NED for many years to come,

Maria

Becky C. - (9/3/2011 - 4:47pm)

Thanks so much for your response. Best wishes to you and your husband.

washoegal - (9/3/2011 - 1:14pm)

I am also stage 3a, I had microscopic amounts in 2 nodes.  I chose to have the remaining lymph nodes removed just to be safe.  Luckily they were all clear.  I too had a high mitotic rate but my primary was  a bit deeper 3.0 MM.  The one thing I have learned is melanoma is unpredictable.  It will go where it wants to when it wants to.  The only defense is vigilance and trying to keep your immune system as strong as possible. 

I am 16 months NED (no evidence of disease) and my strategy is simply keep up with my regular scans, see the derm every 3 months, lots of sunscreen, and try to keep a positive attitude.

Good Luck,

Mary

Life is too short to be anything but happy. Falling down is a part of life, getting back up is living.

Becky C. - (9/3/2011 - 4:49pm)

Thanks for your response. I was glad to see you have been clear when your mitotic rate was high like mine. Best wishes.

jimjoeb - (9/3/2011 - 2:52pm)

I'm IIIa too, had one positive inguinal sentinel node. On the advice of my medical team, I chose a dissection. My surgeon made the distinction between superficial and deep. I haven't heard of levels of nodes. Maybe they don't apply to the inguinal area. I only had the superficials removed (total of 10 on the left side plus one on the right side) because they were all normal size. All but the original sentinel were negative for melanoma. My Breslow was 1.45, Clark level IV and mitotic 5.

I've had lumps in the area that so far have turned out to be fluid (cysts and haematoma). This is all new to me as well. I'm only NED since June 10 of this year (not yet 3 months).

Be Not Afraid-God is with you always
Stage IIIa

Becky C. - (9/3/2011 - 4:50pm)

Thanks so much for your reply.

Vermont_Donna - (9/3/2011 - 10:13pm)

Hi,

 I am stage 3a as well, and a five year melanoma warrior. I had micro mets in my sentinel node and opted for the lymph node dissection. My surgeon is an oncology surgeon. He did the LND and said that basically he went in and scooped out a bunch of tissue, and then that tissue is analyzed for lymph nodes. Then lymph nodes are dissected and looked at for melanoma. My understanding from my surgeon is that pathology doesnt anyalyze the LND lymph nodes to the same degree as the sentinal node. I had 9 lymph nodes in the tissue and they were negative for cancer. I did 11 months of low dose interferon (after only 2 of the high dose due to a PICC line problem). I have had a number of treatments, not to scare you but you can read my profile if you want. I am NED for 6 months now after doing Yervoy.

Best of luck to you. Get to know your body and wtch for any changes and see your melanoma doctors. the best advice is to be vigilant!

Vermont_Donna, stage 3a, NED

Jim M. - (9/4/2011 - 3:13pm)

Hi Becky,

 I'm stage 3C and had an LND. Three of the nodes were positive for MM, one with ulceration. My oncologist said patients have a 60% chance of getting a local recurrence and radiation would reduce the chance of a local recurrence to 10%. After recovering from my nodes being removed I did have radiation. I'm sure with some of your nodes in place radiation would not be an option now. If you would have a recurrence a likely area it would go to are1 or more of the other nodes.

Is your oncologist a melanoma specialist? If not it would be important to find one.

 Best of success and God Bless,

 Jim M.

Jydnew - (9/5/2011 - 3:59pm)

Hi,

My husband was dx stage 3a in 01/2002, with micromets in 2 nodes (one with less than 2mm cohesive cells and one with about 10 scattered cells - no idea how they figure that out...).  His Breslow was 1.3mm, and was Clarks Level IV.  To my knowledge, they did not report mitotic rate back then, so there is none on his path report.  He had a complete lymphodectomy and has been NED ever since.

There have been a few studies done on the pathways that melanoma takes but none that I can find specifically say whether leaving lymph nodes inside you means a greater chance that it will go there first before spreading.  We used to wonder about that, thinking "wouldn't it be good to leave a few to 'catch' any leftover melanoma?"  There are arguments that if it's in your lymph system, it's likely in your body somewhere.  I don't know, and I don't know if anyone knows that.  My husband always lived as though they got it all, and I always lived as though we had to keep his immune system strong to beat a stray cell that might be left behind...

 

This study looks at stage ii and iii - the focus in on whether the patient or a medical professional finds the recurrence, but it gives percentages on recurrance location: http://www.ncbi.nlm.nih.gov/pubmed/19101766

Similar - data is for stage i-iii: http://www.ncbi.nlm.nih.gov/pubmed/17357855

This one is about the site and timing of relapse: http://www.ncbi.nlm.nih.gov/pubmed/20479405

Wishing you a long life of NED,

Wendy

JerryfromFauq - (9/5/2011 - 6:01pm)

Thanks for the url's.  I found it interesting that approximately half of the re-occurance location was between the original site and in the lymph nodes (49% @ MSKCC)  .  I have wondered if such a study had ever been done.  I also found it interesting that vigilance on the part of the patients indentified 50-75% of the first re-occurances. 

 

I'm me, not a statistic. Praying to not be one for years yet.

CKasper - (9/5/2011 - 8:30pm)

Hi,

I'm Stage 3B, first occurence 1984, second in 2005.  I had the tumor removed, the size of a golf ball and then went back into surgery and had 25 lympnodes removed.

All I can say in those first years of having mets is to try to keep sane and strong.  I couldn't do INF therapy so the IL2 therapy is out of the question for me as well.  I consulted a naturalpathic person, herbalist and started a regime of detox herbs and a organic high in antioxidants diet.  My Oncologist was all for it. 

Heck I'm still here.

 

Best Wishes

 

CKasper