Ask Dr. Ulissey | June Q/A

Q. Will I need chemotherapy for my breast cancer, and what about my lymph nodes?

A. Unfortunately, I have to answer this question with the caveat that there are occasionally subtle nuances for an individual woman that will not fit into the general categories I describe below. Your doctor will give you the details, but here are the broad strokes:

Four main factors are involved in deciding whether to use chemotherapy. They are the stage of the cancer, the lymph node status of the cancer, the receptor status of the cancer (estrogen, progesterone, Her2-neu) and the menopausal status of the woman.

If cancer has spread to the local or regional lymph nodes, then generally we would use chemotherapy. Likewise, if the cancer has spread to other parts of the body (bones being one common area), then we would generally want to use chemotherapy. However, if we catch the cancer early (e.g. Stage 0, Stage- ) then it is unlikely we would need to use chemotherapy (hence, early detection).

The type of chemotherapy would most likely depend on the receptor status of the cancer. For example, ER/PR positive, Her2 negative would be treated differently than a triple negative cancer or a Her2 positive one.

Premenopausal women tend to have more aggressive breast cancers, so even if the above generalities don’t fit her particular situation, we might still be more likely to recommend chemotherapy.

In some cases, we recommend using chemotherapy before surgery (called neoadjuvant chemotherapy), usually to do what’s called down-staging the tumor – shrink it before surgery to optimize the surgical outcome and lower the mortality statistics for the woman.

When we sample lymph nodes during breast cancer surgery we generally do a sentinel node biopsy. If the sentinel nodes are negative, then generally that woman does not need further axillary (underarm) lymph node surgery. Sometimes we do sentinel node sampling before neoadjuvant chemotherapy – these are the kinds of details your surgeon and oncologist will discuss with you, because some situations present unique circumstances that I can’t address here.

I hope this helps.

Michael J. Ulissey, M.D., is a partner at the Breast Diagnostic Centers of Auburn and Federal Way. In addition to taking care of patients locally, he continues to participate in research as an adjunct professor at the University of Texas Health Sciences Center. You can reach him at