Six weeks later she started chemotherapy and April 16th of this year she had a masectomy. During the operation 17 residue lymph nodes were removed and one of those nodes was cancerous.

My question is, does this mean that the chemotherapy was not successful and that the prognosis is not good. Also, why did they not give her the masectomy as soon as they found out she had grade 2 cancer and then give her the chemotherapy afterwards?

Also, residue nodes, does this mean all of my mother's lymph nodes have now been removed or could there still be some inside her containing cancer.

One more question, sorry, but she didn't start radiotherapy until 8 weeks after the Masectomy, should it have been started earlier?

-It doesn't necessarily mean the chemo was not successful. I'm sure it does influence the prognosis in a negative direction. I have a friend who had neoadjuvant (before surgery) chemo, and still had multiple positive nodes after chemo . . . that was nine and a half years ago. Clinically, they did observe her high-grade (growth/aggressiveness) primary tumor shrink dramatically. (She was Stage III).

Prognosis is influenced by *many* factors - grade, stage, responsiveness to chemo, various details of tumor pathology, various aspects of patient (age, other health factors, ....). And prognosis is only a statistical estimate, not a crystal-ball insight. My friend's prognosis wasn't super-duper, but she's here & NED today. My prognosis was 60% to 80% depending on which doctor was doing the estimating, and I'm not 60% or 80% alive today, AFAIK.

I'm not a medical professional, but my novice understanding is that doctors think in terms of what a particular treatment is supposed to control. The breast cancer spread may be local (breast only), regional (axillary lymph nodes) or systemic (elsewhere in the body). Systemic spread could be metastatic (Stage IV), i.e., actually be active & growing breast cancer tumors in (typically) bones, liver, lungs or brain. Or, systemic spread could be individual cancer cells roaming around the body, trying to become metastatic disease but not having become established tumors yet. (There's no good way to detect the latter via scans & such.)

Lumpectomy or mastectomy surgery is for local control. The axillary node removal (as I understand it) is usually more for diagnostic purposes (to determine whether there's regional spread) than for local control.

Radiation is for local or regional control. It's pretty much always done with lumpectomy, and may be done with more advanced (regional spread or advanced local or near-to-chest-wall local spread) BC with mastectomy. (I had radiation with mastectomy six and a half years ago, after Stage III diagnosis.) Radiation fields vary, and can include the axillary area (to kill off cancer cells remaining in axillary lymph nodes) or areas such as supraclavicular or mediastinal lymph nodes, which are usually not biopsied.

Chemotherapy is mainly for systemic control. In stage III or lower (i.e., no known established metastatic disease), it's trying to kill off circulating cells (if there happen to be any) or undectectable tiny metastases, and prevent the BC from becoming truly metastatic. In stage IV, it's used mainly when there seems to be a chance of extending life without undue sacrifice of quality of life.