Cording before Surgery?

Suze35

I haven't had my surgery yet, I've been doing neo-adjuvant chemo, with my last one tomorrow. I've had a great response in my breast, and my 4 nodes haven't changed size in 3 months - they shrunk a bit, then "melted" together based on clinical exam. Because of my response to the chemo, my doctor and BS believe the nodes are filled with scarring and dead tissue.



Just a few days ago, I noticed some pain in my arm on that side. When I raise my arm over my head, it feels tight, like I am streching a sore muscle. It starts in my armpit, but in the muscle part, far away from the nodes. I can feel a very thin string-like band that starts at the tender spot in the pit, up my arm. There is also a spot of soreness just under my elbow, like a bruise.



Could I be having mild cording due to non-functioning nodes? I'm not freaking out that it is the cancer spreading, as my nodes haven't changed, are still movable, and there are no new lumps in the area.



I'm concerned because my surgery will include an ALND, given my pathology, nodes, and tumor size. Doesn't bode well...



Any input would be very appreciated!

kira66715

Suze, cording is a clotted lymph vessel and if the chemo is impacting the nodes, it could cause cording. Here's information on cording:

http://www.stepup-speakout.org/Cording_and_Axillary_Web_Syndrome.htm

Usually, cording is treated by lymphedema therapists, with stretching of the cords and overhead stretches--but a national expert in cording, Jodi Winicour PT notes that after surgery, the overhead stretching should be limited for 10-14 days to give the delicate lymphatic vessels the critical time they need to heal.

Here's a link to how to find a lymphedema therapist, you'll need a doctor's referral

http://www.stepup-speakout.org/Finding_a_Qualified_Lymphedema_Therapist.htm

It's a good idea to see one before surgery.

Cording can happen without surgery, and my guess is the chemo triggered it. 

Let us know how you're doing and if that answered your question.

Kira

lago

Get your arms measure before surgery! Cording doesn't automatically mean you will get LE. You should discuss this with your surgeon. And if you get no where insist on being evaluated before your surgery by an LE therapist or LE MD.

The cording in my right arm (from surgery) is much worse than the cording in my left. I have LE in my left where I had level I axillary (10nodes) removed. Right only had sentinel biopsy (4 nodes) I have no LE so far.

Suze35

Thank you thank you!



Kira - those links, just from a quick glance - are very helpful! Based on the description, I do think it is cording. What I am feeling is very thin, but the description is right. I'm going to start doing my research now on prevention of LE, cording, etc.



Lago - it is good to know that it doesn't mean automatic LE. I will definitely take your advice and talk with someone before surgery.

kira66715

Suze, cording used to not be considered a risk factor for LE, but it is now acknowledged as a risk--because the lymphatic collectors are compromised.

So, an evaluation before surgery, and don't overdo it after surgery are good ways to minimize your risk.

It sure does feel like a piano wire. And it can hang around for some time. The belief was that it always went away spontaneously, but PT's have seen the cords linger.

Cording is very, very common--it's a risk, not a definite indicator of LE.

I had tons of cords, and an axillary seroma and that's what tipped me into LE with just 3 nodes out, so when those lymphatic collectors aren't doing their job, it puts you at risk.

Suze, best wishes for your surgery and recovery, and please let us know how we can help.

Kira

hymil

Maybe if the nodes are filled with scarring and dead tissue, that's why they don't work and you are gettting swelling? Does it follow  that you have less to lose by geting them out? Would they be going to improve if they stayed in? And why do they want to take them out once the tumour has regresssed anyway? puzzled by so many things.

kira66715

Hymil, they take them out, I believe, because they were clinically positive and SNB doesn't really work after neoadjuvant chemo--there was a study presented at SABC about false negative SNB after neoadjuvant chemo (Chemo beore surgery.)

http://www.abstracts2view.com/sabcs10/view.php?nu=SABCS10L_1442&terms=

Conclusion: detection rate as well as false negativity rate were in our study higher than corresponding values in patients without neoadjuvant chemotherapy and as such SLNB should not be recommended as surrogate to standard axillary dissection. On contrary we still believe that after necessary modifications of the technique SLNB can become a reliable predictor of axillary lymph node status in properly selected group of patients after preoperative cytotoxic therapy.

Kira

Suze35

Thank you again Kira. I am going to spend some time here reading so that I know the best ways to prevent/deal with LE. I had honestly not really thought much about it until now - not too smart I know.



Hymil - given the extent of the disease in the affected lymph nodes, and because I did not have a SNB before chemo, my BS feels it is best to do the ALND. I do trust her, she has 20+ years doing breasts/nodes, and I don't think I would personally be comfortable leaving them in.

kira66715

 Suze, you have a lot going on, and LE prevention ideally should, but doesn't often come up.

Hope you never join the "swell club".

Hoping for an uneventful surgery and recovery.

Kira