Were my lymph nodes checked?

EbonyEyes · November 2015

I had a total mastectomy a little over two weeks ago and was sent home from the hospital a few days later with two drainage bulbs attached to the bottom of my breast. Both have been removed. There are no scars or incisions in the armpit area -- I thought this is where they check the lymph nodes. Did they check my lymph nodes? I'm getting kind of scared wondering about it.

SpecialK · November 2015

I had bi-lateral mastectomies and bi-lateral sentinel lymph node biopsies done during the same surgery, as is standard. My surgeon, as do some others, accessed the axilla and lymph nodes while the skin flap was open and the breast tissue had been removed so as not to cause an additional incision in the underarm. It is entirely possible that your surgeon did the same. The sentinel lymph node biopsy report should be included with your surgical pathology results and this report should be made available to you.

BarredOwl · November 2015

Hi EbonyEyes:

I am glad you were able to have the surgery as planned. I also had single incisions (bilateral total mastectomy plus SNB on both sides).

My surgeon told me the results of the surgical pathology by phone. Then, I called the office to request a copy of the report by secure email. After studying it, I had follow-up appointments with my surgeon and Medical Oncologist to discuss my questions about the report, such as the sufficiency of the margins, etc. and possible treatment options pertinent to hormone-receptor positive disease.

BarredOwl

Kicks · November 2015

All lymph nodes are not under the arm. They are also in other areas of the breast area. Unless cancer has already been established in the axillary area via biopsies or sentinel nodes (those closest to the cancer) during surgery showed cancer, the axillary nodes would not have been removed. Because of the potential for LymphEdema developing, the fewest necessary nodes are removed.

Your copy of the path. report should tell you the status of any potential node involvement and the Stage which can only be determined at surgery. A call to your Dr (or his/her PA/NP/RN) can answer your questions. Write down your questions before calling so you don't accidentally forget to ask them all.

BarredOwl · November 2015

Just to clarify, I agree that there can be lymph nodes in the breast itself (intra-mammary nodes). I think EbonyEyes is wondering if a sentinel node biopsy (removing one or a few axillary nodes) was done at all. It is my understanding that sentinel node biopsy is a type of "surgical axillary staging procedure", and that the lymph nodes that are assessed for the purposes of surgical axillary staging by a sentinel node biopsy are axillary nodes.

For example, from the NCCN guidelines (to support my comment that axillary nodes are the kind sampled in SNB):

"AXILLARY LYMPH NODE STAGING

SLNB [Sentinel lymph node biopsy] should be performed and is the preferred method of axillary lymph node staging if the patient is an appropriate SLNB candidate"

See the comments above re the possibility of use of a single incision.

BarredOwl

DeeRatz · November 2015

I had sentinel nodes removed from both sides during my BMX. I only have 1 scar on each side from my mastectomy. So it is not unusual. I am glad I didn't have incisions under .my arms

ShetlandPony · November 2015

EbonyEyes, I'm glad to hear you have successfully done your surgery. I know it was a hard road getting there. My sentinel node biopsy was done without an incision under my arm. I am glad to have no scar there.

Kicks · November 2015

According to Mayo Clinic - "The sentinel nodes are the first few lymph nodes into which a tumor drains". Not automatically axillary lymph nodes but the lymph nodes closest to the tumor. There are lymph nodes throughout the entire body - not "can be in the breast" but are there as part of the lymphatic system.

Questions about individual surgeries should be directed to the Surgeon - none of us can possibly know what was or wasn't done.

BarredOwl · November 2015

The concept of "sentinel nodes" is applicable to other cancers which may be located in other body locations, such as melanoma. However, in the context of breast cancer, they are usually axillary per ASCO's web site (emphasis added by me):

http://www.cancer.net/research-and-advocacy/asco-c...

"Sentinel lymph node biopsy. When cancer spreads through the lymphatic system, the lymph node or group of lymph nodes the cancer reaches first is called the sentinel node. In breast cancer, these are usually the lymph nodes under the arms called the axillary lymph nodes. In a sentinel lymph node biopsy, often shortened to sentinel node biopsy, or SNB, one to three or more of the axillary lymph nodes are removed and examined for signs of cancer."

The presence of a single incision does not mean the procedure was not done. Saying it is possible to have a single incision and have undergone an SNB is not an assertion of what was actually done. It is a good suggestion to call and inquire.

BarredOwl

Were my lymph nodes checked?

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