How can surgeon decide which lymph node to remove or keep?

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MoonBlue
MoonBlue Member Posts: 12
edited February 2016 in Surgery - Before, During, and After

Hi, all,

I have one lymph node positive and I am doing chemo before surgery. Most likely I am going to have mastectomy with axillary dissection. My question is, how can the surgeon know which lymph node to keep, which one to remove, especially I do chemo first so they will not be able to see any active cancer cells during the surgery.

Another thing is, even they can tell, can they tell right away or they have to send the samples to lab? If they need to send samples to lab, then how can they make sure they can clear all necessary nodes during the same surgery? I don't want to do surgery over and over again until the lab results finally show as "cleared".

Thanks

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  • wrenn
    wrenn Member Posts: 2,707
    edited February 2016

    What usually happens is you will be injected with a dye that travels from the tumour to the nodes and if any nodes light up they take them out with one extra (I think). 5 lit up on mine so they took out 6. They did all turn out to be benign at pathology post surgery.

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  • Skittlegirl
    Skittlegirl Member Posts: 428
    edited February 2016

    Since I had chemo first, my surgeon said that if they find my sentinel node that was biopsied (so there's the clip in) and the node shows no signs of cancer, they will stop there and not remove any additional ones.

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  • ElaineTherese
    ElaineTherese Member Posts: 3,328
    edited February 2016

    Good question, MoonBlue. Did the radiologist insert a tumor marker in your compromised lymph node? Mine didn't. Ugh! I also had neoadjuvant chemo, and it wiped out the active cancer in the node and breast. Since they no longer knew which node was compromised, my surgeon took all Levels 1 and 2 lymph nodes out (20 total). PLEASE. Ask your radiologist or surgeon for a tumor marker so they only take out the compromised lymph node and a few of its neighbors. Luckily, I didn't get lymphedema, but I hope you can avoid what happened to me.

    Also, if you do neoadjuvant chemo, they will scan you before surgery to see if any nodes are still compromised. They really shouldn't take more than a few out -- just the compromised node and a few of its neighbors.

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  • mmshea
    mmshea Member Posts: 15
    edited February 2016

    hello!

    This seems so confusing to me as well. I am currently trying to decide between two surgeons. I love one but she does not have a pathologist in the OR with her...the other one I like well enough is in a teaching hospital and does have pathology in the OR. I am planning on a Double MX and concerned that if I have any positive nodes they won't know in real time and won't take enough out during the surgery if I go with the BS that does not have a pathologist. Seems like such a major decision and I am paralyzed by it.


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  • MoonBlue
    MoonBlue Member Posts: 12
    edited February 2016

    Thanks for all the answers. The original compromised one has marked. So I don't really worry about that one.


    But I do worry about if there is others, how they detect them and when they remove them. I will try to make another appointment with surgeon to discuss that.

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