Lymph node removal Concerns!

Hi--You really don't know if a lymph node is metastatic unless they take it out and look at it under a microscope. You can suspect sometimes due to the size shown on the imaging. So there is no way to point out which ones to take and leave. That's the issue with "only taking out those with cancer."

They do sentinel node biopsies now because they know that those 1-3 nodes are the first ones they typically go to. Some surgeons will still go in and take out more if the sentinel lymph node(s) has cancer. Some do not. Some rely on radiation to kill the cancer cells that may still exist in the following nodes. And this is, in fact, to minimize problems with lymphedema.

The problem I see in certain situations with leaving the rest of the nodes if one has cancer....you don't know what you're dealing with. I think that's the struggle for some.

In my case, they did a lumpectomy and a sentinel node biopsy. To our surprise, that 1 node had 8mm of cancer in it. We did NOT go in and take more. There was part of me that wanted to, quite honestly, but I followed the guidelines in my situation and just adjusted the radiation to deal with anything that might still be there.

Since your mom is Stage 2, I'm not sure if her guidelines would be different or not. I was Stage I with mass of 2.5cm. More folks will come along with their experiences and advice!

I will tell you that even though I had only a sentinel node biopsy, I have a little lymphedema in my breast and arm. The radiation and surgery can also cause lymphedema, unfortunately. But mine is such that I do exercises, wear a compression bra and sleeve. It's nothing too drastic and we're on top of it. But that's something I didn't understand until it happened to me.

Edited to add--I did not have extra capsular extension on that node. If I did, that may have changed our minds to go in and take more, too....

Lymphadema is a crap shoot. Some breast cancer patients get it after one node has been removed; some (like me) don't get it, even after having 20 nodes removed. I was annoyed when my surgeon took out 20; in retrospect, it was overkill. None of the nodes showed active cancer after chemo according to scans (MRI and PET scan), and I was slated to do radiation anyways. However, when one node tested positive for cancer (before chemo), my surgeon neglected to insert a surgical marker in that node so he could identify it later. So, when my scans were clear, he couldn't just take out that one node, and he ended up taking out all my Levels 1 and 2 nodes.

Less is more. Since you've talked to three surgeons, I would suggest you go with a surgeon who will just focus on the sentinel node(s).

I didn't have any known positive nodes under after my lumpectomy. My surgeon identified that the first node was positive and then took a few more. I ended up with 3 of 4 positive nodes. At that point, I switched my care to the Stefanie Spielman Breast Center at Ohio State Univ. (part of the James Cancer Center). They recommended ALND - based on 3 positive nodes they estimated > 80% likelihood of additional positive nodes. My local surgeon didn't think I should get the ALND. For me, I needed to know whether there were more or I would never rest easy that I did all I could do. Luckily there were no further positive nodes but I don't regret the ALND. At the same time as the ALND I had a Lymphovenous Bypass performed by a plastic surgeon. This is typically done after someone develops Lymphedema, but my center has begun performing it prophylactically and has shown to significantly reduce the risk of developing lymphedema. I just had my surgery 5 months ago so still early, but may be worth looking into for your mother if she moves forward with the ALND. Good luck. I know these decisions are never easy.

Statistically lymphedema becomes more likely with the number of nodes removed. Everyone should make an educated choice for this surgery.

Brittonkb

Can I ask for the name of your surgeon if you were satisfied with the surgery. You can certainly pm me if better.

I get all my treatment at Spielman (super happy with the place). I am a year out of surgery and have mild lymphedema and am considering lvb and reconstruction. So looking to see who liked their surgeon.

Thanks so much!

Just saw your response now. Thank you! I am certainly glad you had a good experience with the surgery so far.