Understanding a sentinel lymph node biopsy
When breast cancer spreads, it often appears first in the sentinel node–the first node to which the tumor drains. I had a full axillary clearance when diagnosed with breast cancer in 2004 – no mention of sentinel lymph node biopsy for me. It was one out, all out. Removing only the sentinel node to check for cancer is a relatively new technique but anyone who has had a full clearance will tell you about the permanent legacy of lymphedema (swelling of the arm) and numbness of the arm, not being able to get bloods taken on that side of the body, among the long – lasting effects.
Melissa Weber writing in Cure Today points out that the sentinel node biopsy technique raises new questions. Does finding a minimal amount of cancer in the node actually matter? And if it does matter, what’s the best way to treat those patients?
In an effort to provide some direction, researchers examined pathology reports of more than 5,600 women and identified nearly 1,400 with positive sentinel nodes. Among women with breast cancer that has spread to the sentinel lymph node, drug therapy after axillary lymph node dissection, or removal of the lymph nodes in and around the armpit, reduced their risk of death by 78 percent and improved their chances of living without a recurrence by 76 percent, according to a study presented at the San Antonio Breast Cancer Symposium. After a median follow-up of almost eight years, poor histologic tumor grade—how abnormal the cells look under the microscope—and larger size (more than 2 mm) of the errant tumor were the most accurate predictors for worse survival. Interestingly, the treatment benefit in disease-free survival was particularly pronounced in middle-aged women, with very young and very old women having a higher risk of a recurrence.
In another study presented in San Antonio, researchers found a nearly four-fold increase in isolated tumor cells in the sentinel node in women who had prior surgical excision of the tumor compared with those who did not. Although this suggests the procedure results in displacement of cancer cells, investigators found no spread to other lymph nodes. Researchers concluded that for isolated tumor cells found in the sentinel node after an earlier surgical excision biopsy, axillary lymph node dissection may not be needed.
This is such an interesting read this morning, especially as I have often regretted that i was never offered the choice of a sentinel node biopsy, but had a full clearance. This as you ahve pointed out has left a legacy of lymphedma and numbness which remains extremely unpleasant.
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I had partial lymph node removal on both sides. Now I am faced with the horror of dealing with blood pressure and blood draws elsewhere. I have a port right now but am going to have it removed during my final surgery and am not sure what I will do after that. I hate this constant threat of lymphedema and the numbness.
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Marie,
I’m sorry to hear that what you call “axillary clearance” (which is described as “axillary dissection” here) was not part of the protocol at the time of your treatment. I had a sentintel node biopsy in l998 – and based on those findings – had another 28 removed. Having the first three out wasn’t too bad, but the other 25, another matter. Then I see with Karen’s comment, (above) that she had a full dissection on both sides.
I still stand by providing any and every woman who is newly diagnosed a copy of Susan Love’s Breast Book, now going into its fourth edition. It’s thick, it’s thorough, and everything is discussed in great detail. In time we will see the sentinnel node biopsy bite the dust and the expression of tumor qualities — and the TREATMENTS to combat them – the true measure of fighting cancer.
Yesterday I was talking with Brenda Coffee (@bcsisterhood) about cancer staging. There are women like Elizabeth Edwards diagnosed with a Stage II cancer, who die from the disease and women like myself, with Stage IIIB disease, still here to write about it. I can’t wait for the day when qualities — other than lymph nodes — are fully known and treatments available.
In the meantime — I feel for all of us whose arms won’t ever be the same. Yes, it’s a small price to pay and yes, it IS different.
Thanks for bringing up an important topic,
Jody
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Jody thanks for sharing your take on this – it has certainly been hugely helpful to me in understanding the protocol and Karen, I do hope it has given you a measure of comfort and understanding too.
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Marie,
Thanks for this information. I had a sentinel biopsy on both sides, one side clear the other not, so had 14 nodes removed on the nonclear side. That side still feels slightly off and I do dread always reminding medical people about “no work” to be done on that side. I guess I’m lucky though, I didn’t have to have them all removed. None of my doctors expected lymph node involvement, so we were all surprised. I do worry about lymphedema and need to learn more about preventing it, it that’s possible.
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I must clarify my post. I did have a sentinal biopsy on both sides prior to surgery.I had partial removal on both sides. I had around 28 removed on the left and about 8 removed on the right. I had one positive sentinal node on the left which is why they took more there. I have a lot of numbness on the left but the right, where few were taken, is tolerable. I had breast cancer on both sides. I had 2 different types of breast cancer.
I am so glad I found your blog. I had joined a breast cancer site but there was so much petty arguing that it defeated the purpose. I look forward to more.
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Hi Karen, so glad to read your comment here and I do hope you will become a regular visitor..and I promise no arguing here – petty or not. We are all about empowering and uplifting each other x
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I am a 4 year Breast Cancer Survivor! But I had a Total Axilllary Node Dissection with all my 24 Lymph Nodes removed in my Right Arm., in December 2006! I had 2 Positive Cancer Nodes , 5% in mySentenel Node, and 5% in my Right Axillary Node. I did not have any Extra Capsulary Extension! Unfortunately I did develop alot of Scar Tissue, with Post Breast Pain Syndrome, Lymphedemia, Peripheral Neuropathy, and Chemo Brain. My Right Arm does not look swollen, but it always feels very Heavy, Numbness, Tightness, Pains, in my Arm with Constant Heaviness, and it feels like I am carrying a Ball permenently in my right armpit! I had Lymphedemia Massages, wear Compresssion Sleeves, and do constant exercises! It never goes away! I take Selenium, Vitamin B6, and Alpha-Lipoic Acid, and Advil and Tylenol. I hope one day they find more treatments for all these terrible Side Effects! Thank You, Stephanie Faith Kruse
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Blogging keeps me insane. Keep up all the positive work. I too love to blog. I found this one to be very informative
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Hello. I have had a lump in my left breast for almost 4 months now. It didn’t grow or bother me until about 3 weeks ago. Since then it has doubled in size and another lump has formed in between my breast and armpit. I do not have insurance and have been to several ER’s that have literally told me it’s not an emergency and to see a reg doc. like I said I have no insurance and am at a loss. Can anyone give me some advice? I am very terrified and would appreciate any help. Thank you.
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Andrea, I am so sorry that you are experiencing such a distressing time. I am not familiar with the US health system, so I am going to put this question out to readers who are and hope you will get a reply which will be of help to you.
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Im sure your site gives a lot of hope and support to sufferers – thank you very much.
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