Latest study finds radical surgery to remove lymph nodes not always necessary
I’ve always had a problem with the fact that I had axillary clearance of my lymph nodes when I now believe a sentinel lymph node biopsy would have been the better option (as it turned out I had no lymph node involvement).
I now know that a node biopsy is a diagnostic tool rather than, as I was led to believe a curative one, and I am still angry that I was never given that information or choice. Having all my lymph nodes removed has led to a host of problems which have affected me long-term.
Now the latest research showing that limited lymph node removal in early stage breast cancer doesn’t result in poorer survival, appears to bear this out. The researchers note that removing lymph nodes from the armpit ‘carries an indisputable and often unacceptable risk of complications,’ including infection and chronic and painful swelling of the arm.
Among patients with early-stage breast cancer that had spread to a nearby lymph node and who received treatment that included lumpectomy and radiation therapy, women who just had the sentinel lymph node removed (the first lymph node to which cancer is likely to spread from the primary tumor) did not have worse survival than women who had more extensive axillary lymph node dissection (surgery to remove lymph nodes found in the armpit), according to a study in the February 9 issue of Journal of the American Medical Association (JAMA).
‘This is really a move toward less radical surgery’ for breast cancer patients, Dr Armando Giuliano, lead researcher explained. “That move began several years ago when doctors stopped routinely removing entire breasts and surrounding tissue, except for women with more advanced disease.”
“Implementation of this practice change would improve clinical outcomes in thousands of women each year by reducing the complications associated with ALND and improving quality of life with no diminution in survival.”
Marie – thanks for highlighting this, I did have sentinel node biopsy (SNB) before mastectomy, although I had to ask for it because it wasn’t being routinely offered at my hospital in 2007. Although it does mean another surgery with a general anaesthetic, it is certainly worth considering for the benefits of possibly not removing all the nodes – as you point out here. I understand that it is being offered more now, but that may vary depending where you are treated. It is good to make women aware of this sentinel node biopsy procedure so they can discuss it with their surgeon.
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I’ve been shocked by this report, but not for the reasons you’ll think.
I mistakenly thought that the majority of women with early stage breast cancer were undergoing sentinel node biopsy to eliminate the possibility the more extensive surgery.
How I wish we’d been connected when you were diagnosed, Marie! The sentinel node procedure, though yes it is uncomfortable, would indeed have spared you. I’m sorry you had to go through it — and am angry along with you.
My surgery was in l998. I thought it was the smartest thing since sliced bread. My surgeon at MD Anderson was a proponent of the procedure and I was all for it. The only thing he did NOT prepare me for the fact that injecting the dye that “traces” the lymph drainage stings like a million bees.
What time will tell is — in what cases – will full dissection still be needed if micrometastic disease is found.
Thanks so much for sharing this.
Jody and Sarah – thank you both for your comments – Sarah you are so right – it really does depend on where you get your treatment – treatment is all too often a lottery in terms of what happens!
Same as you Marie, I had no lymph node involvement but was told that due to my age (then 25) that I had to have a full auxillary clearance. Initially, they thought that the SNB would be sufficient but then changed their minds and it wasn’t up for discussion. I live in fear of infection or injury to my right arm because I know what the repurcussions are and I frequently experience nerve pain in both my upper back and arm.
I always strongly felt that the SNB would have been sufficient in my case and I hope that it will become the standard treatment as opposed to the method of full lymph node removal.
So Paula it does seem that this latest research bears out what we now feel that we were overtreated. This news comes too late for us – but hopefully it will be in time for other women to ask questions before their treatment.
Marie, you are going to help so many women by giving a human voice to the headline news.
I had sentinel nodes removed during my mastectomy as a precaution, because I had so darn much DCIS it made my doctors nervous. It sounds like they did me a favor by not having a separate procedure. (Why is it they forget to mention something might hurt like Hades? In my case it was a not-wonderful stereotactic biopsy.)
I am sorry for everyone who had to be a trailblazer in terms of being overtreated, but I do believe you are helping those who follow.
Being called a trailblazer helps me to come to terms with things so thank you Jackie for your comment x
I had an Auxillary Node Dissection of 24 Nodes removed on December 5, 2006. with a Right Lumpectomy. I did have 2 Nodes, Auxillary and Right Nodes with 5 % of Cancer, with no Extracapsular Extension! I did have the Sentenel Node Biopsy. I wonder if I only had 2-3 Nodes removed with this, instead of the entire Auxillary Node Dissection. My Surgeon decided to take all my Lymph Nodes because of the 2 Nodes that were positive. Thank God there were no other Nodes involved but, maybe it would have saved me from having this horrible Lymphedemia, with constant tightness, Pains in my Right Breast and Right Arm all day with thiese feeling of carrying a Rock, in my Right Armpit all day, with tightness, and nerve pains all day too! I take Selenium which somewhat helps, with Advil, and ASA too! I had Her2 Breast Cancer with ER- and Pr- which was more Agressive, so he stated he believed that he did the right thing! I am happy that I survived, but this Lymphedemia is a constant reminder, and is very bothersome even with having Compression sleeves, and Massage Therapy too!
I am so sorry Stephanie that you are suffering the side effects of lymphedema. We have to beleive that the best was done for us at the time, even though research means that treatment is changing all the time. Thanks for taking the time to leave a comment and wishing you well on your healing journey x
I, too, had Sentinel node and six others removed, all clear, but have to take precautions to prevent lymphedema. I wear a compression sleeve when I fly and workout, or scrub floors, rake leaves, etc. Someday, they’ll look back on everything about the way they treat breast cancer and think it primitive and barbaric.
Brenda, I so agree with your last sentence!
I can’t help agreeing with Brenda – some day they will look back on the way they treat breast cancer and think it barbaric!
Whenever I get upset about a “better” procedure, I remind myself how envious the women who came before me would be of our options today. It helps a little.
I had 14 lymph nodes removed on one side and that side still feels pretty off. My doctor told me yesterday, it would probably always feel that way. I don’t want to believe that, but…
Maybe we are all trailblazers in our own way! That does make me feel better!
Oh wise woman Nancy – you are so right in this – that is why I loved what Jackie said about us being trailblazers
I had a SNB with a positive node for cancer. The axillary surgery removed 22 total nodes and 7 were cancerous. That feeling of having a rock in your armpit and the tightness is awful. I have been to a lot of physical therapy and found that massage, moist heat, stretching, and laser therapy are very helpful.
Marie, I had a SNB during my mastectomy in Jan 2007. Before surgery I was injected with the blue dye – which as Jody said stings like a million bees- and they used a type of xray machine to find my sentinel node and marked it before surgery.
Then while I was under the surgeons and pathologist examine slices of the SN to look for cancer. Mine was clear. They ended up taking 7 nodes total – including the sentinel just as a matter of course and due to the mastectomy.
Latter imunohistochemical stains revealed micro-metastases in one node the SN. My surgeon talked with my Onc and they felt that further surgery on the lymph nodes would not change treatment so I decided not to have any further nodes removed. I am lucky to have no real problems with my left arm, no lymphadema, just some tightness on occasion and not completely 100% range of motion.
I am glad I did not have further surgery to remove more nodes but can’t help but wonder/second guess – as is normal to do but not much help – that if I had more nodes removed would I not have had Mets to my bone? I think that it would not have changed things for me.
The entire discussion of micro-mets is another topic worth pursuing as the doctors seem to have mixed responses as to what to do with them.
Thanks for posting and sorry you had to go through an extended surgery without being given all the options and information. No one should have to go through that!
I was told to get a lymph node biopsy at UCLA. However, they actually removed most of a tumor I had. If they had done a biopsy before surgery, they would know what kind of tumor and would have removed all of it, and I would be done.
So, now that the type of cancer is known, I have to OK a second surgery in the same spot for removal of remaining tumor. Did they leave some to justify a second surgery?
And, if first surgery was only for biopsy, why was incision four inches long? How long will my next incision be?
Now they want to do a radical removal of lymph nodes. What ever happened to sentinal biopsy? It was explained initially but evidently never done.
I am fearful of altered appearance and function. I hurt and have swelling and inflammation from first surgery, and was
told to expect a swollen arm after next surgery. Hey, why not
radiate tumor and surrounding area, enough to kill cancer cells and let me go home!
This is the most fearful situation of my life, and I am 64. Doc
said half of people like me will be dead in 5 years. What good
is all this surgery if it is not going to keep me alive and well?
Well, I was not treated well at one clinic and transferred to another in same hospital organization.
I have avoided so many close calls over the years and now this.
I am not that brave, not that strong, and just feel terrible. At least I have God and asked him to take care of me. Maybe, just maybe, I will come out alright this time also.
God bless all of you,
Oh Lin, you have all our very best wishes and thoughts. Please try to let go of some of the fear – you will come through this – thinking of you x
I had breast surgery just over a year ago and had quite a few lymph nodes removed at the same time. From diagnosis to the op was only a few weeks (with Christmas) in between) and I didn’t really research anything – just went with what my surgeon said. I have read so much since about sentinel node removal and so wish I had asked about it but it wasn’t even mentioned to me at the time.
I had triple neg stage 1 grade 3 tumor. I don’t know if this is why they decided to take a lot but my node results came back as clear, so I too was a bit angry that I wasn’t given the option. My arm is a constant reminder as it is numb underneath ( which I can deal with) but the horrible sensation and feeling of a lump under my arm is no joke. Also I cannot do anything even slightly strenuous using that arm – and it is my right – without it feeling swollen, uncomfortable and heavy.
When I went back for check up I was told it was not lymphodema or if it was it was only very minimal and there was nothing much that could be done apart from the usual exercises and they they only refer severe cases to a clinic.
I’ve dealt with the whole trauma of breast cancer pretty well and am now trying to forget but this is a constant reminder. Hopefully things will improve for future patients.
Some of you have mentioned sleeves. Do these help? I’ve never been offered one. How can i get one?
Thank you x
I’m a product of this product and I’m really happy to share it with you. My arm went from 24 inches to 13 and it’s going down every day. I had several heart surgeries which led to a screwed up lymphatic system. You can read my story here and maybe you can share the same results: http://www.chrisbyrnes.com/2011/12/04/herbal-release-released-the-pressure/
I am a younger woman 30 at finding my falsely diagnosed fibroadenoma with BC in 2011 I had grade 1a 14mm tumour removed and SNB just one node removed.
Two years latter I find a small enlarged gland in my upper under arm. I go straight to the surgery to get a biopsy and yes it is a false negative or re occurence they cant tell me.
24 lymph nodes removed with just one positive. I live in fear of a life time of looking after my right arm. I am a ballet dancer so obviously that effects my work.
What I find more disturbing is that I have no immune system now on the right side basically!! I mean who will my body fight any cancer on that side now that no immune system is there! And they are wanting to Radiate further lymph nodes which do not recover>>> barbaric who thought of this why not come up with a better idea that treats the really problem instead of treating the symptoms and put all that money into that!!!! we have a fun run for cancer every week! Where is the money going!!!! a bit let down.