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Medical Forum / Diseases and Disorders / Breast Cancer / April 2005Node dissection
Prior to surgery my wife's surgeon said that during the op the sentinel node would be dissected and if cancer was found, further nodes would be removed. As he was a man with an international reputation working at a first rate hospital we took his word that this was the right thing to do, but in retrospect I have some doubts. The sentinal node tested positive and in all 21 nodes were dissected with 10 testing positive. I can see the value of knowing whether the cancer has spread to the lymph system in planning further treatment but I'm far from clear as to the usefulness of knowing whether it has gone further than one node particularly when the price of that information may be an increased tendency to lymphedemia. Of course in my wife's case it's too late, but still I'd be interested in opinions on this; also it's something that those who have not yet got to surgery might want to think about. > Prior to surgery my wife's surgeon said that during the op the sentinel node > would be dissected and if cancer was found, further nodes would be removed. [quoted text clipped - 9 lines] > this; also it's something that those who have not yet got to surgery might > want to think about. This is standard practice. The fact that cancer is detectable in one node means there are probably stray cells in some of the others, beneath the threshold of detection. You can't tell how many would carry on the invasion, so you have to remove the lot. It isn't something you want to fool around with. Lymphedema is a pain, but metastasis is an order of magnitude worse.  SignatureTim Jackson -Who needs to pay Microsoft? Free Open Source Software- www.mozilla.org FIREFOX Web Browser, THUNDERBIRD Email/News www.openoffice.org Office Suite >> Prior to surgery my wife's surgeon said that during the op the >> sentinel node would be dissected and if cancer was found, further [quoted text clipped - 3 lines] >> > This is standard practice. And staging depends in part on knowing the nature of the nodal involvement. Then the stage helps guide treatment decisions. As far as lymphedema: The risk is worrisome, and the condition can be a significant quality-of-life problem . . . but the majority of women who have nodes removed do *not* get lymphedema, which may be somewhat reassuring. Best wishes to you & your wife! Ann T. Remove 'dontsendspam' from address to reply by email >>> Prior to surgery my wife's surgeon said that during the op the sentinel >>> node would be dissected and if cancer was found, further nodes would be [quoted text clipped - 12 lines] > > Best wishes to you & your wife! Thank you both, but I remain sceptical for two reasons. First there are no studies, at least none that I have been able to find, which establish a positive correlation between node dissection and survival rates, so this is a diagnostic procedure. But is the treatment different depending upon the number of positive nodes? I suspect not. My wife had 10 positive, and her treatment was 6 months A&C, six months Taxol and now 5 years Tamoxifen. Would this have changed if she had 5 nodes positive? Or three? Or one? Probably not. And lymphedema, while not, as Tim points out, in the same class as cancer is nonetheless very troublesome. If we go through this again, and I suppose we might as my wife has one remaining breast, I'd take quite a bit of convincing that node dissection beyond the point where one had tested positive, made sense. But I'm certainly open to correction on all this! >>>>Prior to surgery my wife's surgeon said that during the op the sentinel >>>>node would be dissected and if cancer was found, further nodes would be [quoted text clipped - 27 lines] > had tested positive, made sense. But I'm certainly open to correction on > all this! The statistical tipping-point for node count is supposed to be four, so the difference between 5 and 10 wouldn't alter treatment much. There was a study that showed that chance of metastasis was directly related to node count with 50% chance coming at about four positive nodes. With high node counts what we are mostly talking about is survival time rather than recovery rate (not that some don't recover, but they are a minority). The long established traditional treatment for diagnosed breast cancers has been axillary clearance. I don't know how proven the technique is/was, or how much it improves survival time, such decisions long pre-date the internet, so you wouldn't be likely to find the studies there, you would have to research it the old way. I don't think there is much medical discussion as to whether it is a good idea, it is pretty accepted; the sentinel node argument is really around whether it is safe enough to forgo clearance if the one node is -negative-. SignatureTim Jackson > The statistical tipping-point for node count is supposed to be four, so > the difference between 5 and 10 wouldn't alter treatment much. There was > a study that showed that chance of metastasis was directly related to node > count with 50% chance coming at about four positive nodes. The hospital we went to calculated the likelihood of mestasis on both the size of the tumor and the node count. They ascribed 3% to each node for, in my wifes case, a total of 30% and added 50% for the 3cm tumor to give 80%. They then reduced this by 30% because she was having chemo. The surgeon, a blunt man, put it more simply. He said that if 100 women in my wife's condition came to his office, 50 would be dead in a couple of years; fortunately he did not say this in her hearing! > > The statistical tipping-point for node count is supposed to be four, so > > the difference between 5 and 10 wouldn't alter treatment much. There was [quoted text clipped - 8 lines] > condition came to his office, 50 would be dead in a couple of years; > fortunately he did not say this in her hearing! ----------- Let me chime in here with my experience. I had an 8 cm tumor (very large--stage 3, grade 2). I was given chemo first to shrink the tumor, then mastectomy. The chemo shrank the tumor down to an impalpable size, and I asked my doctor whether she could do a sentinel node biopsy rather than an axillary node dissection. She took some time to think it over, then said that because the tumor had been so large and so fast-growing she did not think it would be safe to do the sentinel node biopsy. The mastectomy was done in December 04. 15 lymph nodes were removed. No active cancer was found in any of them (remember, I'd already had chemo). My arm is uncomfortable but far from unbearable, and I have not yet developed lymphedema, which, like your wife, I dread. I also have a "50/50" chance of survival, but I got this information from a website recommended by Tim, not from my doctors who have been relentlessly positive! I don't regret having the axillary node dissection. I appreciate my doctor's having considered the question and erring, if at all, on the side of caution. Eva > I don't regret having the axillary node dissection. I appreciate my > doctor's having considered the question and erring, if at all, on the side > of caution. > > Eva I think that's absolutely the best way to look at it. However as my wife's caregiver I worry that I may not have been diligent enough in protecting her best interests. Difficult to know, of course. > The mastectomy was done in December 04. 15 lymph nodes were removed. No > active cancer was found in any of them (remember, I'd already had chemo). All my nodes were removed and none had cancer cells found in them. > My arm is uncomfortable but far from unbearable, and I have not yet > developed lymphedema, which, like your wife, I dread. I don't dread it, it's, as Tim said, a quality of life issue (IF it develops which isn't even the majority of cases in my limited experience), not a life threatening one. I have a mild lymphoedema but it doesn't affect my life. I live. > I don't regret having the axillary node dissection. I appreciate my > doctor's having considered the question and erring, if at all, on the side > of caution. I don't regret it either, I do appreciate the care and consideration given by my team to my case - which was a pretty good one from the start. Since I knew nothing I put myself into their hands. Only since my surgery have I developed an interest in breast cancer. I wouldn't dream of researching the matter and questioning the team's desicions, I'm confident that they know far more about the subject than I could find out. Mary Mary > Eva >>The statistical tipping-point for node count is supposed to be four, so >>the difference between 5 and 10 wouldn't alter treatment much. There was [quoted text clipped - 8 lines] > condition came to his office, 50 would be dead in a couple of years; > fortunately he did not say this in her hearing! That sounds about right. The figures I referred to were overall averages for node count alone, obviously if you are combining risk factors, the component risk figures are different. They would have been rather less optimistic in your wife's case, but those statistics were recorded 30 years or so ago, and treatments have improved since then. SignatureTim Jackson You are aware that sentinel node biopsy has only recently replaced node clearance as standard practice? It's a relatively new technique. When I had a mastectomy in 1997 there was no such thing and I had 19 negative lymph nodes removed as a normal part of the surgery. Cussot > Prior to surgery my wife's surgeon said that during the op the sentinel node > would be dissected and if cancer was found, further nodes would be removed. [quoted text clipped - 9 lines] > this; also it's something that those who have not yet got to surgery might > want to think about. > You are aware that sentinel node biopsy has only recently replaced node > clearance as standard practice? It's a relatively new technique. When I > had a mastectomy in 1997 there was no such thing and I had 19 negative > lymph nodes removed as a normal part of the surgery. My surgery was in 1998 (in UK) and I had sentinel node biopsy. Mary |
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