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Treatment

 
Treatment

Chapter: 6 - Treatment

Subchapter: 6 - Lymph Node Removal

In addition to your surgical procedure, your doctor may wish to remove and examine lymph nodes; this is to determine whether the cancer has spread and to what extent. Your doctor will perform a Sentinel Lymph Node Biopsy and/or an Axillary Node Dissection. Let’s discuss both methods.

Sentinel Lymph Nodes and Sentinel Node Biopsy
While it is not easily controlled, the spread of cancer is sometimes predictable. The cancer cells spread through a customary path, out from the tumor and into the surrounding lymph nodes, before they progress throughout the body.

To be able to identify the sentinel lymph node, the surgeon will inject dye or a radioactive tracer into the tissue near the tumor; the lymph nodes that are the most susceptible to the cancer’s spread will be marked by the dye or a radioactive tracer. During surgery, the lymph nodes will be removed and checked for the presence of cancer cells.

Axillary Node Dissection
To determine if the cancer has spread to the lymph nodes, examinations can be performed with ultrasound and more carefully by removing one or more of the first draining lymph nodes with sentinel lymph node biopsy. Patients with a tumor that has spread to these lymph nodes may require complete removal of the lymph nodes in the armpit, a procedure known as an axillary lymph node dissection. An axillary dissection is generally performed subsequent to a sentinel lymph node biopsy, unless a woman has had a positive fine needle aspirate of a lymph node.

A mastectomy or lumpectomy operation often includes a sentinel node biopsy and/or an axillary node dissection; both procedures involve a separate incision for lumpectomy patients. Following surgery, the pathologist will test the lymph nodes to determine whether the cancer has spread to the lymph nodes.

Lymphedema
Removing lymph nodes raises your risk for developing Lymphedema, a condition that may cause abnormal swelling of the arm, breast, axilla, or chest wall on the side of your cancer. Swelling up to one month after surgery is not unusual and does not indicate the presence of lymphedema. However, if you experience new or persistent swelling in these areas after one month has elapsed since your surgery, you should notify your doctor.

Related Questions

  • Susan Green Profile

    My oncologist said that cancer could have spread even though I had a mastectomy with negative lymph nodes. Has anyone had this happen?

    Asked by anonymous

    Patient
    about 8 years 6 answers
    • View all 6 answers
    • Sharon Danielson Profile
      anonymous
      Survivor since 2007

      I think it all depends on the pathology of the breast cancer. There are so many other findings once a detailed report comes back one needs more information. Did you doctor say this in a context of recommending further treatment such as chemotherapy or radiation? There is probably always a...

      more

      I think it all depends on the pathology of the breast cancer. There are so many other findings once a detailed report comes back one needs more information. Did you doctor say this in a context of recommending further treatment such as chemotherapy or radiation? There is probably always a possibility of a cancer spreading but you / we need more information. If you are unsure about additional treatment, I would advise you to get a second opinion. Susan, good luck to you. There are a ba-zillion of us alive and well post breast cancer!

      4 comments
    • Sharon Danielson Profile
      anonymous
      Survivor since 2007

      Well, dang I wrote a whole long bla-bla and somehow it vanished. The testing your doctor is waiting for is probably an "Oncotest DX" This test looks at the actual tumor cells and pathologists are able to grade them as to their probability of recurrance. If they are a higher grade on the scale,...

      more

      Well, dang I wrote a whole long bla-bla and somehow it vanished. The testing your doctor is waiting for is probably an "Oncotest DX" This test looks at the actual tumor cells and pathologists are able to grade them as to their probability of recurrance. If they are a higher grade on the scale, they will recommend further treatment. This way, if they are a low grade for recurrance, you won't be receiving unnecesary treatment. My brother-in-law had breast cancer and the onco DX and his cells were so low grade he didn't have to have any further treatment after his mastectomy. I did not have an onco test 4 years ago because I had one positive lymph node. (BUT...) My oncologist had just returned from a breast cancer symposium and there had been a completion of a study which benefited me. I only had to have 4 rounds of chemo because of the study because the study showed any more chemo would NOT benefit my type of breast cancer.....YAHOOOO! . Every single day, little advancements are made in diagnostics and treatments. The way it is going, treatments are becoming less drastic than they were in the past. This test you are waiting for does take longer than the other pathology for your tumor. This will be the final one in the line of all the diagnostics. You will move along to the next step. Susan, don't worry.... you will be ok. There are a ton of positive stories out here. Women are living long lives. I hope you keep in contact. We are a great big supportive group out here. We want to help other sisters who are going through this all too common battle. Again, please stay in touch. All the best to you, we all know what you are going through. Big healing hugs, Sharon

      Comment
  • Thumb avatar default

    I had a second surgery as they didn't get clear margins the first time. So far I am stage 2a grade 3 2 lymph nodes involved. Is that bad? Still draining so can't get chemo yet.

    Asked by anonymous

    Stage 2A Patient
    over 7 years 7 answers
    • View all 7 answers
    • Sharon Danielson Profile
      anonymous
      Survivor since 2007

      Breast cancer IS just plain bad! I was 2A and after my surgery was downgraded to a 2B because I had one lymph node positive. It is better if you don't have any lymph node involvement but you deal with what you have. Not knowing any more about your breast cancer except stage and grade,(type) 2A...

      more

      Breast cancer IS just plain bad! I was 2A and after my surgery was downgraded to a 2B because I had one lymph node positive. It is better if you don't have any lymph node involvement but you deal with what you have. Not knowing any more about your breast cancer except stage and grade,(type) 2A has you far from the end of your rope. Your surgeon and/or oncologist will go over all of your tests before you go on to the next part of your treatment. You are at a very treatable stage so you will be ok. Hang in there and take care, Sharon

      Comment
    • Marianne R. Profile
      anonymous
      Survivor since 2011

      I had lumpectomy then a second to clean up margins by the everything was done I was stage III ER no nodes. Mentally and emotionaly I was a wreck. I'm not a stupid person but I just get my head wrapped around everything. Everyday more life changing decisions to make. I had to make decisions about...

      more

      I had lumpectomy then a second to clean up margins by the everything was done I was stage III ER no nodes. Mentally and emotionaly I was a wreck. I'm not a stupid person but I just get my head wrapped around everything. Everyday more life changing decisions to make. I had to make decisions about issues I didn't think I had full understanding. Looking back I think it was denial. Breast cancer is a very bumpy road and so indivdual I finely figured out to trust my doctors/nurses/trusted and my good judgement.

      Comment
  • amy LAMM Profile

    What is the difference between a lumpectomy and excisional biopsy with clear margins?

    Asked by anonymous

    Learning About Breast Cancer
    over 8 years 2 answers
    • Jennifer Jackson Profile
      anonymous
      Learning About Breast Cancer

      I am a RN with 35 years nursing experience, and I had an excisional biopsy myself last month. The terms mean pretty much the same thing. Technically, a lumpectomy is simply the removal of a lump. In an excisional biopsy, the lump is removed as well as a portion of healthy tissue surrounding...

      more

      I am a RN with 35 years nursing experience, and I had an excisional biopsy myself last month. The terms mean pretty much the same thing. Technically, a lumpectomy is simply the removal of a lump. In an excisional biopsy, the lump is removed as well as a portion of healthy tissue surrounding the lump. The terms clear, clean, or negative margins all mean that no suspicious cells were close to the edge of the excised tissue. In other words, they got it all. Close margins means suspicious or cancerous cells were close to the edge of the excised mass, and positive margins would mean that suspicious or cancerous cells were all the way to the edge of the excised tissue. In those incidences you would go back to surgery so they could take out a little more.

      Comment
    • amy LAMM Profile
      anonymous
      Learning About Breast Cancer

      and also, has anyone ever heard of a phyllodies tumor? I guess there is a possibilty my tumor might just be that, but being it's so rare there are not many studies out there about it and each web site says something different, so I was hoping someone could shed some light my way?

      Comment
  • Lorie Maddox Profile

    11 days since stereotactic breast biopsy (Dx DCIS) I'm experiencing pain, numbness and hypersensitivity (all at the same time-awesome) in the biopsied breast. Is this common?

    Asked by anonymous

    Learning About Breast Cancer
    over 5 years 4 answers
    • View all 4 answers
    • joan jones Profile
      anonymous
      Stage 0 Patient

      Agree - call the doctor to be sure ...
      But I experienced swelling and annoying discomfort post biopsy .
      And all was "normal " per the doctor - but I did report my concerns .
      Best wishes and keep us posted

      1 comment
    • André Roberts Profile
      anonymous
      Stage 1 Patient

      I say yes, it is common, but you should call the dr or speak with the nurse and tell them how you are feeling. I'm sure they will just say to ice the area and take some Tylenol. Prayers to you.

      Comment

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