Extra nodal extension

Hello,

What exactly does extra nodal extension mean? The oncologist tells us that the cancer is slow growing because she is in her 80s but then the pathology report came back and she has a Bloom Richardson grade of II which from what I've read so far on the forum is moderately aggressive. One node was completely replaced with extra nodal extension.  What does that mean? If the surgical margins are free of tumor, does that also mean that the surgical margins for the axillary node dissection were also free of tumor? Since 4/7 nodes were positive, can the surgeon go back and remove more lymph nodes?


Thanks.

[CCF-RN,MSN-rf]

Dear emilysjsu:  Extra nodal extension generally implies extension of the cancer outside of the lymph node.  If a person has an axillary lymph node dissection, this usually includes the "fat pad" that is under the arm.  Whatever is within the fat pad is the "sample" of lymph nodes.  Surgeons do not go back and remove more lymph nodes.  However, depending on the findings, additional therapy, such as radiation may be recommended.  While it is often true that cancers grow more slowly in older folks, this situation indicates that either the cancer has been present a long time or it is more aggressive than once thought.  Depending on the health of this individual, chemotherapy and possibly radiation therapy will likely be recommended.