Lymph Node Removal After Masectomy

[Terismom]

I had a masectomy for 2 different types of breast cancer 2 weeks ago and they found 2 out of 3 lymph nodes that they took out were positive on the last slice.  They want to take out 12 more lymph nodes when they put in the chemo port.  Why is it necessary to take out more lymph nodes - isn't the chemo supposed to take care of anything else that may or may not be left?  

[Cleveland Clinic]

DearTerismom, Checking the lymph nodes for possible spread of cancer is part of the process of staging.  This information helps to determine recommendations for treatment.   There are situations in which additional treatment to the area (radiation) might be recommended if cancer has spread to 4 or more lymph nodes.   As 2 of the 3 lymph nodes removed contained cancer cells, knowing if there was additional disease in the other lymph nodes under the arm would help in the treatment recommendations.   You would want to discuss the particulars of your case with your surgeon who can put their recommendations for further surgery into context of your individual situation.

[lizziecee]

Hi there - the nurse doesn't answer questions over the weekend, so thought I would say hi and post my experience in the hope it helps.

I had a WLE and 8 sample nodes removed for a 2cm invasive ductal tumour and DCIS, Jan 2003. 3 of the 8 lymph nodes were cancerous, so I was strongly advised to have further surgery to remove all lymph nodes, which I had a month later. One more node was positive. So, 4/18 positive.
It was at this point that chemo was first mentioned - beforehand I was told I could either have a mastectomy and no rads, or a WLE and rads. The fact that the cancer had spread to the lymph nodes was what changed the treatment plan. As bc can spread through the lymph nodes to other organs (liver,lungs,bones etc.) and/or the vascular system, it is prudent and good practice to remove all lymph nodes, if even only one of them is cancerous.
I knew nothing about bc then, and just went along with what my surgeon advised, and I am thankful that I did - still here 4 years later, with no metastases and doing fine.

From what I understand now (it has been a huge learning curve) if the cancer has already progressed to the lymph nodes, then total axillary surgery is the normal procedure, followed by chemo and rads. I questioned my Oncologist as to why chemo and rads, and was told there could be microscopic cancer cells throughout the body, (unable to be detected on any kind of scan) which the chemo would hopefully take care of, and the rads was to blast any remaining cells in the affected breast. I am very at ease with my decision to have had the best treatment my medics advised. However, every case of bc is slightly different, and not all patients wish to have all the treatments. That is a personal choice, which we all respect.

If you are still unsure as to whether or not to have total axillary removal, I would question your surgeon and/or Oncologist for their views.

Take care - hope all goes well. I am sure the nurse will answer on Monday with more technical information than I have.
Liz.

[Terismom]

Thank you for your response.  I just hate the thought of going through more surgery and another drain (YUCK!) if it is not absolutely necessary.  They already have me scheduled for chemo and said I would need radiation if I elected not to have more surgery.  From what I have read on the boards I still may need the radiation after more lymph nodes are removed anyway.  I have another appointment with the surgeon to go over my options again.

It is great that you are doing so well!  I appreciate your sharing your experience :)

[japdip]

Hello there:  Trust me, they don't do unnecessary surgery. The more information the Dr.s can obtain, the better able they are to formulate the proper treatment plan for your individual case.