I just wondered . . . . . .

Hi All

Does anyone know the answer to this.

If, god forbid you get cancer back in the same breastand you have had all lymph nodes removed the first time, does that mean it cant spread via nodes or how can they check???

Hi Alise. You might want to ask the real experts - your doctor and the BCC help line. But I thought I would write as you haven’t had an answer yet! (I used to be a lymphoedema nurse). There are lymph nodes in many places throughout the body, and around the breast there are numerous nodes in several levels under your arm, also in the area of the collar bone, in the neck and centrally in the chest as well. Even where nodes have been removed, the lymph will find new channels to flow around the nodes that have been removed . This is a good thing and what the aim of treatment for lymphoedema is - to encourage new pathways to be established and help the drainage from arm and breast where the nodes have been removed. Pathways open up to the nodes under the opposite arm, into the neck, and for people who have had a double mastectomy into the nodes in the groin. It’s a bit like what happens if you dam a river, new tributaries open up around it.

The lymphatic system drains dead cells and excess tissue fluid and drains back into the venous system at vessels in the base of the neck to be excreted by the kidneys. Lymph and vascular systems are closely connected. Some of us (like me) have been told that we have “lympho vascular invasion” around the tumour - it is just not possible to differentiate at the miscoscopic level one from the other. Even if many lymph nodes have been removed because of known spread to them there is, unfortunately, no guarantee that cancer cells will not appear in other parts of the body if they have spread from a tumour, either the original one or a recurrence. Of course removing lymph nodes that are known to contain cancer cells is done where this is possible, but it is to “mop up” any “escaped” cells that chemotherapy is given. So I think that if ever there was a recurrence in the same breast, chemotherapy would be offered depending on your own circumstances. Minute cancer cells in the body cannot be detected, chemo works as an “insurance policy” where there is the possibilty of a spread, based on the oncologist weighing up the likelihood of this having happened and the pros and cons of the treatment. Once they are detectable, in the form of tumours, they are known as secondaries, and will have been found usually because the person is having symptoms (often in bone, liver or lungs) - further specific treatment is then offered depending on the individual. Hope this is of some help, but please check with the experts! Good luck. Sarah.

Hi both,
seabird you are spot on, thank you for giving this valuable information.
alise sometimes talking through your concerns can help, so please do call our freephone helpline on 0808 800 6000, and speak to one of the nurses there if you want to, they will be happy to hear from you.

BW’s to you both
Tara, Clinical Nurse Specialist

Hi Sarah

Thank you very much for replying - that reall helped.

Love Alise x

Hi Tara - Thanks for letting me know that was right! Was typing it at 4.00 am and it took me about two hours as my brain was feeling a bit addled!!! Alise, I’m glad it made sense and helped. Sarah.