Hello
What is the definition of lymph node clearance I wonder?
I signed a consent form for “axillary clearance” and have always known that 13 nodes were positive but I have lately discovered that only 13 were removed so that is 13/13. I know we don’t all have the same number of nodes but exactly what constitutes CLEARANCE?
Look forward to some diverse answers.
Hi Dahlia
From what I understand, there are different levels which can be sampled, levels 1 in the armpit which are closest to your breast then level 2 which are higher up and level 3 which are very high up and which I don’t think most surgeons will attempt to remove. If people are node positive, it is possible they may be given radiotherapy in the under arm area and also around the collar bone area just to make sure. I had my lymph nodes removed - 15 in total so I’m guessing this is level 1 and 2. Of those removed, 1 was positive (although had had chemotherapy first so I don’t know if that means other nodes could have been positive before chemo). I had chemotherapy to my collar bone area but not to my underarm even though I asked my oncologist if I could. He just said there was no reason for me to need it there since all my lymph nodes had been removed.
I don’t know if this helps but I did attend the Younger Womens’ Forum recently where they explained a bit about the positioning and structure of the lymph nodes.
Ruby
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I wonder too how foolproof ‘Clearance’ is. I had clearance and 5 nodes were removed (3 affected). Because I have so few nodes I naively assume that the surgeon probably got them all because surely he would have been looking for more! But if you are correct Molly he wouldn’t know at the time anyway. I also feel 5 is a rubbish number to have - it doesn’t offer much of a barrier does it!
What I still do not understand is why everybody on here seems to get axillary clearance if even just one positive node is found - the surgeon I had would not remove mine even though the 2 removed in SNB were positive . I’ve just had to rely on chemo and radiotherapy - so have no idea how many were positive. I hate the idea that cancer was left in probably and consequently imagine an early recurrence.
Sarcath
The subject of NODES gets me all anxious and i wonder whether they actually know what they are talking about, but we have to trust the surgeons on it.
I was told i had to have a total clearance but didnt want it as i had seen lymphoedma which my mum had very badly.
an hour before surgery as it was a different surgeon doing the lumpectomy i was offered a sentinel node biopsy, as they thought from ultra sound scan the tumour was 1.7by 1.9. she said if it was more than 2cm she did a total clearance.
NO nodes involved they took 4 sentinel ones ( ones nearest the tumour) However the tumour was 4.5cms and i needed a mastectomy.
I asked and asked about these bloomin nodes but she was adamant i did not need anymore removed. Yet i had to have chemo so they must have thought something could have spread, but how if not through nodes?
All very confusing, we are in their hands and as much as people know about treatment and options and advances in treatment i still feel i am controlled by what the surgeons and oncologists advice.
R
I am very grateful that I have a very honest and upfront surgeon who is my age and female. She doesn’t bullsh*t or patronise me and I have been able to lead the way in all of my treatment so far. As the Americans say - I Iucked out. I would be tearing my hair out if I wasn’t being given options and the full picture all the time. I am amazed (by comments I read on another thread) that some people aren’t given their full pathology reports as a matter of course. It’s our cancer for God’s sakes!
R - ask them for a copy of your histo-path report so you know what your nodes actually did look like. Other than nodes vascular invasion will probably make chemo a requirement.
There is currently a trial underway around the country to see if micromet spread into nodes will do just as well by being left and zapped with chem/radiotherapy rather than clearance. I have been reading how the issue of nodes is still a very grey area. They are very hung up on the issue of lymphoedema and are trying everything possible to avoid clearances because they think it might be overtreating in so many cases. I have elected to have mastectomy, ovary removal and full axillary clearance - because psychologically I am happier with the chop eventhugh I might do just as well with the alternatives.
M xx
As I understand it in the past if you had a mastectomy they would take out all the lymph nodes regardless. Things have moved on a bit from then. I had SNB and one node was shown to be affected, no lump, just evidence to suggest that cancer had passed through the nodes. I had a further 25 removed during the mastectomy, which were clear.
I think that the medical profession have a large flow-chart in their heads and have many different things to consider when looking at you as an individual. That is why treatment varies so much.
take care
Pauline
I had full node clearance - went in for mast and SNB, then findings during the op made the surgeon change to full clearance, when he came to see me the next day he said surgery was far longer and extensive than he originally planed. My results were 8cm lump 15/20 nodes which included level 3 and later my Onc told me the highest ones were included up under the collar bone. (thats graphic enough for me to get the message, I dont need to see it written on a path report).
I had 8 x chemo, herceptin and rads to 3 areas even with full clearance.
Debbie
I had SNB which showed 3/4 nodes affected. Was told I had to have full clearance. A total of 6/21 nodes were affected.
I have never been offered the full pathology report. Information is drip fed to me and only when I ask for the information. Never told after mastectomy that i was PR+ only HER2.
After axilliary clearance registrar told me that infected nodes left in cause lymphodema at a later date. This is borne out by another thread which says if lymphodema subseqently develops they check to see if cancer is back. Not sure which thread it is but I read it on here a couple of days ago.
I just had node sampling[he said all level one]ie 5 nodes all clear so that was that.Because I am triple neg had chemo anyway.Vx
I had SNB - 2 nodes removed both positive. I was given no choice about axillary clearance - they just did not do it. When I tried asking why not and why was it considered safe to leave the nodes in I could not get a satisfactory answer. Next doctor I saw - 3 months later - told me he was surprised the nodes were not removed and that a local recurrence was more likely in this case. Great! Still could never get a satisfactory answer except that they claimed overall there was no difference between removing the nodes and not removing them in terms of long term survival - except that, as I understand it SNB hasn’t been around all that long anyway. Just hope the chemo and radiotherapy have done the trick - what else can one do?
Sarcath
Sarcath - there is certainly a hypothesis around that removal does not impact on survival and that rads and chemo can do their stuff just as well. After my SNB they found the one node with isolated tumour cells in. My hospital has weekly specialist team meetings - 3 of the docs said I should have the lymph nodes removed and 2 said I shouldn’t.
It is surprising that they just made that decision on your behalf and didn’t offer you options. But I shouldn’t worry too much - the trial I mentioned in my earlier post is all about proving that clearances may not be necessary.
Molly x
Thank you,Molly, for those words of reassurance. I’m trying to convince myself I won’t have a local recurrence, believe me! But for someone with my disposition I realy think it would have been better to get rid of them - for ages I had sleepless nights - and still do tho’ not as often.
My case is a bit different in that I was originally told by the first bc oncologist I saw that chemo would not be as effective for me because I had had it before for another cancer - she said even if it was different drugs they would not be as effective. So relying on chemo didn’t make sense to me.
As for a trial - should they not ask you if you will take part? I did one for my other cancer and there were quite a lot of formalities to go through.
One thing I willingly admit is that one year on I have not and never have had any problems with lymphoedema ( hope that’s not a case of famous last words! ) But that would be poor compensation for getting a recurrence sooner rather than later.
Sarcath
Cancer in the lymph nodes is a marker for the likelihood that breast cancer could spread elsewhere. The main method of spread is thought to be via the blood stream rather than the lymph system. The lymph system is a way of detecting disease and fighting it and can often identify abnormal cells such as viruses and kill them. Cancer is more difficult as the cells are basically normal body cells gone wrong so the lymph system sometimes confused them with normal cells.
Cancers tend to spread via the blood stream to particular areas with good blood supplies such as the bones, the lungs and the liver. At least that’s what I read. The book I read said that most cancer cells do get killed on the way if they have the tendency to spread. Chemo is designed to stop the process as are other so called ‘systemic’ treatments such as tamoxifen, arimidex and herceptin
Radiotherapy is meant to act against local recurrences in the breast not systemic spread as it can zap small areas of tumour which may be missed by surgery. It isn’t much good for bigger tumours though. It tends to kill cancer cells - normal cells will be harmed temporarily but then recover. At least that’s the theory although it is is completely correct why does my left breast which had radiation seem permanently stiffer than the other one?
Mole
I had auxilliary clearance at same time as WLE.I had 21 removed and all clear
Hi everyone, On 18 June 08 I had WLE with 7 nodes removed, (they were originally gong to take 5 but decided to take 7) 1 proved to have cancer in it. 14 July 08 They then did Axillary clearance, I have my appointment on Monday to see how many that was and subsequent results as to what/how much Chemo I will be having. I was told they never take all the lymphnodes because that would result in definate lymphodemia.
I know we can only go by what we are told by our individaul consultants/Oncs. (I’m not looking forward to my appointment on Monday) but Why are we all told so many different stories?
Why oh why is there not a ‘standard practice’ across the whole of the medical profession for all these treatments for BC? I know each case is individual but the treatments are so diverse it’s scary.
Sorry thats my rant for the day
Laurel x
I was told that all nodes had to come out to guard against local recurrence. I was also told that diseased lymph nodes left in likely to cause lymphodema. i agree they should all get their act together and tell everyone the same. I get told different things by different people in the same hospital. All very confusing.