Why would I have fewer lymph nodes than average? - Neoadjuvant chemo?

I have had neoadjuvant chemo and then mastectomy and ANC. I saw my onc rather than surgeon for my path results, and was surprised (as was my onc) that only 5 lymph nodes had been removed. The onc said my axilla had “not been adequately dealt with surgically” but that instead of further surgery I will have rads to the axilla. I wrote to my surgeon to ask why he had not cleared more nodes, worrying that some cancer had been left behind. Today I got a letter back from him, and the following is the key extract which I don’t understand:

 

“I would like to reassure you that the surgery performed… is what we agreed to. I removed the pad of fat which contains the axillary lymph glands and after the surgery, there was very little tissue left in your axilla. The confusion I think is coming from the fact that in thin patients who have had chemotherapy, it is not uncommon that a smaller number of lymph glands are retrieved, much less than would be anticipated under normal circumstances. As mentioned, there was very little more tissue to take and I carried out the usual standard surgery…”

 

Why would having chemotherapy reduce the number of lymph nodes I have? Obviously it can kill any cancer in them but can it destroy the nodes themselves? And I wasn’t always thin - all through my teens and early twenties I was moderately overweight, so do nodes come and go as weight fluctuates during a lifetime? Or is there just less fat around the nodes so it’s harder for the surgeon to find them even if they are still there? Has anyone else only had a total of 5 nodes found? Although I’d love to be reassured, I’m feeling uneasy about it all…

Hi Fimbo,

I’m really interested in your post - I had neoadjuvant chemotherapy and also had a very small amount of lymph nodes. Well, of 6 that we’re removed, 5 contained cancer. I asked my surgeon at the time why only 6 had been removed and he said he took absolutely everything he could find. It has worried me ever since why I only had 6 lymph nodes (and obviously the fact that 5 of them contained cancer). He didn’t mention anything to do with the chemotherapy, he just said that everybody has different amounts?!

Thanks for posting, will be interesting to see if anyone else can shed any light.

K x

Hi Fimbo

Did you have a ‘Sentinel node biopsy’ done, where they inject you with blue dye?  As I understand it (and someone please correct me if I am wrong), if that is the procedure you have had done, they only take the first (sentinel) nodes in the chain.  The reason for this is that if there is no cancer found in them, there wouldnt be any in nodes further along the chain.  Lymph nodes are joined like a chain, so if the first one is healthy, it follows that those further along will be healthy too.  I only had 4 nodes taken when I had my initial surgery, which were all clear luckily.  They did take a further 4 when I had my mx, which were tested and clear too.

 

Also (as far as I know), there isnt a ‘normal’ number of nodes, it does vary from person to person.  its a shame you had your follow up with the onc instead of the surgeon, I’m sure they would have put your mind at rest!

 

Personally, I would be querying why you are having rads to your axilla.  If you have had the sentinel nodes taken and they were all clear, I wouldnt have thought you would need rads there too.  Of course, I could well be wrong and I’m sure they know what they are doing, but you probabaly need to get some clarification from your surgeon.

 

Good luck

Joan

Thanks for your replies.
KAM80, it’s interesting to know the same thing happened to you. Are you also “thin”? (I don’t consider myself thin but I have a healthy bmi). I hope you’re doing ok now.

Patchit, I asked for a clearance rather than SNB because I was concerned that the false negative rate for SNB is quite high for ladies who have had neoadjuvant chemo (ie the chemo has killed off cancer in the sentinel but not further up the chain). As only 5 nodes were removed I did ask my surgeon for confirmation that he had done a clearance rather than SNB, but his letter seems to say he removed what he could. In the end 2 out of the 5 were positive, so because of that and the fact my onc thought there could be some nodes left behind I’m having rads to the axilla.

Anyone else had neoadjuvant chemo and few nodes remaining afterwards?

I’m doing ok so far thanks Fimbo. I was reasonably thin (certainly had a healthy BMI) until starting treatment, then piled on 3 stone! I’ve lost a stone of it so far, just another 2 to lose. The tamoxifen doesn’t help though! Not sure how being thin can affect the number of lymph nodes though?

I also had rads to the axilla, as well as obviously chemo, mastectomy, ANC and now tamoxifen. At least I know I’ve thrown everything I can at it.

Be interesting to see how many others have experienced this. Hope you are doing ok too.

K x

KAM80, I don’t get the thin element of it either! My attitude is to try to be glad I’m having the works as far as treatment goes too - I’ve just started Tamoxifen with 25 rads starting in January.

Aroha, really sorry to hear that your sentinel node was involved - that must have been a nasty shock when you thought it was negative. I always knew I had more than one enlarged node on MRI, so all through chemo I imagined the worst. It was almost a relief when I learnt there were “only” 2 positive nodes even though that was after chemo. I had to wait 2 weeks and 2 days for my results - my bcn just said it was asking too much of the path lab to get them sooner, so your wait doesn’t sound worryingly long. Chemo isn’t fun but you’ll get through it. Just take one day at a time and keep plodding on. I joined one of the monthly chemo threads on this forum, and it really helped me to know I wasn’t going through it alone and we could share worries with each other. I hope it all goes well for you x