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Axillary clearance after one positive node?


Re: Axillary clearance after one positive node?

Hi Peachy,


My experience is a little different but I had to do a lot of research until I could find a solution that worked for me.


When I was first diagnosed I had one cancer lump in one breast and a positive cancer test on one lymph node. What alerted me to my breast lump was that the lymph nodes in my neck to my breast became painful and swollen. I followed this down from my neck and found the lump in my breast,


When they did the initial biopsy it was only from the lymph nodes close to the breast so I have no idea what was happening above.


Chemo was for me a great success (that is apart from the side effects which are another story). The lump shrunk enough so that I could have a lumpectomy.


My clinic wanted me to have a lymph node clearance as that is their standard practcise when there has been any cancer detected in that area.


I did some research and asked them to do a Sentinel Node Biopsy instead. Luckily for me no cancer was detected in the SNB and we got good clear margins around the lump.


In order through to ask for a SNB instead of a clearance I had to research the evidence. For me that was published studies in journals.


What I found is that opinion is divided and changing on clearance of lymph nodes even if one is discovered to have cancer.


What is changing that opinion and practice is a USA study in 2011 called Z0011. 

( https://www.ncbi.nlm.nih.gov/pubmed/21304082 )


"CONCLUSION: Among patients with limited  SLN metastatic breast cancer treated with breast conservation and systemic therapy, the use of SLND alone compared with ALND did not result in inferior survival."


and this trial is changing practice in the USA


"From the 2.72 million breast cancer cases diagnosed between 1998 and 2011 and listed in the database, the investigators found that 74,309 patients met the Z-11 trial’s eligibility criteria for having SNB alone.  These patients underwent lumpectomy and radiation therapy to the whole breast; had tumors 5 centimeters or smaller (less than 2 inches) that appeared clinically node negative; had negative surgical margins (no cancer cells seen at the outer edge of the breast tissue removed); and had two or fewer tumor-positive sentinel lymph nodes."





In the UK things are moving a little slower. Because UK docs like to replicate the work down abroad before they change things too much here we have the POSNOC trial taking part. The results won't be out for another 10 years or so





I hope that helps in some way to make the decision easier. I did elect to go ahead and have radiotherapy after all because I thought that would be less invasive than lymph node surgery. To be fair I did rather feel pushed into this by the team treating me. 


It sounds as if your doctors are adopting the latest USA best practice maybe? 




Re: Axillary clearance after one positive node?

Hi Peachy. Hopefully both consultants gave you some evidence for their decision?


what you need to do...is keep asking yourself that same question......'will I be worrying that I should have had node clearance if I dont?'


we cant make your decision....you must make it as you will have to live with your choice.....however, a couple of thoughts.....I did have full clearance and it still came back.....so that isnt foolproof.......and can you manage to 'move past it'   if you dont have node clearance?


the other thing you can do....is leave the door open...say you want to think things over.



hope that helps




Re: Axillary clearance after one positive node?

The situation has changed slightly in that both the surgeon and radiotherapy consultant are recommending that I don't need either a clearance or radiotherapy as I don't meet the criteria. However my double mastectomy was after chemo so everything had shrunk anyway. Originally I had a 24mm grade 3 tumour with other multi-focal lesions on the right side (they only measured the biggest one) and DCIS on the left. One node was suspicious but inconclusive from biopsy on the right so they put a clip in so they could make sure they removed it during the sentinel node biopsy. After chemo I was left with 3 grade tumours, downgraded to grade 2, all about 10mm and a micromet in one of the 3 lymph nodes taken from that side although I am not sure if the clipped one is one of them yet. The left side was clear. My concern is that if I still have a micromet after chemo then if there is cancer in any of my further nodes then surely I should have more treatment to them as the chemo hasn't necessarily got rid of it all? Both consultants are happy to do the clearance or radiotherapy if I want it (I believe it would be an either/or) but both are saying I don't really need it. I know I should take their advice but not sure how I can live with the fear of some still being there. Any advice/experience welcome!

Re: Axillary clearance after one positive node?

Hi Peachy


i had total node clearance and then opted for rads, as 12/13 were affected and it had spread out of the nodes and  around them too,


i did get lymphoedema...but only because 

i got i fections around mt implant.


have had it for about 15 years....but still am glad I had all that cancer out.


however, you are going to be bilateral? So have a long think before deciding....get all the info and ideas you can xx


Best of luck with it




Re: Axillary clearance after one positive node?

Hi Peachy


Are you likely to have radiotherapy as part of your treatment in addition to the chemotherapy?

I had a left mx with immediate reconstruction and the pathology from that operation indicated that of two sentinel nodes removed that one was clear and the other full and encapsulated with cancer.

My breast surgeon was of the opinion that I should have an axillary clearance but sent me to see the oncologist "for some statistics!!" He said that if I was having chemotherapy that would most likely get whatever - if anything - that was in the axillary nodes and the radiotherapy which I would be having anyway would finish the job.

The outcomes whichever route I went down would be similar so I went for whole breast/axillary radiotherapy and avoided another operation. That said, lymphodema may still be a side effect of radiotherapy which was explained to me when I had my planning appointment.

It might be worth asking your oncologist what he thinks.


Good luck


Re: Axillary clearance after one positive node?

Hi Peachy,


Thank you for your post. I am sure some of our users will be along to share their experiences and show their support soon. 


In the meantime you can always post on our Ask the Nurse board or call our helpline on 0808 800 6000, who will be able to talk you through any questions you have and offer a friendly ear. The opening hours are below:


Monday-Friday, 9am-5pm
Late opening Wednesday, 9am-7pm
Saturday, 9am-1pm


Best wishes, 



Axillary clearance after one positive node?

I have just had a double mastectomy (grade 3 multi-focal on right and DCIS on left) following chemotherapy. Micromet was found in 1 of the 3 sentinel nodes on the right, suggesting that at least one was involved before chemo started. I will probably have radiotherapy (I am only 39 so belt and braces!) but I am not sure whether to have a full lymph node clearance. Has anyone else been in this position? Had I had surgery before chemo then I would have had the clearance as they would have seen the positive node. My surgeon has agreed to do it but thinks the risk of the side effects (lymphodema) are not worth the effort but would do it for my peace of mind. Would appreciate any thoughts!