One of the scariest aspects of breast cancer surgery – the removal of lymph nodes in the area around the breast and armpits – is unnecessary for many women with early-stage breast cancer, according to new research.
A study published in the September 2017 issue of the Journal of the American Medical Association tracked women with early-stage breast cancer followed by radiation or other therapies to kill the remaining cancer cells. He was treated with other therapies. In the study, half of the women had only a few lymph nodes (abbreviated as sentinel lymph nodes) removed from under the underarm, while the other half had a large number of lymph nodes removed, called axillary lymph node discussion. But 10 years after the follow-up, both groups had similar rates of recurrence and survival.
The Question of What to Do About Lymph Nodes Has Been a Puzzle
Early stage breast cancer is usually defined as a disease that does not spread beyond the breast or axillary lymph nodes. Most breast cancer patients in the United States are diagnosed with early-stage cancer.
Nearly two decades ago, research led by Armando Giuliano, MD, director of the 2017 trial at Cedars Seine Medical Center in Los Angeles and executive vice chair of surgical oncology, revealed that breast cancer often spreads to nearby lymph nodes first. These are called sundial nodes. Removal and testing of one to three sentinel nodes called sentinel lymph node biopsies can help physicians assess the spread of cancer.
“The sentinel node is the first lymph node in which cancer spreads, if it spreads,” says Dr. Giuliano. “We’ve proven that if the sentinel node is negative (no cancer), 99% of the time, the cancer doesn’t spread anywhere else in the body.”
What if a sentinel node is positive?
But the question is whether, when the surgical node is positive for cancer, surgeons need to remove the secretory nodes to remove the semen. As a precaution, doctors usually removed the axial nodes. “We expected there to be more positive nodes, and you don’t want to leave them behind,” says Giuliano.
Although many doctors embraced the results of previous studies, others felt that it was too small and had too few patients who could draw solid conclusions. The new study followed patients for 10 years and confirmed the actual results. “Now, after 10 years of following, I think everyone is accepting that advice,” says Giuliano.
Giuliano says the news should reassure women a lot. “This study shows that you don’t have to do that. Women are scared of this operation. The operation is associated with side effects.
Removing Lymph Nodes Is Not Without Consequences
Removing the axial lymph node, which usually involves removing 15 to 25 nodes, can have disturbing results. The lymph nodes carry fluid, called lymph, to areas of the body to help fight infection and remove toxins. When a large cluster of small, round nodes is surgically removed, the lymph fluid may not be able to flow freely. Fluid formation is called lymphadenopathy.
“Some women get terrible swelling of the arm from lymphedema,” says Gilliano. “You may have shoulder problems, such as a limited range of motion, numbness, and pain that can be chronic and long lasting. These problems are very difficult to handle.
When this cancer is found in one or two sentinel nodes, some women may be anxious to maintain the lymph nodes. But, in the early stages, most breast cancer patients also receive radiation therapy, which kills cancer cells in the lymph nodes, Gilliano said. Chemotherapy, hormone therapy, and targeted therapy – medicine given to some women based on the type of breast cancer – which also eliminates cancer in the lymph nodes.
The results of the study only apply to women with early-stage breast cancer who have lumpectomy and additional treatments, such as radiation and chemotherapy. Further research is needed to see if patients with other types of breast cancer can avoid removing lymph nodes from the precautionary cells.
“The important question now is how to manage the lymph nodes of a breast cancer patient if they have had chemotherapy before the operation,” says Gilliano. “What is the effect of chemotherapy on noodle involvement?”
But for now, women with early-stage breast cancer who choose to have a lymphoctomy after additional therapy should discuss the need to remove the bloody lymph node with their doctors before surgery. If it is recommended to remove the classical node, “get a second opinion,” he says.