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All TopicsForum: Surgery - Before, During, and After → Topic: Axillary Node Dissection

Topic: Axillary Node Dissection

Forum: Surgery - Before, During, and After — Surgical options and helpful tips for recovery and side effects.

Posted on: Jan 14, 2011 08:42PM

Sereena wrote:

Dx stage II breast cancer and now am going in for level I and Level II lymph node dissection. What is the "real" recovery time. Have already had 2 surgeries and sentinel node dissection.

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Jan 15, 2011 06:45PM lago wrote:

makingway I consider them unreliable based on how mollyann uses them to support her position. They are not sites used for making medical decisions because the information can be out of date or in one case the editors are not medically-trained.The study from San Antonio has merit but it's only one study.

I have posted an image of my arms in the lymphedema section and one person couldn't even tell that I had it.The picture posted which mollyann linked to showed lymphedema that was out of control. How many women get it that bad? That picture would scare any person away if she though that the outcome was 49% would be looking like the woman in the picture. I got my lymphedema after my  4th chemo treatment.

As far as survival I'm not sure if enough studies have been done. That's why standard care has not changed yet. These things tend to flip back and forth till enough studies have been done to be deemed conclusive. Yes Sereena should present this information to her BS. That's what I have been stating all along but she should go in with a close mind and say to her BS "I'm not letting you do this because of this study."

DONE!! alturl.com/3o9ni • Tattoos 2.7.2012 • Nipples 10.6.2011 • Exchange 6.24.2011 • Chemo 1.18. 2011 • BMX 8.31.2010

Dx 7/13/2010, IDC, 5cm, Stage IIb, Grade 3, 0/14 nodes, ER+/PR+, HER2+
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Jan 15, 2011 07:42PM, edited Jan 15, 2011 07:45PM by mathteacher

Iago,

Did you read the studies Makingway posted were all from peer review journals? Did you realize anatomy hasn't changed so the study date doesn't matter? Are you familiar with using Pubmed for research? It might be helpful to learn how to use it since you are giving frequent advice.

I realize it's hard for you to accept you were unaware of the medical research when you had your node dissection. But please don't try to talk others into a decision that has already harmed you and all the poor souls on the many Coping with Lymphedema threads.

I wish you the best. You have a lifelong disability and it can't be easy falling into that 49% after trusting your doctor. You are in my prayers.

Resending Makingway's study finds-----------------------------------

Completion axillary lymph node dissection not required for regional control in patients with breast cancer who have micrometastases in a sentinel node.Arch Surg. 2010 Jun;145(6):564-9.
http://www.ncbi.nlm.nih.gov/pubmed/20566977

Micrometastasis in the sentinel lymph node of breast cancer does not mandate completion axillary dissection.Ann Surg. 2004 Jun;239(6):859-63; discussion 863-5.
http://www.ncbi.nlm.nih.gov/pubmed/15166965

Prognostic and therapeutic impact of sentinel node micrometastasis in patients with invasive breast cancer.Tumori. 2002 May-Jun;88(3):S4-5.
http://www.ncbi.nlm.nih.gov/pubmed/12365385

Comparison of sentinel lymph node biopsy alone and completion axillary lymph node dissection for node-positive breast cancer.J Clin Oncol. 2009 Jun 20;27(18):2946-53. Epub 2009 Apr 13.
http://www.ncbi.nlm.nih.gov/pubmed/19364968

When in doubt, read the actual studies and do the math.

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Jan 15, 2011 07:42PM makingway wrote:

<Banging head against wall>....

Visit my website for helpful tips when using cold caps:penguincoldcap.wix.com/help

Dx 3/2/2009, ILC, 4cm, Stage IIb, Grade 2, 1/19 nodes, ER+/PR+, HER2-
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Jan 15, 2011 07:55PM tninalabama wrote:

Sereena, I had axillary dissection in July. I had the remaining nodes removed and 12 /13 positive. I found a swollen node in November 09 and went through neoadjuvant to shrink any possibles. Didn't really help in my case. Anyway, my arm is still stiff. It bothers me in the evenings and when I try to get to sleep. During the day it's not too bad, just like a tight muscle from too much exercise. I have NOT had any lymphedma problems. My BS warned about problems with my first surgery, nothing then either. 

11/07 triple neg metaplastic, 12/07 lump, 01/08 bilat mast., EC x4,Taxotere x4, recurr 11/09, Xeloda x 6, Axill. dis. 07/10, rads,09/10, Pet scan 02/11, 3 nodes ,hilar,axillary, mediastinal, CTscan 05/11, NED 05/11, PET 08/11, still on Abraxane

Dx 11/2007, 2cm, Stage IIb, Grade 3, 1/6 nodes, mets, ER-/PR-, HER2-
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Jan 15, 2011 08:43PM lago wrote:

Source: www.cancer.gov/cancertopics/pd...

"For patients who require an ALND, the standard evaluation usually involves only a level I and II dissection, thereby removing a satisfactory number of nodes for evaluation (i.e., 6-10 at least), while reducing morbidity from the procedure. Several groups have attempted to define a population of women in whom the probability of nodal metastasis is low enough to preclude axillary node biopsy. In these single-institution case series, the prevalence of positive nodes in patients with T1a tumors ranged from 9% to 16%.[51,52] In another series, the incidence of axillary node relapse in patients with T1a tumors treated without ALND was 2%.[53][Level of evidence: 3iiiA] Because the axillary node status remains the most important predictor of outcome in breast cancer patients, insufficient evidence is available to recommend that lymph node staging can be omitted in most patients with invasive breast cancer." 

Those studies have small samples. This is why it seems the jury is still out. But even if they are correct, for people like me who had large tumors it appears that ALND is still standard. It also appears it is still standard for non-micro mets in lymph nodes. Sereena has both micro and macro mets in her nodes. Again I am not saying she should do the surgery but find out the rational from her surgeon. These studies indicate to me that further studies need to be done with larger samples. The San Antonio one was more significant because it was the largest study to date. They aren't changing the rules yet for a reason.

DONE!! alturl.com/3o9ni • Tattoos 2.7.2012 • Nipples 10.6.2011 • Exchange 6.24.2011 • Chemo 1.18. 2011 • BMX 8.31.2010

Dx 7/13/2010, IDC, 5cm, Stage IIb, Grade 3, 0/14 nodes, ER+/PR+, HER2+
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Jan 15, 2011 08:56PM, edited Apr 16, 2011 10:49PM by mollyann

Every study finds the same thing. You can follow the studies back through Fisher and Halstead. Remember them?

And as far as not changing the surgery rules, there are no rules. Many of the more educated surgeons absolutely will not invade the nodes because there is no survival value. The node invaders will be left behind in the medical world as butchers who crippled their patients. I would not want to be the last patient a surgeon operated on and took nodes before he changed his mind and modernized his procedures.

Look it up. Ask questions. Question authority. Respect other's choices.

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Jan 15, 2011 09:23PM lago wrote:

Mollyann I stop insulting my intelligence with this bull that I've only been on this site here since July. You don't know what I know. You don't know my background. You don't know anything about my research skills and my understanding of how to interpret the research.Every time I disagree with you you either ask for some links or say I haven't been on this site or had breast cancer long enough to know.You won't even share your diagnosis with folks. I wonder why?

I personally take offense when you infer my BS is a butcher that cripples his patients. That's just a nasty thing to say. Out of control, mean comments like that this make you sound very unbelievable. You'd make a great tabloid journalist. Take a little bit of truth and blow it up to get an attention getting headline.Totally irresponsible.

Odd that your signature says "respect other's choices" You have done nothing but insult mine.

DONE!! alturl.com/3o9ni • Tattoos 2.7.2012 • Nipples 10.6.2011 • Exchange 6.24.2011 • Chemo 1.18. 2011 • BMX 8.31.2010

Dx 7/13/2010, IDC, 5cm, Stage IIb, Grade 3, 0/14 nodes, ER+/PR+, HER2+
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Jan 15, 2011 09:42PM, edited Apr 16, 2011 10:48PM by mollyann

 You reply to messages before reading the evidence from peer-review literature. You have already made up your mind so you feel you're above reading the scientific record since Halstead.

Most people are like you, they get the surgery without researching and their doctors don't provide full disclosure. I'm sorry you got lymphedema. 

What I object to is your trying to recruit people into repeating your mistake and encouraging them to disregard the medical findings.

Look it up. Ask questions. Question authority. Respect other's choices.

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Jan 15, 2011 11:07PM Beeb75 wrote:

Highly educated and respected breast surgeons still perform ALNDs, so the question is why? Surely not for mere staging purposes. My surgeon (who went to Harvard Med...just sayin') told me "Lymph node ratio is important." Well, you can't have a low ratio unless a lot of nodes are removed, that's just high school math.  

So what about studies like this one?

http://www.ncbi.nlm.nih.gov/pubmed/12217299

RESULTS: Node-negative patients with < 14 lymph nodes removed had a 10 year survival of 79% compared with 89% in patients with > or = 14 lymph nodes removed (P=0.005). The 10 year survival for patients with an LNR > or = 0.2 was 52%, compared with 73% for patients with an LNR < 0.2 (P<0.0001). A Cox proportional hazards model showed that, for node-negative patients, only age and total number of removed lymph nodes were significant prognostic factors. For node-positive patients, age, total number of removed lymph nodes and the LNR were significant risk factors for survival outcome. The LNR was also significantly associated with the presence of distant metastases during follow-up (hazard ratio 3.56, range 1.63-7.77). 

There are numerous studies about the importance of lymph node ratio. And clearly, our breast surgeons believe they our improving our chances for survival by getting us a better ratio (by taking more nodes.)

Would the ALND naysayers care to respond to this point? 

Dx 7/2010, IDC, 2cm, Stage IIb, Grade 3, 1/20 nodes, ER+/PR+, HER2-
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Jan 15, 2011 11:37PM mathteacher wrote:

Beebe,

That study is just what the critics of lymph node dissection are saying. A better diagnostic tool has been found in tumor biology. You must have read it wrong.

Read the San Antonio study and look at the video of Armando Guiliano, MD

http://www.youtube.com/watch?v=Jnq-LVlgyIw

Institutions vary in their resistance to change. I see the San Francisco area doctors are more progressive.

When in doubt, read the actual studies and do the math.

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Jan 15, 2011 11:53PM EClaire wrote:

I have a question. How does knowing the number or ratio of lymph nodes impact treatment recommendations?

 After reading an article about the Guilliano study, I asked my radiation oncologist if my treatment would be any different if he only knew I had a positive sentinel node vs. knowing I had multiple nodes positive from having an axillary lymph node dissection. He said he might tweak things just a little if he knew that I had multiple nodes involved, but essentially it wouldn't make a difference in treatment (so doing the ALND doesn't seem to add info that he needs).

So, does having more info about the number and ratio of nodes make a difference in treatment determinations of a medical oncologist--such as the type or duration of chemotherapy? My oncologist has already said if I have a positive sentinel node, the Oncotype DX is no longer of value, so I assume that means if I have even one positive node, chemotherapy is recommended. But, from your experience, is the chemo somehow different if there are multiple nodes involved? 

 BTW, I have not had my surgery yet, so this is a topic of great interest to me. 

Dx 12/17/2010, ILC, 1cm, Stage I, Grade 2, 0/3 nodes, ER+/PR+, HER2-
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Jan 16, 2011 12:28AM, edited Jan 16, 2011 12:33AM by mathteacher

Eclaire,

You are at the best place to be--before surgery!

I wouldn't suggest letting your radiation oncologist anywhere near your nodes. Radiating nodes virtually guarantees lymphedema. I don't know what he meant by tweaking your treatment. Can you get more details? Chemo is temporary. Radiation damage is forever.

I have a smart friend who is a lawyer who made her surgeon sign the consent form that she would take no more than three nodes. She had seen her mother suffer with lymphedema and she wasn't going to risk it if she could help it.

If you have one positive node they are saying it trumps the Oncotype DX?  It depends on the philosophy of the surgeon. The guidelines are only guidelines. Can you get your surgeon to read the Guiliano study? Do you have the NY Times version? Surgeons don't like reading complex stuff, they like to cut. Ask any nurse :)

When in doubt, read the actual studies and do the math.

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Jan 16, 2011 12:59AM Beeb75 wrote:

Hi Mathteacher,

The study was looking at the relationship between number of lymph nodes removed and lymph node ratio, and survival and it found:

RESULTS: Node-negative patients with < 14 lymph nodes removed had a 10 year survival of 79% compared with 89% in patients with > or = 14 lymph nodes removed (P=0.005). The 10 year survival for patients with an LNR > or = 0.2 was 52%, compared with 73% for patients with an LNR < 0.2 (P<0.0001).  

Doesn't that info alone make you want have more lymph nodes removed?

If I'm missing something, please explain!

I do find the abstract from San Antonio interesting, though perhaps not definitive. Two things that concern me: the study closed early due to low accrual/event rates...and I also wonder if the almost identical survival rates at 5 years have more to do with current chemo and hormonal treatments that "push" any relapses that will happen further into the future....Would love to see 10- and 15- year results!  

EClaire: Yes, I think your oncologist will want to be more aggressive with your chemo/hormonal treatment if you have lots of positive nodes. There are currently three "levels" of chemo and as they increase in potential efficacy, they also increase in serious side effects. Also, the duration/intensity of your hormonal treatment might be affected by your nodal status. Put simply, the more nodes involved, the higher your chance of relapse and the more your doctor will want you to hit the cancer hard, with everything they've got, to keep you disease-free. 

As a real-world example: I had an allergic reaction to my first Taxol and my doctor suggested I quit chemo then (after 4 AC and 1 Taxol) and go straight to Tamoxifen. She said that with 1 node positive, I don't have a super-high risk of recurrence, and there was a chance another Taxol treatment could send me into anaphylactic shock (which could kill me). Another woman told me that when she developed a rash after Taxol, her oncologist was like, "Sorry about that rash, but you've got to finish chemo" and that was because she had lots of positive nodes, so chemo was more crucial for keeping her cancer-free.

 Also, now that I think about it, node number also comes into play for radiation. My radiation oncologist ultimately recommended skipping radiation of the axillary area and doing chest wall only, because my axillary was "treated" surgically, through the ALND (and radiation would increase my risk for lymphedema). If you have no positive nodes, or 1-3 nodes, you may or may not need axillary radiation (the dreaded "grey area") But if you have 4 or more positive nodes, they will definitely want to radiate that area.

Best of luck!

Dx 7/2010, IDC, 2cm, Stage IIb, Grade 3, 1/20 nodes, ER+/PR+, HER2-
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Jan 16, 2011 01:18AM Binney4 wrote:

Just to clarify for anyone who might be reading this and be terrified by the exaggerations of this discussion, radiation to the nodes does not "virtually guarantee lymphedema." While the science of lymphology is relatively new, it is at least in its Renaissance, and we can be sure, based on the science we already understand, that that statement is simply not true.
Binney

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Jan 16, 2011 05:45AM BarbaraA wrote:

RE: Oncotype test - I had a micromet in one of 4 nodes and my onc ordered the test which came in at 17. The new 'standard' about the test is <3 nodes. I think my micromet went to the node after the biopsy. JMO.

Sometimes you're the bug and sometimes you're the windshield.

Dx 4/30/2010, IDC, 1cm, Stage Ib, Grade 2, 1/4 nodes, ER+/PR-, HER2-
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Jan 16, 2011 07:33AM lago wrote:

"And I would respect your choice if you had a chance to make one one. You made no informed choice whatsoever because you weren't given the literature."

Again you don't know what I know. I questioned my BS not only on the level 1 (and the possibility of level II) and about the sentinel on the other side. I did my research. With a tumor my size the chance of it not being in my nodes was only 20%. We needed to know if the cancer had spread there and to how many. Yes that did effect my treatment. I'm sure radiation would have been recommended if in my nodes and pretty sure I would be on a different chemo cocktail too (from what I have researched).

So again don't say you know what I know based on a few posts. My posts do not give medical advice but encourage people to talk with their doctors. You come right out and tell them not to do certain surgeries, hormone therapy, etc. I don't care how much research you have done in the past couple of years as a patient… you are not an MD. I find you twist the research to fit your needs.

Remember not too long ago they felt Zometa prevents bone mets based on a few studies. Now they are not so sure based on a study that refutes it. The research you presented is still not enough to change standard care practices as they stand today. The research only indicates that more studies have to be done. I just don't understand why that doesn't make sense to you.

mollyann I find you rude and insulting to me. I think you need to get over yourself and stop discrediting me because I've only known I had cancer for 8 months.

DONE!! alturl.com/3o9ni • Tattoos 2.7.2012 • Nipples 10.6.2011 • Exchange 6.24.2011 • Chemo 1.18. 2011 • BMX 8.31.2010

Dx 7/13/2010, IDC, 5cm, Stage IIb, Grade 3, 0/14 nodes, ER+/PR+, HER2+
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Jan 16, 2011 11:37AM kmmd wrote:

beeb, I've posted that issue regarding the ACOSOG Z-1011 trial the San Antonio abstract was based on also.  The trial closed due to lack of accrual.  While the results are interesting, and I'm happy we're all still learning something from the money and time spent on that trial, it surprises me how often that important piece of information is left out.  I'm assuming it gets overlooked a lot because the results either confirm what many of us already thought about the subject or tell us what we want to hear. 

www.youtube.com/watch?v=vrpJD2... Keep breathing is my new motto. Kate

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Jan 16, 2011 01:11PM NannaBaby wrote:

Hi Sereena

The ladies have gone off topic here.  I don't quite understand what you mean by "real" recovery.  Do you mean to have completely healed incisions and no soreness at all? Or do you mean when will you feel normal again and be able to move your arm around with minimal stretching sensation?  Because honestly, it only took me 2 weeks to feel good.  I was very adamant about the stretching exercises given from my surgeon.  I started the day I got home from surgery.  And applying heat to the pectoral/armpit area helped a lot.  It is important to keep your blood flowing.  Go for short walks, meditate and stretch.

NannyBaby, dx May 2010 at age 28. Neo-Chemo AC+Taxotere, surgery uMx, 25 Tomo rads, more chemo Cisplatin+Vinorelbine.

Dx 5/28/2010, IDC, 6cm+, Stage IIIb, Grade 3, ER-/PR-, HER2-Chemotherapy 06/04/2010 Adriamycin, Cytoxan, TaxotereSurgery 12/14/2010 Mastectomy (Left); Lymph Node Removal: Axillary Lymph Node Dissection (Left)Radiation Therapy 02/20/2011 3-D conformal external beam radiationChemotherapy 04/01/2011 carboplatin, NavelbineSurgery 07/13/2012 Reconstruction: DIEP flap (Left)
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Jan 16, 2011 01:49PM kayb wrote:

I'm coming late to this discussion but I'm totally with "lago" on this one. Decisions like this should be made with your doctor! If you want to read and print some actual studies to discuss with your doctors by all means do so. Medscape.com is a good place to start. But don't take medical advice from other patients! If you feel you need another opinion, get an appointment with another doctor.

My surgery is upcoming on the 24th. I HAVE talked to my BS about that latest study out of San Antonio and her feeling is that this one study is simply not enough "to hang your hat on" at this time. It has to be replicated and/or refined by others before the data can be considered reliable. Too much other research has shown benefit to cancerous node removal. She said she hopes it can become standard care in the future but the scientific evidence is just not there yet and she woud be uncomfortable leaving any cancerous tissue behind. That made sense to me so I'm willing to defer to her judgement. My onc agrees - I discussed it with him too. 

Your doctor may feel differently and if he/she does then that's fine if you feel good in their hands. While those of us on this board may be able to offer support and links to interesting info, that's where our role should end IMO - not trying to do an end run around actual doctors by dispensing medical advice without a license. If someone else's experience makes you want to look at other options I think that's fine as long as your medical team is involved. Honestly - I'm going to have a very long relationship with my doctors and I can't imagine not trusting their training and knowledge. That's not to say I don't come armed with studies and questions! I do! I just don't think it would be wise to side step them when I make decisions regarding my treatment.

Just my two cents.

DX May/2010, synchronous bilateral cancer, triple positive

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Jan 16, 2011 03:02PM Claire_in_Seattle wrote:

Sereena,

To answer your initial question, I was fine the next day with a lumpectomy, port placement, and axillary node dissection.  Of course, real healing took longer, but I felt fine, and even did a 2 mile walk.

In terms of was it necessary????  I had one grossly positive node going in, which turned out to be the ONLY one affected.  I was extremely lucky in that regard.  Even my surgeon used the words "extensive involvement" to my friend who was with me.

So yes, given my initial symptoms, the right course of action would be "to clean those suckers out of there".

As for how am I fifteen months later?  Still have a bit of discomfort on my left side, but don't feel limited at all.  Take the normal BP and injection precautions, and that's about it.  My upper body is fit and toned.  Have full movement on that side, but that was true the day after surgery.

As for whether you should go down that road, the right thing to do is ASK YOUR DOCTOR!!!!  By "asking", I mean have him or her describe the risks/benefits, and why this course of action is appropriate.  If you don't like the answer, get a second opinion.

This goes back to listening to some of the counsel offered here.  Some of it is just wrong-headed and not everyone here is playing with a full deck when it comes to medical issues.  You have to be cognizant of this.  You can, however, use all this input to understand why you are going down a particular path and the benefits.

Because, in the end, you need to be confident that you and your medical team have made the best decision.

Completed all active treatment (AC +T, lumpectomy, and radiation). Now on to the rest of my life. So much to celebrate.

Dx 8/2009, IDC, 2cm, Stage IIb, Grade 3, 1/21 nodes, ER+/PR-, HER2-
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Jan 16, 2011 03:04PM ruthbru wrote:

Here's a good booklet with exercises to help with recovery after surgery.

 http://www.cancer.org/Cancer/BreastCancer/MoreInformation/exercises-after-breast-surgery

It is always important to have information and be an active, questioning member of your own health care team. Certainly, though, if it comes down to it; I would go with their advice (or get a second or third opinion by qualified medical personnel) over following the advice of ANYONE on these boards (myself included). Each case is unique, and what was a right choice for me may very well be a wrong choice for someone else. The main goal of treatment for anyone in Stages 1 through 3 is CURE; and the best chance of that is to have the most accurate information possible; which, depending on the circumstances, may include a standard lymph node dissection. Best of Luck to All! Ruth

"Invisible threads are the strongest ties." Friedrich Nietzsche

Dx 2/2007, Stage IIa, Grade 3, 0/11 nodes, ER+/PR-, HER2-
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Jan 16, 2011 04:42PM maltomlin wrote:

Hi. I'm with Claire_in_Seattle and Beeb75 on this one.

I'm in the UK so it maybe slightly different but I am being treated by one of the two major cancer centres in the UK. I should add that I have absolute faith in both my BS and Onc who are wonderful.

I had level i and ii clearance as they felt it important to 'get all the cancer' out. 24 nodes were removed and 3 were affected. My Bs told me the same as Beeb75 has said, that it is the ratio that is important. 3 out of 24 giving a better prognosis than 3 out of 10.

Full movement was regained very quickly although the area was numb for over a year. I have no problems whatsoever now. Many of my friends and colleagues had full clearance (some many years ago) and I don't know of anyone with any problems.

These matters should be discussed fully with your doctors. Whilst lymphedema is a risk to all us all I don't think that scaremongering is good for anyone, especially those seeking  some re-assurance.

Mal

Dx 5/2/2008, IDC, 3cm, Stage IIb, Grade 3, 3/24 nodes, ER+/PR+, HER2-Surgery 06/15/2008 Lumpectomy (Right)Chemotherapy 07/21/2008 Ellence, XelodaHormonal Therapy 12/29/2008 FemaraRadiation Therapy 01/07/2009 External
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Jan 17, 2011 03:31AM makingway wrote:

What few have seemed to realize is that your body works as a 'system'. Removing the lymphnodes, even if cancerous, does NOT improve survival rate. Lymphnodes are not 'closed systems.' Lymph fluid travels throughout your body and into the bloodstream. This is how metastasis occurs. The tumor can secrete 'seed' cells which lay dormant. The removal of the tumor can cause these seed cells to start growing. This is called Surgery Induced Metastasis. http://www.lef.org/magazine/mag2009/dec2009_Preventing-Surgery-Induced-Cancer-Metastasis_01.htm

So, my point is that no one is improving their survival by removing lymphnodes. In fact it is causing more of a burden on the body, to have to work harder to repair the damage been done, and also accomodate for the lymph fluid without it's usual channels.

Visit my website for helpful tips when using cold caps:penguincoldcap.wix.com/help

Dx 3/2/2009, ILC, 4cm, Stage IIb, Grade 2, 1/19 nodes, ER+/PR+, HER2-
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Jan 17, 2011 08:48AM lago wrote:

Makingway, that article you posted states "Surgical removal of cancer typically provides the best chance of disease-free survival. " Here are the other points:

# A growing body of evidence suggests that cancer surgery itself may increase the risk of metastasis (spread to other areas) via numerous mechanisms including: increasing cancer cell adhesion, suppressing immune function, promoting angiogenesis, and stimulating inflammation.

# Since metastatic disease is often deadlier than the original tumor, it is important to utilize preventive strategies to prevent cancer metastasis.

# Steps to help prevent cancer metastasis include: combating cancer cell adhesion, supporting immune health, heightening immune surveillance, inhibiting angiogenesis, minimizing inflammation, and choosing surgeons and anesthesiologists who utilize advanced techniques that may reduce metastatic risk.

# Certain nutrients, drugs, types of anesthesia, and surgical techniques are associated with reduced risk of metastasis. 

I do not see it saying that in order to prevent metastasis that surgery should not be done.

DONE!! alturl.com/3o9ni • Tattoos 2.7.2012 • Nipples 10.6.2011 • Exchange 6.24.2011 • Chemo 1.18. 2011 • BMX 8.31.2010

Dx 7/13/2010, IDC, 5cm, Stage IIb, Grade 3, 0/14 nodes, ER+/PR+, HER2+
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Jan 17, 2011 10:42AM, edited Jan 17, 2011 10:44AM by lucy88

The 49% chance of lymphedema is very serious for a procedure that has never been shown to help breast patients live longer. There are so many studies on this, not just the most recent one. Why are only a few people reading them?

The lymphedema deniers must get real and point out the casualties of this disease. It is not ethical to suppress the information. I just found another picture. Please, to those contemplating this surgery, look before you leap.

http://www.google.com/imgres?imgurl=http://www.health.state.ny.us/publications/0399/images/arms_128x175.png&amp;imgrefurl=http://www.health.state.ny.us/publications/0399/&amp;usg=__9u9xFuKk1PCJXLvsJdj2i71aksc=&amp;h=175&amp;w=128&amp;sz=12&amp;hl=en&amp;start=49&amp;zoom=1&amp;tbnid=y7n7lo-QfgTAuM:&amp;tbnh=140&amp;tbnw=102&amp;ei=g3A0TaTECMTKgQfAoOyoCw&amp;prev=/images?q=lymphedema+arm+pain&amp;um=1&amp;hl=en&amp;sa=N&amp;biw=1011&amp;bih=602&amp;tbs=isch:1&amp;um=1&amp;itbs=1&amp;iact=hc&amp;vpx=615&amp;vpy=268&amp;dur=4977&amp;hovh=140&amp;hovw=102&amp;tx=150&amp;ty=102&amp;oei=cXA0TcOkLsOCgAe8t82jCw&amp;esq=4&amp;page=4&amp;ndsp=15&amp;ved=1t:429,r:13,s:49

"Not knowing when the dawn is coming, I open every door." -- Emily Dickinson

Dx 1994, IDC, 1cm, Grade 3, ER+/PR+
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Jan 17, 2011 11:17AM lago wrote:

Lucy this below image is my lymphemeda. The image you posted way out of control and should not get to this point. I'mnot downplaying lymphedema butI don't think your images is typically.

lago arms

DONE!! alturl.com/3o9ni • Tattoos 2.7.2012 • Nipples 10.6.2011 • Exchange 6.24.2011 • Chemo 1.18. 2011 • BMX 8.31.2010

Dx 7/13/2010, IDC, 5cm, Stage IIb, Grade 3, 0/14 nodes, ER+/PR+, HER2+
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Jan 17, 2011 11:28AM makingway wrote:

lago-the last article I posted is referring to the primary tumor and 'cause' of metastasis. It is not on the subject of axillary lymphnode removal. I posted it so that you may see how the lymph system functions. It does not function as a closed impenetrable system. Based on this fact one must consider that the removal of the tumor and/or micrometastais does not provide freedom of mind of recurrence. Couple this with the damage to the lymphatic system as a whole, and an axillary lymph node dissection doesn't appear to be a just choice. This is another exerpt from the same article:

  Less Invasive Surgery Reduces Risk of Metastasis

Surgery places an enormous physical stress upon the body. There is considerable scientific evidence supporting that surgeries that are less invasive-and therefore less traumatic-pose less risk of metastasis, compared to more invasive and traumatic surgery.

Axiallary lymph node dissection is an extremely invasive and tramatic surgery. I don't base my conclusions after reading just a few articles. I've read many studies, reports, articles, etc. I keep an open mind when learning because I don't want a recurrence as much as anyone here doesn't. As I wrote previously, most doctors don't take the time to study current findings. The would rather leave it to 'the other guy' to change the tide of standards. Did your doctor share with you how to reduce your chance of surgery induced metastasis as provided in the article? The suggestions have been well documented in the scientific literature.

After reading your posts I don't believe you have a full grasp of the English language. If you can't understand what is written, as it is written, you've misinterpretated the data.

Visit my website for helpful tips when using cold caps:penguincoldcap.wix.com/help

Dx 3/2/2009, ILC, 4cm, Stage IIb, Grade 2, 1/19 nodes, ER+/PR+, HER2-
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Jan 17, 2011 11:30AM lucy88 wrote:

Iago, I'm so glad your swelling and pain is not bad but your own experience doesn't represent those who suffer. There is a thread right now called LYMPHEDEMA PAIN in which the women discuss having pain all day. They talk about the medications they take. Do you want to go to that thread and tell them they are liars? I hope not.

Before Lymphedema Therapy

"Not knowing when the dawn is coming, I open every door." -- Emily Dickinson

Dx 1994, IDC, 1cm, Grade 3, ER+/PR+
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Jan 17, 2011 11:36AM lago wrote:

"After reading your posts I don't believe you have a full grasp of the English language. If you can't understand what is written, as it is written, you've misinterpretated the data."

What a nasty thing to say. Insults will not change my mind. Your insults only make me think less of you as a person and confirm my suspicions that you will say anything to get people to think you are correct.

BTW you shouldn't comment on my understanding of the language and then post the word "misinterpretated".

DONE!! alturl.com/3o9ni • Tattoos 2.7.2012 • Nipples 10.6.2011 • Exchange 6.24.2011 • Chemo 1.18. 2011 • BMX 8.31.2010

Dx 7/13/2010, IDC, 5cm, Stage IIb, Grade 3, 0/14 nodes, ER+/PR+, HER2+
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Jan 17, 2011 11:46AM lago wrote:

Lucy as I mentioned I'm not downplaying lymphedema but if 49% of women do get lymphedema they all don't get to the level of those photos. That's the point I'm trying to make.

Lymphedema is not great, even at my mild level. I still have no regrets with my surgery. I understand why my surgeon chose to remove my nodes and we discussed it. The research results have not been repeated enough times to prove that ALND is not beneficial to survival. It may come in the future for now I believe this was the best course of action based on the likelihood I ther could have been an invasion in my lymph nodes.

DONE!! alturl.com/3o9ni • Tattoos 2.7.2012 • Nipples 10.6.2011 • Exchange 6.24.2011 • Chemo 1.18. 2011 • BMX 8.31.2010

Dx 7/13/2010, IDC, 5cm, Stage IIb, Grade 3, 0/14 nodes, ER+/PR+, HER2+

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