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Breast Cancer Patients May Say Goodbye To Lymphedema

By February 18, 2011

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Axillary Lymph Nodes, Close Up
Art © A.D.A.M.

Lymph node status is part of your breast cancer diagnosis - and many patients have had large numbers of nodes surgically removed - so these can be examined for the possible spread of cancer.  Having the greater the number of lymph nodes removed via axillary lymph node dissection results in a swelling called arm lymphedema.  But a new study shows that patients with early stage breast cancer - tumors less than 2 inches and lymph nodes that appear unaffected - can safely opt for sentinel node biopsy: the removal of only two or three lymph nodes.

This Phase 3 trial study was designed by The American College of Surgeons Oncology Group and was  set at 115 different locations across America.  Patients had similar diagnoses and treatments: lumpectomy, and  whole-breast radiation.  One group had axillary lymph node dissection and the other group had sentinel node biopsy.  Patients in both groups had similar 5-year overall survival rates.  The study concluded that Sentinel Node Biopsy is all that is needed for early stage breast cancer.

Axillary lymph node dissection (ALND) and arm lymphedema will not go away altogether.  For breast cancer patients with tumors over two inches, or with swollen lymph nodes, the removal of extra lymph nodes will be needed to determine the risk of metastasis.

This news will change the way that breast surgeons and oncologists diagnose and treat early-stage breast cancer.  While some surgeons already confine lymph node removal to a targeted 2 or 3 nodes, it has long been standard surgical practice to remove between 15 and 40 nodes - putting patients at higher risk for arm swelling.  Women who have arm lymphedema must take special care of their arm for the rest of their lives - using compression garments, preventing cuts, even small burns, and sometimes requiring lymphatic massage to get relief.  Now that more patients may be able to avoid the risk of arm lymphedema, dealing with breast cancer survival will become easier.

Source: Axillary Dissection vs No Axillary Dissection in Women With Invasive Breast Cancer and Sentinel Node Metastasis. Armando E. Giuliano, MD; Kelly K. Hunt, MD; et. al. JAMA. 2011;305(6):569-575.

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Comments
February 19, 2011 at 3:41 am
(1) recovery says:

I read about it, highly interesting.

February 19, 2011 at 7:40 pm
(2) riselda gutierrez says:

Thank you for keeping us imformed.
I would like to know were I could received Lymphatic
massage for my painful arms after seven years of bilateral
mastectomy and daily suffering of needing to buy huge
blouses in order to fit my arms.

February 23, 2011 at 8:50 am
(3) gillian says:

That is not 100% true. Well, what is not correct is that it is not only lymph node removal which causes lymphedema. I had breast cancer and had no surgery as did not have a primary tumour ie nothing in the breast but two cancerous lymph nodes.
Now I am high risk for lymphedema, do manual lymph drainage massage twice a day totalling just under one hour daily, have had to wear a compression sleeve at various times when my arm swelled and see a lymphedema expert weekly – because the radiotherapy I had affected the lymph.

February 23, 2011 at 9:38 am
(4) drabdulgafor says:

Thanks for interesting subject I have practised breast surgery for the last 10 days &doing mastectomy & axillary dissection arm is an uncommon problem in my patients.for my openion type of cancer &its agressiveness &postoperative radiotherapy are the most important determinent of arm lymphoedema &its severity.

February 23, 2011 at 4:56 pm
(5) Pat says:

The headline is misleading and the study results to not apply to all women. Patients should find additional information resources to supplement this article.

February 24, 2011 at 10:30 pm
(6) Cathy says:

Lymphedema can occur many years after surgery or radiation. The patient always have to take precaution to the affected side to prevent the onset of symptoms. MLD is very effective. Being a CLT in the Vodder method in Nashville Tn, I can say this has promising results.

April 1, 2013 at 5:59 am
(7) salina says:

2004 I had partial mast and one out of two sentinel nodes was positive so surgery took out 18 more all negative axillary dissection chemo and eight weeks radtiation hormone therapy then arm and trunul lymphdedma in my effected breast back, It has been nine years no cancer however women who didn’t have axillary dissection came out the same as the ones who did. I had only first node positive tumor 2.1cm I was never told about lymphedema and now they are coming to find out removing total axilla dissection not necessary, Living with stage 2 lymphedema is chronic, uncurable and bactercia infections, fungal, visus are my new best friends for life and many prescription medications don’t do it ladies………………

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