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Breast Cancer Health Center

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Lymph Node Removal Not Needed for Breast Cancer Patients

Study Shows Breast Cancer Patients Do Well Without Surgery to Remove Lymph Nodes Under the Arm

Should Lymph Nodes Stay or Go? continued...

In one group, surgeons removed only the first one or two lymph nodes to which cancer had spread, the so-called sentinel nodes. In the other group, doctors removed at least 10 more lymph nodes under the arm.

Women in both groups had lumpectomies to remove their tumors and radiation of their entire breasts.

Five years later, about 92% of women were still alive in both groups.

“Survival was exactly the same,” Carlson says.

And the vast majority of study participants were still cancer free at five years -- about 82% in the group that had their axillary lymph nodes removed and 84% who had only their sentinel lymph nodes taken.

Losing Lymph Nodes

Normal lymph nodes are typically 5 to 8 millimeters in size, about the size of a grain of rice. They function as the local guard stations of the body’s immune system, filtering and catching nearby bacteria, viruses, and invaders like cancer cells.

Lymph nodes are scattered throughout the body, but the ones most likely to be affected by breast cancers are under the arms. When lymph nodes are removed, lymph fluid may build up in the area, leading to painful swelling.

In one 2010 study of 400 breast cancer patients, 15% developed this kind of swelling, which is called lymphedema, in an arm after removal of their axillary lymph nodes compared to just 2% in the group who only had sentinel lymph nodes removed.

The new study suggests that many breast cancer patients may not need to have their axillary lymph nodes removed, but Carlson cautions that there are still certain circumstances where women and their doctors may decide to take that step, for example, in later-stage cancers or in cases where only part of the breast is treated with radiation. Whole breast irradiation appears to also treat lymph nodes under the arms, and so only treating part of the breast may miss some spread of the cancer.

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