Sunday, March 3, 2024

Do I Need Chemo If Lymph Nodes Are Clear

Treatment Of Breast Cancer Stages I

Will I need Chemotherapy for My Breast Cancer?

The stage of your breast cancer is an important factor in making decisions about your treatment.

Most women with breast cancer in stages I, II, or III are treated with surgery, often followed by radiation therapy. Many women also get some kind of systemic drug therapy . In general, the more the breast cancer has spread, the more treatment you will likely need. But your treatment options are affected by your personal preferences and other information about your breast cancer, such as:

  • If the cancer cells have hormone receptors. That is, if the cancer is estrogen receptor -positive or progesterone receptor -positive.
  • If the cancer cells have large amounts of the HER2 protein
  • How fast the cancer is growing
  • Your overall health
  • If you have gone through menopause or not

Talk with your doctor about how these factors can affect your treatment options.

What Do Lymph Nodes Do

Lymph nodes play numerous roles within the very complex lymph system. The lymph system is part of the bodys immune system, producing white blood cellsB lymphocytes or T lymphocytes that fight infection by killing harmful cells. The lymph system also includes the tonsils, spleen and thymus.

The lymphatic fluid that flows through the vessels to the lymph nodes brings oxygen and nutrients to tissue cells and takes away waste products from the cells.

The lymph fluid filtered by the lymph nodes, no matter where theyre located, moves to the chest and recirculates back into the bloodstream. Each group of lymph nodes filters a specific region of the body.

Going Into Hospital And Pre

Going into hospital may be a new experience for you and you might feel anxious, particularly if youre not sure what to expect.

You may find it helpful to read our booklet Your operation and recovery, which has more information about your admission to hospital, during your stay and your recovery at home.

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How To Treat It:

  • Manual lymphatic drainage: This specialized type of skin massage mobilizes and moves built-up fluid to areas of the body where it can be absorbed.
  • Good skin care: Maintaining healthy skin through scar care, moisturizing and careful shaving is important for avoiding infections. Even a small cut or scrape can potentially lead to problems because of an inefficient lymphatic system.
  • Exercise: Some patients believe if they donât move, they wonât swell, but the opposite is true. We move fluid by pumping our muscles, so being active is very, very important. Precautionary steps must be taken to not aggravate lymphedema, but the benefits outweigh the risks.
  • Compression: If limbs are swollen, they must be compressed. Special types of bandages are initially used in physical therapy to reduce swelling and then patients are fitted with a compression garment to maintain reductions. Compression is an important key for treating lymphedema.
  • Surgery: In recent years, new surgical procedures such as lymph node transfer have been developed that provide relief from swelling and discomfort and generally make lymphedema easier to manage.

We encourage all cancer survivors to be proactive in learning about this condition. With help, you can learn strategies to be able to manage it on your own.

Information courtesy of Lexi Harlow and Sue Frohreich of Seattle Cancer Care Alliance’s Physical Therapy Clinic

Has lymphedema affected your life? Tell us about it on .

What To Expect On The Day

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You will usually be admitted to the hospital on the morning of your operation or occasionally the day before. You will have pre-surgery checks that include a visit from the anaesthetist and a doctor from the surgical team.

Once the pre-surgery checks have been done, youll be taken to the anaesthetic room. Youll be given a combination of drugs into a vein. This will usually include an anaesthetic, pain relief and anti-sickness drugs.

Youll usually be asked to take deep breaths and as the anaesthetic takes effect you will fall into a deep sleep. Once you are fully anaesthetised you will be taken into the theatre.

For more information about going into hospital, see our booklet Your operation and recovery.

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What If Cancer Is Detected In The Lymph Nodes

If you have lymph node positive breast cancer, it is likely you will be offered chemotherapy. Premenopausal women and those with multiple positive lymph nodes generally benefit from chemotherapy. If your breast surgeon detects cancer in your lymph nodes before surgery, there may be specific advantages to undergoing neoadjuvant chemotherapy.

If you have lymph node positive cancer and are elderly or not healthy enough to tolerate the side effects of chemotherapy, you may conclude that the risks of chemotherapy outweigh its benefits. These situations vary greatly from person to person. A detailed discussion with your medical oncologist is essential to make the best decision for yourself or a loved one.

Some women who have an early stage, lymph node positive breast cancer may meet the criteria to consider genomic testing of a sample of their tumor to see if they might be able to avoid chemotherapy. This is a rapidly evolving field in breast cancer. Ask your medical oncologist if a node positive genomic assay is appropriate for your unique cancer situation.

For Metastatic Breast Cancer

Chemo can be used as the main treatment for women whose cancer has spread outside the breast and underarm area to distant organs like the liver or lungs. Chemo can be given either when breast cancer is diagnosed or after initial treatments. The length of treatment depends on how well the chemo is working and how well you tolerate it.

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What Should I Take With Me To Hospital

Your hospital team should give you information about your admission and hospital stay as well as what to take with you.

You will usually be given a telephone number at your pre-assessment appointment. You can call if you have any questions about preparing for surgery, or are unclear about any instructions you have been given .

Treatment For Cancer In The Lymph Nodes

Leave my lymph nodes alone! When less is more – Maggie DiNome, MD | UCLAMDChat

Treatment for cancer in the lymph nodes varies depending on the tumor size and location and whether the cancer has metastasized to other areas of the body.

Surgery may be used to treat some forms of metastatic cancer that has spread to the lymph nodes. Other treatment options for cancer in the lymph nodes may include chemotherapy, radiation therapy, a stem cell transplant, immunotherapy or targeted therapy.

Theres a higher risk for cancer to come back following surgery when a cancer has spread to lymph nodes. In those cases, chemotherapy or radiation therapy may be recommended after surgery.

Removing lymph nodes during cancer surgery is highly unlikely to weaken the patients immune system, because it is large and complex and is located throughout the body, the ACS says. Lymph node removal may leave the affected part of the body unable to drain off lymph fluid, which may lead to a fluid backup and may become a continuing problem. The greater the amount of lymph nodes removed, the greater the chance for lymphedema to occur.

Expert cancer care

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Removing Most Or All Of The Lymph Nodes

An operation to remove most or all of the lymph nodes under the arm is called an axillary lymph node dissection or axillary clearance.

You have a general anaesthetic for this operation. You will be asleep the whole time.

The surgeon makes a small cut in your armpit to remove the lymph nodes. Generally, they remove between 10 and 15 lymph nodes. But the number of nodes in the armpit varies from person to person.

The surgeon sends the lymph nodes to the laboratory. A pathologist checks them for cancer cells. You get the results at your follow up appointment, about 2 weeks after surgery.

Some people will have radiotherapy to the lymph nodes instead of surgery.

New Developments In Cancer Research

Progress in the field.In recent years, advancements in research have changed the way cancer is treated. Here are some recent updates:

Uterine cancer.Women who use chemical hair straighteners frequently could have a higher risk of developing uterine cancer than women who have never used the products, according to new findings from a national study that has followed nearly 34,000 U.S. women for more than a decade.

Breast cancer.A new study suggests surgery may not always be necessary for all breast cancer patients. A small early-stage clinical trial found that a carefully selected group of patients who responded remarkably well to chemotherapy could skip surgery altogether.

Cancer vaccines.For a long time, the promise of cancer vaccines that would protect healthy people at high risk of cancer has only dangled in front of researchers. Now, though, encouraging animal data and preliminary studies in human patients are making some doctors feel optimistic.

Rectal cancer.A small trial that saw 18 rectal cancer patients taking the same drug, dostarlimab, appears to have produced an astonishing result: The cancer vanished in every single participant. Experts believe that this study is the first in history to have achieved such results.

Endocrine therapy also has side effects, which can include hot flashes and other symptoms of menopause, weight gain and pain in joints and muscles. Tamoxifen can increase the risk of cancer of the uterus.

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Getting The Results During Surgery

In some hospitals, the surgeon gets the results of the sentinel lymph node biopsy during the operation. This is called an intra operative assessment. They can remove the rest of the nodes if necessary. You then avoid having a second operation.

Your surgeon will explain this to you before your operation, so you know what to expect.

What Questions Should I Ask My Healthcare Provider

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You may want to ask your provider:

  • What type of breast cancer recurrence do I have?
  • Has the cancer spread outside the breast?
  • What stage is the breast cancer?
  • What is the best treatment for this type of breast cancer?
  • What are the treatment risks and side effects?
  • Should I look out for signs of complications?

A note from Cleveland Clinic

Most breast cancer recurrences respond well to treatments. You may be able to try new drugs or combination therapies in development in clinical trials. Your healthcare provider can discuss the best treatment option based on your unique situation.

Last reviewed by a Cleveland Clinic medical professional on 03/24/2021.


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Ovarian Ablation Or Suppression

In women who have not yet experienced the menopause, oestrogen is produced by the ovaries.

Ovarian ablation or suppression stops the ovaries working and producing oestrogen.

Ablation can be done using surgery or radiotherapy. It permanently stops the ovaries from working and means you’ll experience the menopause early.

Ovarian suppression involves using a medicine called goserelin, which is a luteinising hormone-releasing hormone agonist .

Your periods will stop while you’re taking it, although they should start again once your treatment is complete.

If you’re approaching the menopause , your periods may not start again after you stop taking goserelin.

Goserelin comes as an injection you have once a month.

What Are The Complications Of Breast Cancer Recurrence

Breast cancer that comes back can be harder to treat. The same therapy isnt always effective again. Tumors can develop a tolerance to certain treatments like chemotherapy. Your healthcare provider will try other therapies. You may be able to try drugs under development in clinical trials.

If breast cancer spreads to other parts of the body, your healthcare providers still treat it like breast cancer. For instance, breast cancer cells that move to the lungs cause breast cancer in the lungs not lung cancer. Metastatic breast cancer is more difficult to treat than cancer in only one part of the body.

You may feel stressed, depressed or anxious. A mental health counselor and support groups can help.

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What Happens After A Sentinel Node Biopsy

If the lymph nodes do not contain cancer cells, you wont need to have any more nodes taken out.

If cancer cells are in the sentinel nodes, you have another operation to remove most or all of the lymph nodes under your arm. This is an axillary lymph node dissection or clearance. You generally have it about 2 weeks after you get the results.

Some people have radiotherapy to the armpit to destroy any remaining cancer cells instead of surgery.

Rude Stares And Repeated Infections

Lymph, lymph nodes, & lymphatic system | Life processes | Biology | Khan Academy

Seattle cancer survivor Cindy Alsobrook, 42, developed lymphedema in her left leg shortly after she finished surgery, chemo and radiation for cervical cancer in December 2013.

âI had surgery to remove my ovaries and Fallopian tubes and they took 32 lymph nodes because they were looking cancery,â she said. âSo my lymph system had quite a few nodes removed and then the radiation went in and fried what I had left. â

As a result Alsobrookâs left leg has doubled and even tripled in size and sheâs suffered repeated cellulitis infections and one hospitalization.

And those are only the physical symptoms. The condition also carries a heavy psychological burden.

A former preschool teacher whoâd just launched a new career in retail, Alsobrook was forced to give up her job. She routinely deals with stares and rude comments from strangers. Thanks to lymphedema, she canât exercise, wear her favorite clothes or even go for a walk without feeling its effects.

âI spend a lot of time lying on the couch watching movies or reading now,â she said. âI used to go roller skating. I used to walk three to five miles a day. Now, walking four to five blocks to the grocery store is about all I can do. And Iâm much slower than I used to be. Iâm getting lapped by grandmas with their walkers. I miss skinny jeans and cute shoes something terrible. Even things like yoga pants can be difficult. To get the big leg to fit, the skinny leg is swimming.â

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How Cancer Treatment Impacts Lymph Nodes

Lymphedema is tied to the bodyâs cell waste disposal system, which acts a bit like a garbage pickup service. Cells create waste that are picked up and shuttled along by the lymphatic system and then processed by the lymph nodes, which act as the garbage and recycling plants in the bustling city that is your body.

Unfortunately, when these lymph nodes are blocked or damaged or removed thanks to a tumor, surgery or radiation, our cellâs âgarbageâ starts to pile up and the limbs begin to swell. If left untreated, lymphedema can trigger a chain reaction of complications, most notably sudden, serious and recurrent infections brought on by unchecked bacteria that thrive in the trapped lymph fluid.

âAny patient who has a tumor or surgery that disrupts the lymphatics under the arm or adjacent to the neck or in the groin may end up with edema of the extremities,â said Dr. Gary Lyman, researcher and breast cancer oncologist with Fred Hutchinson Cancer Research Center and its treatment arm, Seattle Cancer Care Alliance.

âIt can be relatively mild to quite severe,â he said. âItâs unsightly, puts patients at increased risk of recurrent infections and pain and quality of life can be dramatically affected. Most breast cancer patients today donât develop severe lymphedema but it still occurs and when it does, itâs a major life event and a lifelong event.â

Fortunately, lymphedema isnât all that hard to manage if caught early.

What Is The Role Of Chemotherapy In Breast Cancer

Chemotherapy is typically used to shrink breast cancer tumors before surgical removal. This is especially necessary when:

  • The tumor is so large that it cannot be removed via surgery. Once the tumor regresses with chemotherapy, it becomes easier for doctors to remove it without risking spread to adjacent organs.
  • Doctors want to check how well a particular medication works on your breast cancer. This helps them decide whether to continue the same drug after surgery or switch to another medication if the previous one does not work.

Breast cancer varies from person to person, and the type of medications your oncology team prescribes will depend on the goals of treatment and the features of your particular cancer.

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New Evidence About Why Clear Margins In Breast Cancer Surgery Are Such Good News

Medical College of Georgia at Augusta University
When a breast cancer tumor is removed with no signs of cancer left behind, it’s great news for patients, and now scientists have more evidence of why.

When a breast cancer tumor is removed with no signs of cancer left behind, it’s great news for patients, and now scientists have more evidence of why.

They’ve shown that once the breast tumor is successfully removed, the immune response turns its attention to destroying the tumor cells it has inevitably sent to nearby lymph nodes and organs like the lungs, says Dr. Hasan Korkaya, tumor biologist at the Georgia Cancer Center and Department of Biochemistry and Molecular Biology at the Medical College of Georgia at Augusta University.

The fact that metastasis did not occur in their model even months later, indicates the immune system destroyed the disseminated tumor cells rather than pushing them into a dormant state, Korkaya and his colleagues report in the journal Nature Communications.

In contrast, when the primary tumor was not completely removed, the immune system appears to begin to support the tumor, which grows back faster and bigger than the original mass, and its disseminated tumor cells survive.

“We wanted to see if we could mimic what was happening in the clinic,” says Korkaya, the study’s corresponding author.

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Chemo Drugs For Breast Cancer That Has Spread

Although drug combinations are often used to treat early breast cancer, advanced breast cancer often is treated with single chemo drugs. Still, some combinations, such as paclitaxel plus gemcitabine, are commonly used to treat metastatic breast cancer.

For cancers that are HER2-positive, one or more drugs that target HER2 may be used with chemo.

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