From Our 2011 Archives
Lymph Node Removal Not Needed for Breast Cancer Patients
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Study Shows Breast Cancer Patients Do Well Without Surgery to Remove Lymph Nodes Under the Arm
By Brenda Goodman
Reviewed by Laura J. Martin, MD
Feb. 8, 2011 -- Many women being treated for early breast cancer can keep the lymph nodes under their arms without fear that it will hurt their chances of survival or the increase the odds that their cancer will return, experts say.
A new study shows that about 92% of women with early-stage breast cancers that have spread to a nearby lymph node who have lumpectomies and radiation to treat their tumors will be alive five years later, whether or not they have multiple lymph nodes removed from under their arms, a procedure called an axillary lymph node dissection.
The study is published in the Feb. 9 issue of TheJournal of the American Medical Association,
That's good news for many who are diagnosed with breast cancer since removal of the lymph nodes from the underarm area may lead to infection, pain, stiffness, numbness, and swelling. It also increases the length of time spent on the operating table.
"The traditional treatment of breast cancer had been to remove the lymph nodes underneath the arm," says Grant W. Carlson, MD, a breast cancer surgeon at the Winship Cancer Institute at Emory University in Atlanta.
"That thought probably lasted over 50 years, then we realized that a lot of cancers spread through the bloodstream first, or at the same time as they are spreading through the lymph nodes, and that removing the lymph nodes isn't curative in and of itself," says Carlson who co-authored an editorial that accompanied the study.
But doctors have gotten progressively better, not only at treating the cancer but doing it more conservatively, which helps to minimize complications to patients and maintain the quality of their lives.
"I think we should celebrate the progress we've made in breast cancer, not only in the more conservative treatment of it but also in our ability to treat systemic metastasis," Carlson says.
Should Lymph Nodes Stay or Go?
For the study, doctors randomly split 891 women -- all with breast tumors 2 inches or less in diameter that had spread to their lymph nodes -- into two groups.
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.
SOURCES: Giuliano, A. The Journal of the American Medical Association, Feb. 9, 2011.Carlson, G. The Journal of the American Medical Association, Feb. 9, 2011.Grant W. Carlson, MD, Winship Cancer Institute, Emory University.Sagen, A. Journal of Clinical Oncology, 2010.