Lymph Nodes

-
Lymph nodes are small round organs that are part of the body’s lymphatic system. They are found widely throughout the body and are connected to one another by lymph vessels. Groups of lymph nodes are located in the neck, underarms, chest, abdomen, and groin. A clear fluid called lymph flows through lymph vessels and lymph nodes.

Lymph nodes are important parts of the body’s immune system. They contain cells that monitor lymph for the presence of “foreign” substances, such as bacteria and viruses. If a foreign substance is detected, some of the cells will become activated and an immune response will be triggered. Lymph nodes are also important in helping to determine whether cancer cells have developed the ability to spread to other parts of the body; many types of cancer spread through the lymphatic system, and one of the earliest sites of spread for these cancers is nearby lymph nodes.

In the past, ten or more underarm lymph nodes on the cancer side were typically removed in what was called an axillary lymph node dissection. However, it has been found that strategic removal of just one or a few key underarm nodes - the sentinel nodes - can accurately assess overall lymph node status in women who have relatively small breast cancers (smaller than 5 cm) and who have lymph nodes that don't feel abnormal before surgery. Studies have shown that after almost 5 years, women who had just the sentinel node removed were as likely to be alive and free of cancer as women who had more lymph nodes removed, and without the unpleasant side effects such as lymphedema, swelling of the arm due to lymphatic fluid back up.

The sentinel lymph node is the first node "standing guard" for the breast. In sentinel lymph node dissection, the surgeon looks for the very first lymph node that filters fluid draining away from the area of the breast that contained the breast cancer. If cancer cells are breaking away from the tumor and traveling away from the breast via the lymph system, the sentinel lymph node is more likely than other lymph nodes to contain cancer.

In order to identify the sentinel nodes, the  surgeon injects a radioactive substance, a blue dye, or both near the tumor. The fluid travels through the lymphatic system in the breast and then on to the underarm area. The surgeon then uses a device that detects radioactivity to find the sentinel node or looks for lymph nodes that are stained with the blue dye. Once the sentinel lymph nodes are located, the surgeon removes the node, ideally through the same incision that will be used for the mastectomy. The sentinel node is then checked for the presence of cancer cells by a pathologist. If cancer is found, the surgeon may remove additional lymph nodes and/or recommend radiation.

Breast cancer patients typically have their sentinel lymph nodes removed from the underarm area on the cancer side during the removal of the primary tumor. However, at my pre-op appointment with Dr. Funk last Thursday, I learned that I will have my sentinel lymph nodes removed on the 19th just before the delay procedure. The reason for doing it early is two-fold: so that if the sentinel nodes come back positive, additional nodes can be removed during the mastectomy, and because the delay procedure will disrupt the flow of lymph and make it difficult to accurately identify the sentinel nodes afterwards.

Three of my lymph nodes were biopsied soon after my diagnosis and came back negative. However, there is no way of knowing if they were sentinel nodes - from a purely statistical standpoint, they probably weren't. That is why we can't simply rely on the biopsy results alone. And even if the sentinel nodes come back negative, we still can't be absolutely certain that my cancer hasn't metastacized - like with everything in cancer treatment, there is no such thing as a 100% guarantee. But at that point there are no more tests or procedures that can be done to provide further assurance, so we just have to have faith.

Information from breastcancer.org and cancer.gov.

Comments

Post a Comment

Popular posts from this blog

Advance Health Care Directives

-
Over the last few months, I've had a growing awareness that as a seriously ill person, I should have some kind of documentation in place about my wishes should things take a turn for the worse. Really, every adult should, and I realize now that I at least should have done it prior to giving birth - but as a young, healthy person, it really just wasn't part of my consciousness. Until I started looking into it, I was pretty hazy about what the different types of documents were and what the terminology meant. I learned that a dvance health care directive is the general term for a legal document that spells out your decisions about end-of-life care ahead of time. Advance health care directives generally include two important components: a power of attorney for health care and a living will.  A power of attorney for health care names your health care agent (also sometimes referred to as a health care proxy), the person you designate to make health decisions for you if you are una...
Read more

Hormonal Therapy (Part 3)

-
Seth and I spent hours on Friday morning talking through my fears for my treatment, and I cried more than I have at any time during this illness, including at diagnosis. He listened to my concerns and read the articles that I handed him and dried my tears, and ultimately said, "We need better information." I realized that he was right - we didn't need more information, but we needed actual data, not anecdotes. Even the articles from reputable sources were of limited helpfulness when they quoted doctors' opinions rather than facts, and many of them contradicted each other about which side effects were most likely to occur. But then I found the results of a National Cancer Institute study called NSABP P1 , wherein 13,000  women at high risk of getting breast cancer were randomly assigned to receive either tamoxifen or placebo. The primary goal of the trial was to assess the value of tamoxifen in preventing cancer, but it also included  a set of questionnaires to as...
Read more

Two Years Out

-
Image
This past Sunday marked two years since my last day of treatment. Two whole years! It's so long, but it's so short. I remember everything, but everything's a blur. Early in my treatment, my mother, a breast cancer survivor herself, promised me that the day would come when I would no longer spend every waking moment thinking about cancer. At the time, it was very hard to imagine that day. But she was right - I can go for weeks now without giving it a thought. Life does indeed move on, and the enormous mental, emotional, physical, and logistical space that my treatment took up has quickly refilled with my family, my career, and my interests. But October will always be my own personal Breast Cancer Awareness Month, even if it wasn't for the rest of the world. The change in the air that happens in LA this month, the chill in the mornings and the low slant of the setting sun in the evenings, will always bring back memories of the end of my treatment. I wept off and ...
Read more