In 1999 Dr. Peter Blumencranz, director of Morton Plant Hospital's Comprehensive Breast Care Center, and a group of physicians launched a study on survival rates of women that did not have lymph nodes removed – even if they tested positive for cancer. The study was recently was recently published in the Journal of the American Medical Association.
The surprising results of the study revealed that women who kept their nodes, even if cancer was present, fared just as well as those who had them removed. The question remains, will doctors and patients knowingly leave behind anything cancerous, even just a lymph node or two?
It will be a tough sell, admits Dr. Peter Blumencranz, leaving behind lymph nodes known to have cancer goes against physician training and most current medical guidelines. It was difficult to get women to sign up for the study, but as the results began to filter out more and more women signed up to participate.
For decades, doctors removed all lymph nodes from all breast cancer patients. Later, researchers found that only women with positive sentinel nodes (the first nodes where breast cancer typically spreads) had to have all their nodes removed. The thought behind the study was that radiation and chemotherapy would eradicate stray cancer cells in the lymph nodes. "The good news is, after six years of follow-up, those women who kept their nodes did as well as those who had their other nodes removed," Blumencranz said. There are restrictions in who is eligible for this approach; only those who have early-stage breast cancer and are treated with lumpectomy, chemotherapy and whole breast radiation
The removal of lymph nodes is the primary cause of lymphedema; a painful swelling of the arm due to the body’s inability to remove fluid without the lymph nodes. For some women the risk of leaving cancer behind may be too frightening and they would rather risk lymphedema. But, many women will appreciate having at least another option to consider.
Want more information on lymphedema?
What is lymphedema?
The lymphatic system collects and flushes out bacteria, viruses and waste products from the body through infection-fighting cells in the lymph nodes. If nodes are removed, fluid builds up, causing pain and swelling.
What helps?
Light exercise, to keep fluid moving; massage; compression sleeves or stockings to force fluid out of the affected limb.
Research
The H. Lee Moffitt Cancer Center is participating in an investigation of the use of liposuction to remove fat cells from lymphedema patients so fluid can't collect as easily. So far, a 70 percent reduction in symptoms has been reported. Among the research subjects is Cheri Wetzel. "I'm back into regular clothing, have full use of the arm and no discomfort,'' she said. "I still have lymphedema, but it's not to any degree what it was."
Moffitt is seeking additional funding for more research, estimated to cost $15,000 per participant. "Lymphedema can pop up 20 years after breast cancer surgery, so we'll need to continue finding ways to treat it," says Moffitt's Dr. Christine Laronga
Posted on
Mon, April 4, 2011
by Alicia Prince