For women with small breast cancer tumors, removing just a few lymph nodes from under the arm instead of several could be just as effective as more extensive surgery, a recent study has found.
If the data hold up, the less-invasive approach could spare some women from further surgery to remove lymph nodes and the problems that sometimes go with it, such as lymphedema, which causes fluid retention and tissue swelling. Numbness, a decrease in the range motion and pain can also occur.
"Most women are pretty happy when I can tell them that we don't have to do as extensive auxiliary surgery," said Dr. Mary Brian, a breast surgeon with Texas Oncology.
But it's not that simple.
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"The less you do the better it is for the patient," she said. "But you don't want to do the wrong thing and leave cancer behind."
The study, published in the February issue of the Journal of the American Medical Association, found that for women with breast tumors less than 2 inches in diameter the survival rate was the same whether only two lymph nodes were removed or multiple nodes were taken out.
All 891 women in the study had small tumors and cancer cells in no more than two lymph nodes. A sentinel lymph node biopsy was used to detect any cancer cells. The procedure involves injecting dye in the tumor to see which lymph nodes it travels to.
After the surgery, the pathologist examined the lymph nodes over multiple days. The study helps address the question of what to do if there's a very small amount of cancer found after the patient has left the hospital.
"If there's a tiny drop of cancer in the lymph nodes, no more surgery is acceptable," Brian said. "The study showed that there is no improvement in survival by doing more."
The study flies in the face of the longtime practice of aggressively treating cancer by removing at least 10 lymph nodes.
But the trend has been shifting toward performing less surgery, and the study may prompt more doctors to follow suit.
Going into surgery last fall, Kathy Reich, 49, knew a sentinel node biopsy would be performed, and she hoped she would be spared more aggressive surgery.
"If it had been negative, my doctor would have made the decision at that time never to take out any lymph nodes," she said. "But I did have more nodes involved."
She underwent a more aggressive surgery.
Jan Jarvis, 817-390-7664