Advances in breast cancer treatment allow many patients to have only a few โsentinelโ lymph nodes removed to measure the spread of the cancer. However, a leading breast cancer researcher, Thomas Julian, head of breast surgical oncology for Allegheny Health Network, said many women still need the removal of all the nearby underarm lymph nodes, known as axillary lymph node dissection.
In the National Surgical Adjuvant Breast and Bowel Project, Dr. Julian said, โthere was an extraordinarily high level of lymphedema in women who had dissection vs. those who had sentinel node [removal]. That was consistent.โ
โOver 75 percent of the time, women donโt need axillary dissection. But even among those women, 5 percent to 8 percent with sentinel node [removal] will get lymphedema.โ
Thereโs a methodology to decide which sentinel nodes are taken out, Dr. Julian said, but even if only three nodes are removed โ the average number โ it still disrupts the lymphatic system. He said there is research going on to see if a sentinel node biopsy can help determine who is most at risk of lymphedema.
Dr. Julian said heโs familiar with the new surgical treatments being tested on lymphedema patients.
โTheyโre trying to re-create the [lymphatic system] channels,โ he said, citing plastic surgeons at M.D. Anderson and Memorial Sloan Kettering cancer centers.
โThe question is, is surgery to re-create channels enough, or does the patient need physical therapy? Is it a good thing to pursue? Absolutely.โ
He added, โWe need trials to show itโs as good as lymphedema management. ... There will be different classes of patients who might benefit from this.โ
First Published: November 25, 2014, 5:00 a.m.
