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Surgery or Radiation and Lymphedema

Posted 11/19/2013

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  One of the many worries about breast cancer is the possibility of lymphedema. Lymphedema is the swelling of soft tissue caused by fluid build-up, usually because lymph nodes have been removed or are blocked, so the lymph fluid is not freely flowing. This has been a potential problem post breast cancer surgery and radiation forever. You may have seen pictures of women with giant swollen arms; this extreme reaction, blessedly, seems to be ancient history as surgical techniques have changed and improved.

B  But the possibility of lympedema remains, and it is impossible to fully predict who might experience the problem. It can happen soon after treatment or it can happen a decade later. We know that the risk of lymphedema is greater for women who have had a full axillary dissection (as opposed to a sentinel node removed), and that the addition of radiation increases that risk. Even so, most women never have this problem. Fortunately.

  This report from reviews a recent study that suggests that a positive sentinel node does not necessarily require further axillary surgery. Radiating the underarm area seemed to be equally effective in terms of cancer treatment and reduced the incidence of lymphedema. I am sure there are plenty of exceptions, and each case must be individually reviewed, but this is an interesting step forward. Here is the start and a link:

Radiation to Axillary Lymph Nodes Causes Less Lymphedema Than Surgery

A study has found that women diagnosed with early stage breast cancer are less likely to have lymphedema if they get radiation to their axillary lymph nodes instead of having them surgically removed.
The study, the AMAROS trial, was presented at the 2013 European Cancer Congress on Oct. 4, 2013. 
AMAROS trial.”When early stage
breast cancer is removed, the lymph node closest to the cancer called  the sentinel node often
is removed and sent to a pathologist for evaluation. Removing just this one node is called sentinel  or sentinel node dissection.
If cancer cells are in the sentinel node, it means the cancer has spread beyond the breast. In the past, doctors thought that more treatment might be needed to reduce the risk of the cancer coming back (recurrence), including:
removing other underarm lymph nodes (axillary node dissection)
radiation therapy to the underarm lymph nodes (axillary radiation)
hormonal therapy if the cancer is hormone receptor positive
But research has shown that women diagnosed with early stage breast cancer with a positive sentinel node who have no further treatment do just as well as women who have axillary node dissection. They also had a lower risk of lymphedema. The AMAROS trial results also support the idea that no more surgery is needed if the sentinel node is positive: the researchers found that axillary radiation causes less lymphedema than axillary surgery.
Results from this same study presented in July 2013 at the American Society of Clinical Oncology Annual Meeting also found that axillary radiation reduces recurrence risk about the same amount as axillary lymph node surgery


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