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Lymph nodes left with cancer in those removed - questions Lymph nodes left with cancer in those removed - questions

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Unread 02-13-2012, 04:32 PM
Lymph nodes left with cancer in those removed - questions

I am so confused on the choice to remove or disect lymphnodes. I went into surgery for a radical hysterectomy for 2A cervical cancer and my oncologist removed 4 or 6 odd looking lymph nodes but left the rest. After surgery she said she was sure there was at least one lymph node with cancer and so left all the others because she knew I would need radiation and if she removed them I would have terrible lymphodema. Two of the 4 (or 6, not sure) returned with cancer present. All research I have done thus far has turned up with complete lymph node disection along with surgery or...lymph node disection leaving the cervix and uterus to facilitate radiation. My surgen took the tumor but left the nodes. I have been very uneasy with this decision since 2 lymph nodes did have cancer and I fear there may be microscopic cells in other lymph nodes that surgery could have removed. Instead I must rely on chemo and radiation to erradicate those cells. Since lymph nodes are usually removed in order to prevent metastasis to other parts of the body, I feel very vulnerable. Has anybody had this experience?
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Unread 02-13-2012, 08:59 PM
Re: Lymph nodes left with cancer in those removed - questions

Hi there
Not quite the same experience, different cancer, however...
With my kind of cancer, they remove all the lymph nodes if the cancer in the uterus is greater than 50% of the way through.
My lymph nodes appeared normal, but 2 of the nodes were positive for cancer.
On the flip side a cancer buddy of mine, had endo cancer of a very rare and very aggressive form that was found out accidentally when she had surgery for fibroids.
They did scans afterwards and she had 2 enlarged node in the pelvis and one in the upper abdomen.
SHe was on chemo and the two nodes in the pelvis basically disappeared and the one in her upper abdomen stayed.
Eventually since that ONE node remained, she had it removed and now she has been cancer free for at least 2 years.

The really important thing to understand is that the full lymphadenectomy is not done necessariily to TREAT a cancer, it is done to determine how bad a cancer is.
In other words it is done to determine how much further treatment needs to be done.
It is very controversial, and never been totally proven whether the lymphadenectomy is actually done to prevent spread of disease. It is more done to determine how far it has spread.
In my situation (and it sounds like your situation as well) I got the "full meal deal", the most treatment that you can get.

You can get further treatment down the road, but initially this is it, and it does sound like you are getting full treatment.
I sure feel for all that you are going through.
let me know if that does not make sense
Unread 02-13-2012, 10:25 PM
Re: Lymph nodes left with cancer in those removed - questions

Thank you for your reply. What you wrote does make sense. I continue to be haunted by the fact that the only real info for my cancer progression comes from the pet/ct which did not light up anywhere else or show any abnormalities but it is only so accurate. And if there were any cancer cells in those nodes I,d like to have had them cut out instead, or along with being fried out. Before I had the pet/ct the onco told me she would remove the lymph nodes and that is called staging and would be both diagnostic and therapeutic. Well, I guess she didn't need to take them all out to be diagnostic since at least one was grossly affected, but then however the lymph node dissection would be therapeutic I am without. She is treating this cervical adenosquamous carcinoma systemically and locally, so I hope the chemo agents work for any cancer cells to tiny to see floating around in my body somehwere. I also know that some are staged solely on exam and CT without surgery and as such wouldn't necessarily know if there are any microscopic cells in lymph nodes or anywhere else. Whether one is surgically staged or not probably does not make a difference in outcome unless you are being treated too conservatively, when the disease is more advanced that originally thought. I suppose I am probably not having that problem. Thanks for the reply and I hope all is well with you.

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Unread 02-13-2012, 10:32 PM
Re: Lymph nodes left with cancer in those removed - questions

Essentially I am in the same boat as you.
My doctor told me that if she had known that my pelvic nodes were positive, she would have removed my para aortic nodes, but that has more complications
So she did a PET scan at 6 weeks and nothing lit up.
The PET scan IS the best test of all, and in fact in some ways better than some lymph node removals.
PET will pick up the smallest lymph node
how long after surgery did you have the PET?

BTW I am doing pretty well

Unread 02-14-2012, 03:28 AM
Re: Lymph nodes left with cancer in those removed - questions

Different thing I know, but my daughter had Lymphoma. She had cancer in her lymph nodes everywhere, dozens. They couldn't remove them, there was far too many. She was stage 4. Chemo got rid of it. It was the only option and it worked.
Unread 02-14-2012, 07:29 AM
Re: Lymph nodes left with cancer in those removed - questions


I am so glad to hear that you are doing well. I had the PET/CT 5 days before my surgery. My doc knew going into surgery that my lymph nodes were affected and still did not do the lymphadectomy. She removed 2 or 4 hypogastric and 2 external illiac nodes. Two of these were positive, one confirmed by frozen section during surgery. I guess my onco believes that chemo and radiation will take care of anything microscopic in any nodes remaining, and since they can not remove all of the nodes anyway, there is always a chance that you miss some wandering cancer cells and if you are high risk for recurrance, then it's best to just hit it with a powerball of treatment to knock it out (if it's there...I pretend like all the cancer has been removed and all this extra treatment is an insurance policy for my body and for the docs liability ) I brought up my concern with the nurse practicioner I saw after surgery and said I was worried that all this cancer was left behind in my lymph nodes and also believed that removing more lymph nodes would remove the cancers ability to circulate through my system. She seemed to believe that the doc removed the affected ones and then two more higher up in the chain to check for metastisis but also to cut the circulation of lymph upward. She was thinking of my long term quality of life to reduce the risk of lymphadema. Still, everything I read seems to indicate that lymphandectomy is done with or without the hysterectomy.

My oncologist said that I will be getting PET/CT twice a year for the next couple of years, and that will be the only way to track my cancer. Tumor markers such as CA125 have not been useful in diagnosis and since I no longer have a cervix with a tumor to track, the PET/CT will be the only way. Is this the case for you? You had one 6 weeks after treatment, did you have any more following that? I get nervous about the crazy stuff they inject into you, although it seems a little silly after recieving over 45g radiation and numerous injections of the chemical cocktails called Chemo that I worry about the minute amounts of carcinogens required for tests.
Unread 02-14-2012, 07:33 AM
Re: Lymph nodes left with cancer in those removed - questions

Originally Posted by April 1965 View Post
Different thing I know, but my daughter had Lymphoma. She had cancer in her lymph nodes everywhere, dozens. They couldn't remove them, there was far too many. She was stage 4. Chemo got rid of it. It was the only option and it worked.
I am so happy for your daughter!!! And thank you for the encouraging story of success. I hope and pray she remains cancer free.

Unread 02-14-2012, 07:45 AM
Re: Lymph nodes left with cancer in those removed - questions

I do understand your concerns, however, would those lymph nodes have "lit up" if there were cancer cells there
I know that they have to be a certain size ti light up, but....

I had another PET scan about a year later.
It was just done because something showed up on the CT scan, an enlarged lymph node in the area of the rectum
The PET was negative.
that was a few years ago

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