I had a patient who had mastectomy yesterday and the frozen section of the sentinel node showed no cancer. However, once pathology had the tissue, further review showed positive nodes. While this is not an everyday occurence, it does happen. Positive lymph nodes typically ensure that you will undergo chemotherapy and potentially traditional radiation as well. However, it is NOT an automatic death sentence. I survived chemotherapy, herceptin and radiation and you can too! Again, information and knowledge = power. Managing side effects is a major issue as well so again, ask lots of questions and make sure that your needs are being met and questions being answered. Cancer centers that have chemotherapy clinics are usually very well versed in treating the side effects.
A lymph node dissection versus a sentinal lymph node biopsy does put you at more risk for lymphedema. it is important to be aware of that risk and protect your arm for the rest of your life. Lymphedema occurs not due to mastectomy but due to lymph node dissection. About 40% of women have lymphedema as a side effect of the surgery. My sister and I both had the same surgery, chemo and radiation. I have lymphedema and she does not. The lymph system sits basically on top of the vascular system. It acts much like a sewage system cleaning out bacteria, viruses, cancer cells and other waste from the body. When enough nodes are removed from the under arm (axilla), there is a possibility that lymph fluid will "back up" in the arm. This condition is called lymphedema. It is manageable by manual lymph drainage (light massage) and compression garments. However, prevention is the best medicine! Anything that can cause swelling or inflamation can cause lymph edema. Thus, protect your arm/hands with gloves when gardening or working with tools. Protect your arm from sunburn or other burns. Exercise is not harmful, just avoid inflaming the muscle. In other words, when working with weights etc, start very low and work up very, very gradually so as not to stress and thus inflame the muscle.
With sentinal lymph node biopsy, we are seeing some lymphedema in the breast. This seems to be self correcting. However, if it does not, as for a referral to a lymphedema center or therapist. Saving your life and beating the cancer is the most important thing, lymphedema is not life threatening. It is just a nuisance and can be treated so keep it and the risk of it in perspective.
Remember, life is worth fighting for!!
Sherree
