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    What does my biopsy report indicate?

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Posted on Mon, 7 Aug 2017 in Lump
Question: My aunt who is diagnosed with T2N0M0 undergone surgery in XXXXXXX 2017 and the doctor did quadrantectomy with axillary dissection. Total 17 lymp nodes were removed and all were negative.

We were not very much aware of Sentinal Node biopsy at that time and doctor seems to have taken his own decision on this.

Now she is at more risk for lymphedema because the number of lymph nodes removed are more.

Any insight of the pratice of removing lymph nodes and risk of lymphedema and measures to avoid it?
doctor
Answered by Dr. Bhagyesh V. Patel 57 minutes later
Brief Answer:
usually surgeon opts for the best line of action per operative for patient.

Detailed Answer:
Hello dear xxxxxxxxxxxxxxxxxxx,

Thanks for using Healthcaremagic.com
I have evaluated your query thoroughly .

* Doctor must have taken best decision per operative for the sake of well being of
his or her patient to remove 17 lymph nodes .

* There are different school of thoughts for lymph nodes removal in breast cancer
patient as

- Many surgeons prefer per op frozen section biopsy of the sentinel node , decide
further plan of action depending upon that .
- Many surgeons prefer to excise almost all lymph nodes as possible to avoid
any doubts of keeping hidden malignant node inside .

* Risk of lymphedema depends upon the type of post operative care
provided to the patient with other parameters .

* Measures to avoid lymphedema ( usually implies at early post operative period)
are

- Arm elevation .
- Massage of certain types under medical supervision .
- Specific exercises of the shoulder and arms ( which will improve lymph
drainage of the part )
- Prevention of infection with proper choice of antibiotics .
- Certain types of bandage applications and strappings of upper arms with
chest wall .

Kindly provide me further details so that I can assist you further

1. Her current status of the upper limb .
2. Pain , fever or other features if any .
3. Has other systemic issues as diabetes or else .
4. Can work perfectly with that side limb .

Hope this will help you .

Awaiting for your response .

Regards .
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Bhagyesh V. Patel 3 hours later
Thanks for the response.

Please see my answers below for your question.

1. Upper limb is normal in shape. However she complains about numbness and radiating pain. But no evidence of water accumulation.
2. As mentioned she has pain in the arm, as well as in her operated breast area. No fever and no infection signs. Doctor is saying it will take time for the pain to subside.
3. She dont have diabetes and hypertension.
4. She can work on using her operated hand but she feels it is little weaker.

It looks like there is no Lymphedema signs yet. She does regular walking and also few arm exercises as suggested.

1. Do you think that she is at very high risk of Lymphedema as many Lymph nodes are removed?
2. It looks like since they noticed enlarged lymph nodes during operation, didn't perform the Sentinel node biopsy. Do you believe the doctor has taken the right decision?
3. What should we do to avoid her risk of Lymphedema?
4. Is there anything medically possible to do to avoid this risk?
5. What are the other risk factors other than Lymphedema since many Lymph nodes are removed.

Her tumor size was 3 cm and operated with clear margins. ER+, PR+ and HER2-. 21 cycles of radiation is also given after 4 cycles of TC chemo. All nodes(17) are negative after testing.
doctor
Answered by Dr. Bhagyesh V. Patel 2 hours later
Brief Answer:
All answers with case conclusion provided in thorough depth.

Detailed Answer:
Hello dear
Thanks for the details .

* Find all the answers herewith in details .

1. After this much period of time ( almost 6 months ) , she is not at very high risk
of lymphedema at all .

2. I agree with the decision of the doctor for removal of all enlarged lymph nodes
to save patient from future chances of metastatic spread rather than going for
Sentinel node biopsy .

3. To avoid risk of lymphedema
- Regular exercises as suggested by the doctor .
- Maintain her weight through dietary measures .
- Avoid tight clothing around shoulder , arm .

4. Medically nothing is possible to avoid this risk .

5. All possible risk factors as bleeding , infection and else are at this points not
possible at 6 months interval .

* My specific comments for your case after thorough study

- Pain in arm is most likely related to the nerves manipulated during the node
removal in the axilla which supply the whole upper limb .

- Usually this pain lessen to varying extents during time periods , sometime
it remains as such ( it varies from case to case ) .
- Recommendations for her :

* Be positive as thankful to almighty God and the doctor for taking her out
from the cancer condition .
* Do not take much stress for minor discomfort or pain ailment .
* Regular exercises , balanced nutritious diet , general guidelines as given is
sufficient for her .

Hope this will help her .
Wishing her fine health ahead .

Thanks for keeping trust in our medical services .
Always welcome for any further doubts .
Regards .

Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Bhagyesh V. Patel 2 days later
Thanks for your poistive answers and it is conveyed to her and she is doing good so far.

But general protocol for axillary dissection is to perform sentinal node biopsy and do the dissection only if the nodes are positive in sentinel. Now a days this is what advised and followed world wide as per the research I did.

My only concern is that she is sufffeing from unnessary pain and at high risk for Lymphedema without a solid reason for dissection.

Anyways, i dont think wecan do anything on that now and need to take extra precautions to avoid Lymphedema and suffer from extra pain for longer time.
doctor
Answered by Dr. Bhagyesh V. Patel 16 minutes later
Brief Answer:
Follow up answer precisely given .

Detailed Answer:
Respected xxxxxxxxxxxxxxxxx

* Research of world wide follow up is a gross concern , ultimately it varies per
case every time according to the condition only .

* Still , I am with the positive decision of your surgeon .

* Even if with single large node excision , we have came across many cases of
long term neuronal pain .
* No one can change destiny of pre written things to happen in life , which is
only revealed with time .

Let us hope for the best .
Regards .
Above answer was peer-reviewed by : Dr. Kampana
doctor
Answered by
Dr.
Dr. Bhagyesh V. Patel

General Surgeon

Practicing since :1999

Answered : 15655 Questions

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