From reading posts on this forum and other survivor stories, it seems like there’s a lot of variation in terms of how many lymph nodes are removed during RH/RT surgery. I’ve talked to 2 oncologists to hear their recommendations on my 1B1 (2mm deep x 1.5 cm wide) adenocarcinoma. One wants to do a full pelvic lymph node removal and the other wants to do a sentinel node biopsy.
I don’t like either of these options because I don’t want to be super high-risk of developing lymphodema, but I’m not comfortable with the gamble of only taking 1 node. Can there be a happy medium? Did any of your doctors let you in on their thought process re: how they decided how many and which nodes to sample if they didn’t take them all? Given the shallow depth of invasion and no LVSI on my cone pathology, I would be comfortable with sampling 6-8, but not just ONE!
Has the oncologist said how many nodes a pelvic sentinel node biopsy (SNB) would involve? It’s just I’ve read that it might include removal of a few nodes rather than just one. Might be worth asking if you’re not sure.
I wonder what the risk for recurrence of cancer is for SNB versus full removal. It’s my understanding that because the the sentinel node(s) is/are ‘first in line’ for cancer cells then if it/they are clear then any nodes beyond it/them should also be clear - I guess it might (partly) be a question of the inherent limitations of the technique and/or the skill of the surgeon.
I had treatment for a 3.8cm squamous cell cc in 2017 and I think all my pelvic nodes were removed - or at least that was the plan. Prior to my treatment I was worried about the risk for lymphoedema and asked about sentinel node biopsy, but was advised that it wasn’t an option; I don’t know why and I didn’t seek a second opinion.
As it turned out I developed lymphoedema shortly after completion of my treatment (radical hysterectomy and chemo-radiotherapy) - I gather I’m in the minority.
I wish you all the best with your decision making.
Thank you for your reply, Jazza. I plan to ask my oncologist about the details when we talk again next week. Some recent research shows that, statistically, there’s no benefit in overall or disease-free survival with SNB vs full lymphadenectomy in selected cases (e.g. 1B1 or lower stage, bilateral sentinel node identification, and a few other factors). The fact that these authors are referring to bilateral nodes makes it sound like there are always more than 1. But the other oncologist I talked to said it was just the first one that lights up. Seems strange to stop at the first one though.
I think my biggest concern with the technique is based on me having a large conization a few weeks ago, which may change how the dye drains when they inject it into my cervix. The tissue that used to be there is gone, so would the pattern change? That’s something that no one can answer.
