Word: lymph
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Once the cancer puts down roots in the lymph nodes, the prognosis gets worse. The lymph nodes act as a kind of sewer system for many types of toxins and wastes. Tumors growing in the lymph nodes have a greater chance of breaking off and traveling to the bones, brain, lungs or other parts of the body, where they can seed new growths, called metastases. Here again, doctors used to think that any breast cancer that had spread to the lymph nodes must have been growing a long time. Now they realize that the fact the cancer has shown...
...intriguing study on invasive tumors, begun in 1988, provides some clues. The trial included about 1,200 women whose tumors were less than 2 cm across with no evidence of malignancy in their lymph nodes and whose cancer cells looked, under the microscope, as if they weren't particularly dangerous. Although these women did not receive the "watchful waiting" approach pioneered in prostate-cancer patients, they weren't treated as aggressively as they might have been. For five years after their tumors were surgically removed, doctors did nothing more unless there was a recurrence. Though 11% of the women...
Doctors have also developed a new technique for determining whether a cancer has spread to the lymph nodes. Instead of taking 15 to 20 lymph nodes from in and around the armpit for further examination--a procedure that can lead to problems with swelling and disability of the arm--they are focusing on certain key spots called sentinel nodes. The surgical team injects a blue dye into the tissue from which it has just removed a tumor and traces its path through the lymph system. The first node or two that the dye reaches are presumably also the first nodes...
Many doctors would recommend chemotherapy to a woman whose tumor measures 2 cm across, even if it has shown no sign of spreading to the lymph nodes. Why? There is always the possibility that some cancer cells have already escaped to the rest of the body through the bloodstream...
...often does that happen? Statisticians estimate that 20 of every 100 women who get only mastectomy (or lumpectomy plus radiation) for a 2-cm tumor that has not spread to the lymph nodes would, all other things being equal, suffer a recurrence sometime in the next five to 10 years. Fourteen of those tumors would have come back regardless of whether any additional therapies had been tried. The remaining six would have been prevented by chemotherapy. "For a 6% improvement, that's a lot of women who have to accept chemotherapy," says Dr. Gralow at the Fred Hutchinson Cancer Research...