Lymph node question

[Montana]

If the underarm nodes have been removed, where does the breast lymph
fluid drain?

[Jackie07]

Hi,

Complete disection of the underarm lymph nodes is a thing in the past. Sentinel Lymph node biopsy

http://www.cancer.gov/cancertopics/factsheet/therapy/sentinel-node-biopsy

is the technique to identify the node that's responsible for draining/spreading from the tumor. Only when the sentinel node shows cancer would the surgeon go on to remove more nodes.

The Wikipedia link below has information/illustrations on the complex lymphatic system:

http://en.wikipedia.org/wiki/Lymph_node


"Lymph nodes of the arm
These drain the whole of the arm, and are divided into two groups, superficial and deep. The superficial nodes are supplied by lymphatics that are present throughout the arm, but are particularly rich on the palm and flexor aspects of the digits.
· Superficial lymph glands of the arm:
o Supratrochlear glands: Situated above the medial epicondyle of the humerus (http://en.wikipedia.org/wiki/Humerus), medial to the basilic vein (http://en.wikipedia.org/wiki/Basilic_vein), they drain the C7 and C8 dermatomes (http://en.wikipedia.org/wiki/Dermatomic_area).
o Deltoideopectoral glands: Situated between the pectoralis major (http://en.wikipedia.org/wiki/Pectoralis_major) and deltoid muscles (http://en.wikipedia.org/wiki/Deltoid_muscle) inferior to the clavicle (http://en.wikipedia.org/wiki/Clavicle).
· Deep lymph glands of the arm: These comprise the axillary glands (http://en.wikipedia.org/wiki/Axillary_glands), which are 20-30 individual glands and can be subdivided into:
o Lateral glands
o Anterior or pectoral glands
o Posterior or subscapular glands
o Central or intermediate glands
o Medial or subclavicular glands "

[Montana]

Hi Jackie,

Thanks for your reply. I had the complete node dissection in 2004 after the SNB failed.

But this is the info I was looking for:

Supratrochlear glands: Situated above the medial epicondyle of the humerus, medial to the basilic vein, they drain the C7 and C8 dermatomes."

Thanks!

[Jackie07]

Do watch for the possible complications. I got some tiny bug bites while picking figs in the backyard in 2007 during chemotherapy and ended up developing lymphedema because of cellulitis:

http://en.wikipedia.org/wiki/Lymphedema (http://en.wikipedia.org/wiki/Lymphedema)

When the lymphatic impairment becomes so great that the lymph fluid exceeds the lymphatic system's ability to transport it, an abnormal amount of protein-rich fluid collects in the tissues of the affected area. Left untreated, this stagnant, protein-rich fluid causes tissue channels to increase in size and number, reducing the availability of oxygen. This interferes with wound healing and provides a rich culture medium for bacterial growth that can result in infections (http://en.wikipedia.org/wiki/Infections): cellulitis (http://en.wikipedia.org/wiki/Cellulitis), lymphangitis (http://en.wikipedia.org/wiki/Lymphangitis), lymphadenitis (http://en.wikipedia.org/wiki/Lymphadenitis), and in severe cases, skin ulcers (http://en.wikipedia.org/wiki/Ulcer_(dermatology)). It is vital for lymphedema patients to be aware of the symptoms of infection and to seek treatment at the first signs, since recurrent infections or cellulitis, in addition to their inherent danger, further damage the lymphatic system and set up a vicious circle.

[Montana]

My dr. decided I'll have an ultrasound on my arm
after my yearly mamo on Thursday.

[Jackie07]

That's great! Be sure to give us an update.

[hutchibk]

If you are experiencing lymphedema, I highly recommend finding a lymph drainage massage specialist. I go to mine every month and she does spectacular work... make sure they are trained in the Vodder Method.

[Jackie07]

Brenda,

Are you sure about the spelling? (Sorry, just can't help it - the doctor's name sounds so much like vo-do- ... :)

Details from Wikipedia:

http://en.wikipedia.org/wiki/Manual_lymphatic_drainage

[hutchibk]

http://vodderschool.com/

Yep, it's Dr. Vodder's method of MLD. I have been benefitting from it for 5 years.

[chicagoetc]

And here I thought I didn't have sentinel node biopsy. My surgeon said there were three layers of nodes and, given there was a cancerous node in the second level, removed two levels of the three. I guess the only way she would have known would be the SNB? MLD is a great tool to have. I probably should use it more than I do. [Though the removal of nodes did lead to beginning stages of Lymphodema / Lymphedema regardless.] Still...a small price to pay...

Melanie

[BonnieR]

For what it's worth, I had sentinal node biopsy and it only involved 2 or 3 nodes getting removed but STILL I developed a minor lymphedema on one side. Once it got irritated and I needed to take Cipro to deal with the potential cellulitis. I have since taken great care of my arms to avoid injury, sunburns, bites, etc
Keep the faith!

[yanyan]

I think if you have positive nodes to begin with, a node dissection is performed instead SNB. That is what happened to me. I had 23 nodes taken out..i would guess they were all i had. I did notice that the affected arm barely sweats. The upper arm sometimes can look a little bigger than normal one but usually goes down. My surgeon said lymphedema happens in summer more often.

[Montana]

The lump turned out to be nothing they could see on the ultrasound. I guess I just have lumpy elbow pits?!

I had mild lymphedema after the surgeries, but that was taken care of by a certified lymp. therapist.

Regarding sweating, since the radiation also covered my underarm, I never sweat there anymore. Only have to use 1/2 the deodorant.

[Debbie L.]

I agree with Brenda's recommendation, although I think most CERTIFIED lymphedema therapists are competent to deal with lymphedema, and all follow plans similar to Vodder's, even if not specifically identified that way.

I recommend a consult with a CERTIFIED lymphedema specialist after ANY lymph node surgery, whether SLNB or more extensive dissection. You'll establish a baseline, you'll be educated on what to do and what to watch for, and you'll have set up a contact point, for if you do experience problems.

The National Lymphedema Network has worked, since before this was even a generally-recognized condition, to help and educate about lymphedema. They are still a great resource: http://lymphnet.org/

My only quibble about some of the widely-disseminated lymphedema information (including that from NLN) is that some of it is not evidence-based. Lacking good research, some of the anecdotal-based advice somehow gathered momentum and became "gospel" even though it's since been contradicted by good research. This would include things like "don't ever do resistance training" or "don't ever do repetitive-motion exercise". Studies, especially Dragon-Boating ones, have since proven this advice to be inaccurate.

So here's the disclaimer: if your therapist has mandates that do not encourage you to experiment with what works for YOU and YOUR ARM, I'd be wary. We humans so like to think that we know, that we have control. Lymphedema therapists are no exception, and as I said before, some of these mandates are not based on evidence, and do not serve us well.

Another area of controversy and ongoing research is around the benefit (or harm) of wearing elastic sleeves on yet-unaffected but at-risk arms, for such things as air travel.

My basic lymphedema advice is to get that initial consult, and to pay attention to what bothers YOUR arm (or breast). It will be different for each of us. As will what helps control lymphedema when it occurs. If we remember to proceed slowly and with attention when doing any new activity involving our affected arm, we can almost-always stay on top of lymphedema (and remember, the risk of it is always there, after surgery and/or radiation).

What bothers my arm, for one example, is probably different than what bothers your arm: stillness, as in sitting in a committee meeting, on an airplane, or driving -- but as long as I remember to move my arm ("wringing it out" behind my back, reaching up to my shoulder blades, etc), it's fine. Weed-pulling (something about the jerkiness of the release, perhaps?) -- a little MLD/lymphedema-specific exercise helps afterwards. Skate-skiing (lots of arm involvement for that fun recreation), but again all it needs is the awareness, and bit of self-MLD as I drive home.