Removal of Lymph Nodes?

Liora4queen

I am scheduled for surgery to remove a small (CT showed it to be about 1.5cm)kidney mass on December 7th. I'm having a laparascopic partial nephrectomy.
I asked my surgeon if he will be removing any local lymph nodes for testing (the CT did not show any lymph node involvement)and he said that he does not remove any lymph nodes routinely because there are no proven benefits to doing so. He said that he'll examine the nodes during surgery to see if any look suspicious. I'm not sure how I feel about this. I saw another surgeon who gave me a different opinion and said that he always removes some nodes. I guess my concern would be the possibility of microscopic spread to the lymph nodes.
Does anyone have a post surgical perspective on this? Have any of you been in a similar situation? What did you decide? Any opinions on an aggressive vs conservative approach?

Any advice would be appreciated. My main objective, like everyone else, is to get this sucker out with the surgery and never have to deal with it coming back.

kmgerhke

my husband had his entire
my husband had his entire Kidney removed and they did take a lymph node and partial rib-There was no sign of cancer in either-But that was 5 years ago-His had metastasis-But we did not know this till years later-so it is up to you where you feel comfortable-Just always follow up after with test-scans and the like.

garym

Don't sweat it...
Hi Liora4queen,

Your tumor is so small that any likelihood of spreading is minute, so I wouldn't worry too much about lymph nodes if I were you. Early detection is perhaps the largest single factor regarding survival of rcc and yours was discovered very early, concentrate instead on what will most likely be a very long life with only distant memories of having this disease.

Good luck on the 7th,

Gary

Liora4queen

kmgerhke said:

my husband had his entire
my husband had his entire Kidney removed and they did take a lymph node and partial rib-There was no sign of cancer in either-But that was 5 years ago-His had metastasis-But we did not know this till years later-so it is up to you where you feel comfortable-Just always follow up after with test-scans and the like.

kmgerhke
Thank you for your response. May I ask - How big was your husband's tumor when they found it?

Liora4queen

garym said:

Don't sweat it...
Hi Liora4queen,

Your tumor is so small that any likelihood of spreading is minute, so I wouldn't worry too much about lymph nodes if I were you. Early detection is perhaps the largest single factor regarding survival of rcc and yours was discovered very early, concentrate instead on what will most likely be a very long life with only distant memories of having this disease.

Good luck on the 7th,

Gary

Gary
Thank you for your reassuring post. I'm getting so stressed out by all of this - it's become hard to make even simple decisions. No one I know has been through this type of cancer so, it really helps to hear from people who have and have come out the other side.
Liora

garym

Liora4queen said:

Gary
Thank you for your reassuring post. I'm getting so stressed out by all of this - it's become hard to make even simple decisions. No one I know has been through this type of cancer so, it really helps to hear from people who have and have come out the other side.
Liora

Liora
Have no fear young maiden for one day thou shalt be old and wise like me

fyi - Wise and full of bull are interchangeable

Seriously though, the waiting is the hardest part cuz your brain just won't leave it alone. You will be fine and this will all be behind you before you know it, by X-mas you will be thinking that this was the best present you ever received, I promise, and us grampas are always right.

Hang in there,

Gary

newenglandguy

garym said:

Liora
Have no fear young maiden for one day thou shalt be old and wise like me

fyi - Wise and full of bull are interchangeable

Seriously though, the waiting is the hardest part cuz your brain just won't leave it alone. You will be fine and this will all be behind you before you know it, by X-mas you will be thinking that this was the best present you ever received, I promise, and us grampas are always right.

Hang in there,

Gary

Liora - fully agree with
Liora - fully agree with Gary. Worrying is absolutely part of any news like this, but really try to focus on the positives, as worrying is negative energy. It's easy to say, but do try to keep a positive attitude. It is great news that it is small, and the right thing to do is to get past the surgery. By coming to this board, you've found a great resource. There are a great bunch of folks on here, and we're here to help you through.

Stay positive.

Minnesota Girl

Trust the experts
You consulted two surgeons and you have chosen the one you trust to do your surgery - put your trust in his/her opinion. You can worry yourself crazy with second guessing. My tumor was larger than yours, but still a relatively small 2.5 cm. My doctor (urologist) did NOT take any nodes and my oncologist later confirmed he was fine with the decision, too.

donna_lee

Minnesota Girl said:

Trust the experts
You consulted two surgeons and you have chosen the one you trust to do your surgery - put your trust in his/her opinion. You can worry yourself crazy with second guessing. My tumor was larger than yours, but still a relatively small 2.5 cm. My doctor (urologist) did NOT take any nodes and my oncologist later confirmed he was fine with the decision, too.

Started at Stage IV
At Dx, the docs already knew it had spread to my liver, but weren't sure what else.
Right Nephrectomy with an 8x12x4 cm tumor (medium size baking potato),
Left hepatectomy (liver lobe)
Colecystechtomy (defective gall bladder)
and Lymphadenectomy (2 of 11 nodes positive)-visible behind the depression of the removed kidney and with some enlargement.
Both surgeons felt that they had removed all suspected or visible cancer.
A year later, a single node had enlarged to be visible on the comparison CT's and it was cancerous on biopsy and removed.
The following year, a second node in another area was enlarged, glowed hot on the PET scan, was removed and pathology proved cancerous.

My opinion, for what it's worth, is that removing nodes without real evidence of cancer doesn't achieve much. Follow up testing is more likely to show a recurrence, it it does return. And we have lots of lymph nodes who do have a remarkable task of filtering out the bad guys. Leave them there to do their job if you can, rather than take them out for no reason. Trust the Dr. on this one.
Good luck.
donna_lee

Liora4queen

donna_lee said:

Started at Stage IV
At Dx, the docs already knew it had spread to my liver, but weren't sure what else.
Right Nephrectomy with an 8x12x4 cm tumor (medium size baking potato),
Left hepatectomy (liver lobe)
Colecystechtomy (defective gall bladder)
and Lymphadenectomy (2 of 11 nodes positive)-visible behind the depression of the removed kidney and with some enlargement.
Both surgeons felt that they had removed all suspected or visible cancer.
A year later, a single node had enlarged to be visible on the comparison CT's and it was cancerous on biopsy and removed.
The following year, a second node in another area was enlarged, glowed hot on the PET scan, was removed and pathology proved cancerous.

My opinion, for what it's worth, is that removing nodes without real evidence of cancer doesn't achieve much. Follow up testing is more likely to show a recurrence, it it does return. And we have lots of lymph nodes who do have a remarkable task of filtering out the bad guys. Leave them there to do their job if you can, rather than take them out for no reason. Trust the Dr. on this one.
Good luck.
donna_lee

Thanks
Thank you everyone for the responses. Im feeling better about my surgeons more conservative approach now. Just want to have this surgery behind me now. I would have gone crazy without this support group - i am so glad to have found you all.

foxhd

Liora4queen said:

Thanks
Thank you everyone for the responses. Im feeling better about my surgeons more conservative approach now. Just want to have this surgery behind me now. I would have gone crazy without this support group - i am so glad to have found you all.

stressed out
Here is my two cents. Kidney cancer is a traumatic diagnosis. But each day goes on and you deal better with it. You will learn alot about something you never wanted to know about. But thats good. It alleviates your fears. This is the survivors network.