CSN Login
Members Online: 4

You are here

New study recommends that at least 21 lymph nodes be examined

coloCan
Posts: 1956
Joined: Oct 2009

for accurate Dx of stage II CRC, which also impacts 5-year survival rate......as per article posted this date at 7thspace.com (go to medical-its first article listed)......steve

Jaylo969
Posts: 827
Joined: Jan 2010

Steve, I found the article very interesting. As a stage II with 26 negative nodes removed all I can do is give thanks that my surgeon and his 'helper'turned out to be an exceptionally gifted surgeon who also happened to harvest quite a few nodes.

I went to my PCP with stomach pain who sent me to a surgeon he knew ( said he was the best abdominal surgeon in this city ), who promptly put me in the hospital that day. After reading so many posts where people say to make sure you get a colon cancer specialist to do your surgery I began to fret a little. My surgeon was just a general surgeon( and nerdish too).....who also happened in my opinion to be extremely gifted! I guess I lucked out for a change.

Thanks for posting these articles. Gives me a little more confidence and hope.

-Pat

coloCan
Posts: 1956
Joined: Oct 2009

if he was a specialist in colostomies and he replied that he was a surgeon. My lung doctor just last week, when I told him this, said those trained in the 1950s and '60s were taught to do everything. You have to look real close to see scar on stomach where he cut me open to do his magic to keep me alive by removing tumor and all the other stuff he saw, create my stoma and sew me up front and back and see that all was healing well.....From the second I met him I felt instinctively that he knew what he was doing......My attitude is to arm myself as best I can and knowledge is but one way.....steve

John23's picture
John23
Posts: 2140
Joined: Jan 2007

Try HERE

"The 5-year disease free survival rate was significantly higher for patients with 12 or more lymph nodes examined compared to those with less than 12 lymph nodes examined. The significant difference in 5-year disease free survival persisted if the dividing number increased progressively from 12 to 23.

However, the difference in survival was most significant (lowest p value and highest hazard ratio) for the number 21. The 5-year disease free survival of patients with 21 or more lymph nodes examined was 80% whereas that of patients with less than 21 lymph nodes examined was 60% (p=0.001, hazard ratio 2.08).

Multivariate analysis showed that 21 or more lymph nodes examined was a factor that independently influenced survival. The 5-year disease free survival also increased progressively with the number of lymph node examined up to the number 21.

After the number 21, the survival rate did not increase further. It was likely that 21 was the optimal number, at and above which the chance of lymph node metastasis was minimal.

Conclusions: The number of lymph nodes examined in colorectal cancer specimen significantly influences survival."

The unfortunate part of all that, is the skewed logic in the manner
the data was presented.

If 8 lymph nodes were taken, and only 3 were infected, you would
be staged low (1 or 2). But there could be 3 more nodes infected that
they didn't know about, and that would have staged you high (3 or 4).

When they take out the optimum of 21 nodes, the amount of infected
nodes provide a better indication of the spread of cancer cells.

Less than 4 cancer infected nodes out of 21 will produce a low stage rating.
More than 4 cancer infected nodes out of 21 produces a high stage rating.

If only 10 nodes are taken for biop, the count is not sufficient for
any reliable staging.

The consequence, is what happened to my friend that died last month...

He said they examined 5 nodes and he was "clean", so they told
him that nothing more was needed.

Less than two years later, they told him he had cancer throughout
his body, was re-staged at a stage 4, and had 6 to 9 months to live.
He died about a year later.

The number of lymph nodes examined doesn't "give you more time",
it only provides a better, more accurate diagnosis.

Through a better, more accurate diagnosis, you may receive care
for the -real- stage you were diagnosed at.

dschreffler's picture
dschreffler
Posts: 58
Joined: Apr 2010

I am right that the cure rate is not more simply because they harvested more node, but because they use this to determine next step for treatment, more chemo or not, right? So no matter how many nodes get harvested, if I have post surgery chemo anyway, amount is irrelevant? or am I missing something?

John23's picture
John23
Posts: 2140
Joined: Jan 2007

Re:
"So no matter how many nodes get harvested, if I have post surgery
chemo anyway, amount is irrelevant?"

Well.... Try to think of it this way:

If they would have decided to give you a different chemotherapy
regimen based on 10 out of 20 nodes involved, but instead gave you a
regimen based on 1 out of 10 nodes involved, the answer would be no,
it is most definitely not irrelevant.

The chemo regimen should be based on an accurate diagnosis, and if
the diagnosis is inaccurate, the regimen may not do much good for you.

Chemo works best on tumors, clusters of cancer cells, and cancer
cells that have grown large enough to identify. And... growing at a rate
faster than the surrounding cells.

(Chemo was never designed to be used as a "preventative tool", but that
concept had been long lost for some reason or another. If it were a
preventative tool, none of us would have cancer)

Think healthy thoughts, it's less stressful that the alternative.

dschreffler's picture
dschreffler
Posts: 58
Joined: Apr 2010

Cool explanation.. so post surgery chemo regime is based on % of positive nodes then, hence why the amount harvested matters. Like any sample size, the larger enables better statistical accuracy.

tootsie1's picture
tootsie1
Posts: 5056
Joined: Feb 2008

Well, that's just great. I believe I had only 10 lymph nodes examined. Yikes!

*hugs*
Gail

John23's picture
John23
Posts: 2140
Joined: Jan 2007

Don't go worrying about it. The bottom line is, how good your
doctor is, and how well he's explained it all to you.

The nodes are only one of many factors for staging, so don't take
those reports as seriously as the media wants you to.

You're gonna' be A-OK cuz I said so.

Good health to you!

John

tootsie1's picture
tootsie1
Posts: 5056
Joined: Feb 2008

Thanks, John! I like your diagnosis!

*hugs*
Gail

ron50's picture
ron50
Posts: 1729
Joined: Nov 2001

I had 13 nodes removed and 6 were cancerous. I'm still here nearly13 years later. I had a good surgeon and one that was noted for tissue conservation. I really think that it is the person standing at the other end of the scalpel that makes the difference. Mine actually told me he had felt most of my innards looking for problems and that included my liver. Ron.

coloCan
Posts: 1956
Joined: Oct 2009

nor how competent our doctors,the possibility always exists that an undetected cell or two,is hiding somewhere, like a mole in spydom, just waiting for the right time to strike, usually at some other place in the body beyond the colon, any time in one's future......That's the nature of this beast ahd this battle. Bear in mind that contemporary science is more advanced than even a few years ago so there will always be updates on appropriate treatment, testing, etc....Meanwhile, life needs to be lived as best we can. Only trying to enlighten those seeking knowledge with these postings, as not everyone enjoys reading nonfiction......steve

beachinmom
Posts: 75
Joined: May 2008

Quoted from John23

The unfortunate part of all that, is the skewed logic in the manner
the data was presented.

If 8 lymph nodes were taken, and only 3 were infected, you would
be staged low (1 or 2). But there could be 3 more nodes infected that
they didn't know about, and that would have staged you high (3 or 4).

When they take out the optimum of 21 nodes, the amount of infected
nodes provide a better indication of the spread of cancer cells.

Less than 4 cancer infected nodes out of 21 will produce a low stage rating.
More than 4 cancer infected nodes out of 21 produces a high stage rating.

If only 10 nodes are taken for biop, the count is not sufficient for
any reliable staging.

My statement here...If ANY nodes are found cancerous, the stage is NOT a low stage, it is automatically stage 3. Just to clarify.
http://www.cancer.org/docroot/cri/content/cri_2_4_3x_how_is_colon_and_rectum_cancer_staged.asp

John23's picture
John23
Posts: 2140
Joined: Jan 2007

You can have no lymph nodes involved and be staged at a 4.

A friend of mine had 3 lymph nodes involved, and was staged
as a 2. Go figger.

There are several different staging methods, so I wouldn't be so
specific regarding lymph node involvement.

Lymph nodes are there to catch and hold "bad things" for the
immune system to dispense with. Finding 2 nodes local to the
tumor with cancer cells inside, isn't unusual. Finding lymph nodes
that are remote (distant) from the tumor site, is more worrisome.

There are web sites detailing all the ways and means of staging,
but does any of it really matter?

We have stage 4 victims living longer than stage 1 victims....
And we have stage 3 victims that are already gone.

Putting too much weight on staging, or "lymph node involvement"
only causes one to worry about things that may not mean much
in the overall scheme of life.

Cancer isn't always a tragedy, there are many here that will
live a long, long life, in spite of the prognosis based on standards
the multi-trillion dollar industry sets.

Be well!

John

monica14
Posts: 2
Joined: Oct 2010

ok please hold on I have read a lot of stuff but still have yet to come accross anyone who could realy give me an answer...I had 14 that came back + for cancer...my doctor can't get past the 2 and 3 and how bad that is...so am I really out here in no mans land?? I had stage4 colon cancer and was on my last leg when i found a doctor to listen. (was37).I guess this is unheard of cause he was writing my butt off in Jan. of 09
I've just been hit for the second time with cancer idk what they are even calling this one.. my big ? is with 14 + is there still hope for a life or will I be spending the rest of it fighting??

monica14
Posts: 2
Joined: Oct 2010

ok please hold on I have read a lot of stuff but still have yet to come accross anyone who could realy give me an answer...I had 14 that came back + for cancer...my doctor can't get past the 2 and 3 and how bad that is...so am I really out here in no mans land?? I had stage4 colon cancer and was on my last leg when i found a doctor to listen. (was37).I guess this is unheard of cause he was writing my butt off in Jan. of 09
I've just been hit for the second time with cancer idk what they are even calling this one.. my big ? is with 14 + is there still hope for a life or will I be spending the rest of it fighting??

Kenny H.'s picture
Kenny H.
Posts: 503
Joined: Aug 2010

My Onc was impressed surgeon had removed 37 nodes, But 6 were positive. Guess not good enough, getting Port next.

John23's picture
John23
Posts: 2140
Joined: Jan 2007

Just try to keep in mind, that the nodes are there to trap bad
things and hold the bad things inside until the immune system
carts the garbage out. Yes, the cancer can grow inside the node,
and often does, but the point is, that if the nodes caught the
cancer cells, they did their job well, and maybe.... just maybe,
have saved you from having cancer spread to another major organ.

See..... Life's good!

John

Subscribe to Comments for "New study recommends that at least 21 lymph nodes be examined"