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New study recommends that at least 21 lymph nodes be examined

coloCan
coloCan Member Posts: 1,944 **
edited March 2014 in Colorectal Cancer #1
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

Comments

  • Jaylo969
    Jaylo969 Member Posts: 824
    Interesting article
    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
    coloCan Member Posts: 1,944 **
    Jaylo969 said:

    Interesting article
    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

    Pat:When I had my port removed recently, I asked my surgeon
    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
    John23 Member Posts: 2,122
    Link


    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.
  • tootsie1
    tootsie1 Member Posts: 5,036
    Well...
    Well, that's just great. I believe I had only 10 lymph nodes examined. Yikes!

    *hugs*
    Gail
  • John23
    John23 Member Posts: 2,122
    tootsie1 said:

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

    *hugs*
    Gail

    Aww, toots...


    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
    tootsie1 Member Posts: 5,036
    John23 said:

    Aww, toots...


    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

    Thanks
    Thanks, John! I like your diagnosis!

    *hugs*
    Gail
  • ron50
    ron50 Member Posts: 1,723
    tootsie1 said:

    Thanks
    Thanks, John! I like your diagnosis!

    *hugs*
    Gail

    who knows
    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
    coloCan Member Posts: 1,944 **
    ron50 said:

    who knows
    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.

    The unfortunate part is, no matter how many nodes are tested,
    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
  • dschreffler
    dschreffler Member Posts: 58
    John23 said:

    Link


    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.

    Just for understanding.
    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
    John23 Member Posts: 2,122

    Just for understanding.
    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?

    dschreffler -


    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
    dschreffler Member Posts: 58
    John23 said:

    dschreffler -


    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.

    Cool explanation.. so post
    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.
  • beachinmom
    beachinmom Member Posts: 73
    coloCan said:

    The unfortunate part is, no matter how many nodes are tested,
    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

    Just to clarify....
    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
    John23 Member Posts: 2,122

    Just to clarify....
    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

    Generic advice?


    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
    monica14 Member Posts: 2
    so where do i stand
    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
    monica14 Member Posts: 2
    so where do i stand
    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.
    Kenny H. Member Posts: 502
    monica14 said:

    so where do i stand
    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??

    My Onc was impressed surgeon
    My Onc was impressed surgeon had removed 37 nodes, But 6 were positive. Guess not good enough, getting Port next.
  • John23
    John23 Member Posts: 2,122
    monica14 said:

    so where do i stand
    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??

    Monica -

    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