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Are all lymph nodes removed in breast cancer surgery?

Q: My 45 years old sister underwent breast cancer surgery last year. She is to get her sixth cycle of chemo in a while. The surgeon who removed the lump had removed only five of the lymph nodes in the axilla. She visited another surgeon yesterday as she had slight discharge from her breasts. The doctor told her not to worry about that. But the doctor said that the surgeon should have removed all the lymph nodes rather than removing only five. This doctor says that she must get all her lymph nodes removed before she takes radiotherapy. What should she do now? Why has my sister’s surgeon not removed all the lymph nodes?

A:I presume that she had breast conservation surgery for her cancer. The surgeon may have purposely removed only five lymph nodes, perhaps because your sisters breast tumour was small. In any case, if all five nodes are negative for cancer cells, then there is no need to remove all the nodes. However, if some of them are positive for cancer cells, then there may be a need to remove the others


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