In the O.R.

On Cancer: Surgeons Develop Method to Reduce Lymph Node Removal in Gynecologic Cancers

By Jim Stallard, MA, Writer/Editor  |  Monday, July 9, 2012
Pictured: Nadeem Abu-Rustum
Video

Memorial Sloan Kettering gynecologic surgeons, led by Nadeem Abu-Rustum, developed a simple technique to identify and remove the most important lymph nodes during surgery for early-stage endometrial or cervical cancers.

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Memorial Sloan Kettering surgeons have pioneered a way to eliminate the need for extensive pelvic lymph node removal in most patients undergoing surgery to treat some early-stage gynecologic cancers. The approach, which employs a technique called sentinel lymph node mapping (SLNM), could greatly improve patients’ quality of life without placing them at risk for undetected cancer.

“Women with early-stage forms of cervical and endometrial cancer are cured more than 90 percent of the time, and many of them are still young — in their 30s or 40s,” says gynecologic oncologist Nadeem R. Abu-Rustum, who led the team that developed the new approach. “Sparing them unnecessary node removal and the side effects they might endure for decades would be a huge benefit.”

In addition to removing the malignancy in the uterus, surgeons treating women with early-stage gynecologic cancer often take out numerous lymph nodes in the pelvis so they can be examined for cancer cells that may have spread from the primary tumor. This practice, called pelvic lymphadenectomy, may reduce the threat of cancer recurrence but often causes lymphedema, a condition characterized by swelling and skin changes — in this case in the legs.

Now Dr. Abu-Rustum and his colleagues have developed a way to use SLNM to potentially eliminate the need for pelvic lymphadenectomy in these patients.

Tracking Cancer’s Spread

Abu-Rustum’s SLNM technique involves the injection of a blue dye in several locations near the tumor. Lymph fluid carries the dye to the sentinel nodes, the first lymph nodes to which cancer cells are likely to spread.

During the operation to remove the tumor, the sentinel nodes are identified, removed, and examined for cancer cells by a pathologist. If they are free of cancer, usually no additional lymph nodes need be taken out. If any of the nodes do contain cancer cells, the surgeon may remove more nodes for further inspection, and the patient may need chemotherapy or radiation.

One key to SLNM’s effectiveness is that removal of fewer nodes means they can be subjected to more intensive examination by pathologists — a sensitive technique called ultrastaging.

“This is a much more precise, fine-tuned approach because we’re removing only the nodes that are truly important,” Dr. Abu-Rustum says. “It provides pathologists with a better specimen, and they actually find more cancer cells. This enables clinicians to be more accurate in the way they stage and define the disease. For patients, a less extensive operation reduces time spent in surgery, speeds recovery, and decreases the chance they will develop lymphedema.”

An Effective Model

Dr. Abu-Rustum and other Memorial Sloan Kettering experts have now generated a great deal of evidence to validate the use of SLNM for cervical and endometrial cancers and recently reported their success in a series of publications in the journal Gynecologic Oncology.

To ensure that cancer spread does not go undetected, Dr. Abu-Rustum’s group developed an algorithm — a specific set of steps to follow — for SLNM use with stage I cervical or endometrial cancers. An essential part of the algorithm calls for the removal of additional lymph nodes when SLNM provides inconclusive results.

Ultimately, Dr. Abu-Rustum estimates SLNM should make it possible to avoid complete pelvic lymphadenectomy in 75 percent of patients with stage I cervical and endometrial cancers while reliably detecting metastasis. He also is confident the algorithm could be broadly adopted at other institutions, where SLNM use is still rare. 

“Memorial Sloan Kettering is leading the way with this effort, but I think it will start to be used more widely,” he says. “The bottom line is that this is a much more accurate approach that dramatically improves patients’ quality of life.”

Comments

If it weren't for the gyn team at Sloan I would not have celebrated
our fifteen years together. Sloan is beyond awesome.....and they
keep coming up with newer and better treatments. We are among
the fortunate to have coverage that Sloan takes. I hope they never
stop taking medicare. My partner got her walking papers from
Sloan!!! That means remission over five years.

Thank you Dr Abu-Rustum for taking such great care of our Mom. Our whole family thanks you from the bottom of our hearts for the wonderful care and compassion she received from you and from the hospital. Thank you as well for taking care of our family in a time of crisis! You are a wondful Dr and a warm and caring person. Our family could not have gotten through her diaganosis and treatment with out you and the whole team at Sloan! Thank you, Thank you, Thank you!!!

Sounds like a wonderful idea.
Could it be extended to those lymph nodes removed during breast cancer treatment?
Of course I am very grateful for my treatment, but am still suffering the results of losing mine, on both sides....and only one was found to be infected.

You can read more about lymph node removal during breast cancer treatment in this article: http://www.mskcc.org/magazine/july-2011/study-leads-new-recommendations-surgical-treatment-breast. Thanks for your comment!

In 1986, Dr. Rubin performed my surgery. With positive lymph nodes, Sloan offered a research program. Grueling back then. Thanks to Sloan, your physicians and the research, I am happy to say thank you this many years later.

In Dec 2010, Dr Saccini performed left breast surgery, all nodes were removed. MSKCC is really doing wonderful research work for humanity. Hopefully time will come when this creeping disease will be vanished.

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