Removing lymph nodes may raise risk of long-term pain

An analysis of 30 past studies has shown that women who have lymph nodes removed are more likely to develop ongoing, or persistent, pain after breast cancer surgery.

Younger women and those given radiation therapy are also at higher risk of having long-term pain. The study was published in the Canadian Medical Association Journal.

Background

Pain after breast cancer surgery is normal. But that pain usually goes away after a few weeks as your body heals.

Some people feel pain that continues months after they have healed from lumpectomy to remove the cancer and some healthy tissue around it or mastectomy to remove the whole breast. Many have lymph nodes removed during these surgeries. Lymph nodes are the first parts of the body in which doctors may find cancer cells if they travel beyond the breast.

Pain after surgery might be due to nerves being damaged or cut. Studies have shown that ongoing pain, lasting 2 months or longer, affects from 25 to 60 percent of people having breast cancer surgery.

In this study, researchers looked to identify what factors may lead to ongoing pain after breast cancer surgery. They wanted to see what about the surgery or the women who get surgery may affect the risk of persistent pain.

Design

The researchers used four major databases and looked at 30 studies on persistent pain and breast cancer surgery dated from the start of these databases up to March 2015. Their analysis looked at data on about 20,000 women.

Results

The factor most strongly linked to ongoing pain after breast cancer surgery was having an axillary lymph node dissection, an operation where most of the lymph nodes are removed from the armpit area.

Women who had nodes taken out by axillary lymph node dissection had a 21 percent higher risk of developing persistent pain.

Sentinel lymph node biopsy removes and tests the first lymph nodes to which cancer cells go if they leave the breast. If the biopsy shows no cancer in those nodes, then no more have to be removed and the risk of persistent pain is lower.

The researchers said that women could have a lower risk of ongoing pain if they had sentinel lymph node biopsy instead of axillary lymph node dissection to see if cancer has spread.

Younger women also had a higher risk of having ongoing pain. So did women who received radiation therapy. Researchers said future studies should see if amount of radiation used may affect the risk of persistent pain.

What this means for you

It's standard practice is to remove the sentinel lymph nodes with surgery to see if the cancer has traveled away from the breast. This study shows that removing more nodes in axillary lymph node dissection can cause ongoing pain.

Recent standards from the American Society of Clinical Oncology advise using sentinel lymph node biopsy for early-stage breast cancers because it is associated with less pain and works as well as axillary lymph node dissection for finding cancer that has spread to the lymph nodes.

It’s important to get the breast cancer treatment you need. If cancer is found in your lymph nodes, more nodes may need to be removed. Talk with your surgeon about the type of biopsy you will receive.

Your healthcare team understands that pain, whether short-term or long-term, can affect your overall health and quality of life, and will work with you to bring you relief. Many cancer centers and hospitals have pain specialists. They can help you find solutions for pain, from medicines and physical therapy to complementary therapies such as acupuncture, hypnotherapy, massage and yoga. Ask your oncologist or healthcare team for a referral to a cancer pain specialist or other professional who can ease your pain.