Hi Marg

Decision to do a ND ultimately lies with the surgeon in consultation with the team and the patient.

The NCCN guidelines state this before describing which level or grouping of lymph nodes should be removed during ND should this be the chosen path. Lymph nodes are grouped in 5 "levels" (I-V). Years ago, they whipped all the nodes out(radical ND) but nowadays they have figured out which nodes and levels are likely to be involved with which location (and maybe size) of the primary tumour, so can dissect only those levels (selective ND). No dissection and reliance on chemo or rads to mop up is also a reasonable option and is more often considered today as we understand more and develop the technology and skills to better target the tumour and minimise the after effects of treatment.

The five levels of lymph nodes are expressed as roman numerals (I-V) and are easily confused with staging (I-IV)which is also expressed this way. Could this be what you read in the guidelines?

I agree Kelly's staging and T3 don't quite add up but this is not uncommon and would make no difference to treatment.

Klo,

Very interesting read. I always wondered why many on here had different numbers of lymphnodes removed. I had 14 and thought to myself why didn't I have more removed.

Thank you for the information.

Connie

Thanks, Karen - for the info - and good to consider when making decisions of Tx as well as preparing questions for the Treatment Group. My son's TX ended five years ago but at the time, when he had 48 lymph nodes removed, I assumed it had something to do the surgeon's being known as very "aggressive" in his treatment. We had not found OCF until after Rad Tx started and had no idea what kind of questions to ask. Things do change, and improvements are made all the time. And, thankfully - we have OCF now, and great people like you to provide help and info!