In 2012, I had a bunch of lymph nodes removed. Two separate areas were resected, only one was showing growth but both were showing up as hotspots on an Octreoscan.  I had known since shortly after diagnosis in 2010 that ‘hotspots’ were showing in my left ‘axillary’ lymph nodes (armpit) and my left ‘supraclavicular fossa’ (SCF) lymph nodes (clavicle area). Some 10 months previously, I had a major liver resection, and 5 months prior to the liver resection, I had a small intestinal primary removed including work on some associated complications.  There had always been a plan to optimise cytoreduction of my distant metastases, it was just a matter of timing. I still can’t get my head around why metastases from a small intestinal NET managed to get to this area but not others!

Distant nodal metastasis treatment

A total of 9 nodes were removed from my left armpit (a very common operation for breast cancer patients). The surgeon had inspected the area and found some were palpable and my normally stable Chromogranin A marker was showing a small spike out of range.  During the same operation under general anaesthetic, an ultrasound-directed SCF nodal ‘exploration’ was carried out.  When biopsied, 5 of the 9 resected axillary nodes were tested positive (Ki-67 <5) but the 5 SCF nodes removed were tested negative. The subsequent Octreoscan still lit up in the left SCF area but the lights on the left axillary area were ‘extinguished’. There is no pathological enlargement or pain in the left SCF area – so this is just monitored.

Side effects

Apart from a very faint scar in the left SCF area, there does not appear to be any side effects from this exploratory surgery.  The left axillary area cut is well hidden by hair growth, but I do sense a lack of feeling in the area.  Additionally, I have a very mild case of lymphedema in my left hand which occasionally looks slightly swollen – the consequences of cancer and its treatment.  Fluid build-up, or post-operative seroma, can be a side effect of a lymphadenectomy.  In fact, within a month of the operation, I had to have circa 160mls of fluid removed on 4 occasions from my armpit.  It was uncomfortable and painful, resulting in additional time off work.  The surgeon used a fine needle aspiration to draw out the fluid, a painless procedure. It eventually cleared up and everything was back to normal.  The specialist said my left arm would be slightly more susceptible to infections and suggested avoiding using my left arm for blood draws and other invasive procedures and injuries.

Other close calls (“to cut or not to cut”)

I have a 19mm thyroid lesion which was pointed out to me in 2013. This has been biopsied with inconclusive results.  Although the thyroid is an endocrine gland, it looks like a non-NET problem so far. Thyroid nodules are in fact very common and statistically, 50-70% of all 50-70-year-olds will have at least one nodule present (i.e. if you are in your 50s, there is a 50% chance you will have one nodule and so on). The vast majority will never bother a person while they live.  I attend an annual Endocrine MDT where this is monitored in close coordination with the NET MDT. It’s actually managed by the same surgeon who carried out the nodal work above.

I have a 2-3 mm lung nodule, discovered in 2011. Apparently, lung nodules are a pretty common incidental finding with 1 per 500 X-rays and 1 per 100 CT scans finding them.  This is monitored and hasn’t changed since noted.

You may also be interested in my post “Neuroendocrine Cancer – to cut or not to cut”

I watch and wait but I also watch and learn.  Make sure you are under some form of surveillance.