It is important to stage somebody correctly that you examine a reasonable number of lymph nodes.
Many studies now show that the ideal number is 12 or higher. We know that if you have no lymph nodes involved with cancer out of 12 lymph nodes that you really have stage II disease. You might wonder when only two nodes are removed and none are involved in cancer if additional lymph nodes could show cancer. Therefore, even when the pathological stage is II, we would classify this tumor as not well-staged and treat it like a stage III cancer.
We also know that the number of lymph nodes removed not only allows us to correctly stage you to make the most effective treatment recommendation, but the more lymph nodes are removed the better the survival. This makes sense since the number of lymph nodes appears to correlate with the extent of the surgery. The better the surgery, the better the outcome.
There are exceptions to the rule. Despite the fact we have some of the best colorectal surgeons in the country and the surgeries are done by the same surgeons, the number of lymph nodes differ depending on the patient.
An additional factor is the pathologist. If the lymph nodes are small or hidden in the abdominal fat, it is not easy to find them and requires labor and time intensive procedures which are often not done.
Make sure you get your surgery by a colorectal surgeon who has the expertise to do the right surgery. They usually work with pathologists who specialize in colon cancer.
April 25, 2009 at 6:28 pm, A said:
Hi,
If a patient starts out as stage II or III and has no tumour remaining after chemoradiation, I am curious as to whether surgery could be avoided altogether? I know that there is no way to be completely certain whether lymph nodes are cancerous until they are removed and examined but have read some studies that suggest that if the tumour is completely gone after chemoradiation, this indicates a pathologic complete response with no cancer remaining/present in the lymph nodes either.
Thank you.