Imagine hearing from your doctor that you have cervical cancer. Then imagine that the tests conducted prior to your surgery showed that the cancer had spread to your lymph nodes. After undergoing a hysterectomy (removal of the uterus), salpingectomy (removal of the Fallopian tube) AND dissection of your lymph nodes, imagine that you find out the cancer had NOT spread after all. What were thought to be cancer cells in your lymph nodes were actually traces of....tattoo ink.
This was the finding in a case report of a 32-year old woman with extensive tattoos on her lower extremities (which had been applied over an 11-year period). As in many cases of cervical cancer, imaging tests were performed prior to surgery to look for spreading of the disease (called metastases). One of the tests, called a whole-body PET-CT scan, showed what appeared to be cancer in the left and right lymph nodes. Consequently, 40 lymph nodes were removed during surgery to prevent further spreading. However, when the tissue was analyzed by pathologists, no cancer was found. The report states, "Ultimately, pathological assessment of the resected fluorine-18-deoxyglucose-avid nodes indicated the presence of tattoo pigment with no malignant cells."
While this was clearly good news for the patient, the bad news is that the mix-up resulted in extensive and unnecessary treatment. And, while this is the first case of tattoo ink migrating to the lymph nodes of a cervical cancer patient, the idea is not a novel one in cancer medicine. Tattoo ink has appeared in the regional nodes of patients with breast cancer, melanoma (skin) cancer as well as cancer of the testicles and vulva. And the popularity of tattoos in this country makes these finding particularly important. According to statistics provided by organizations including the Pew Research Center, $1.6 billion is spent each year in the U.S. on tattoos, and 45 million Americans have tattoos. Of that amount, a whopping 40 percent are adults age 26-40.
The case report states that the migration of the tattoo ink in the body makes it "difficult to differentiate between the pigment and the metastatic disease." So while tattoos can make you stand out in a crowd, getting an incorrect cancer diagnosis is that last kind of attention you want. Physicians and patients alike should be aware that tattoo ink can look like the spread of cancer to the lymph nodes -- even if it isn't.
Elizabeth Chabner Thompson, MD, MPH, is a radiation oncologist and founder of BFFL Co (Best Friends for Life), which provides a wide range of products for patients undergoing various surgical procedures or cancer treatments. One such product is the Axillapilla® post-surgery pillow featured on the Katie Couric Show. This heart-shaped pillow provides support and stability for a patient recovering from surgery, especially cardiac surgery.