Your doctor might ask you need to remove and examine lymph nodes in addition to your surgical procedure, such as a lumpectomy or mastectomy, to determine whether cancer has spread and to what extent. To accomplish this, your doctor will perform either a sentinel lymph node biopsy/removal or an axillary node dissection. These terms will be defined further below.
What Is the Relationship Between the Lymphatic System and Breast Cancer?
Although breast cancer is difficult to control, its spread is sometimes predictable. Before spreading throughout the body, cancer cells take the usual route, exiting the tumour and entering the surrounding lymph nodes.
What exactly is a sentinel node?
The sentinel lymph node (or nodes grouped in some cases) is the first node “downstream” from cancer in the lymph circulatory system. If cancer spreads from the breast tumour to the lymphatic system, this node would be the first to show signs of breast cancer.
What Exactly Is A Sentinel Node Biopsy?
A sentinel lymph node biopsy examines the lymph node closest to the tumour because this is where the cancer cells are most likely to spread. First, the surgeon will look for the “sentinel lymph node,” which is the lymph node (or nodes) closest to the tumour. The surgeon will inject dye or radioactive substances into the tissue near the tumour to identify the sentinel lymph node. The dye or radioactive substance will mark the lymph nodes that are most vulnerable to cancer spread. The nearest lymph nodes will be removed and examined for cancer cells during surgery.
A biopsy is almost always taken from the sentinel node, which is usually removed for dissection by the breast surgeon.
What Exactly Is Axillary Node Dissection?
This test determines whether cancer has spread to more than one of your lymph nodes. Axillary node dissection involves the removal of some of the axillary lymph nodes, which are lymph nodes located under the arm. The pathologist dissects and examines all of the tissue and individual nodes under a microscope after removing them.
Is it always necessary to remove the lymph nodes?
Not always, especially when no cancer is found in the lymph system, a sentinel node biopsy or an axillary node dissection is commonly performed as part of a mastectomy or lumpectomy. For lumpectomy patients, both procedures require a separate incision. Following surgery, the pathologist will examine the lymph nodes to see if cancer has spread beyond the breast. When there is evidence of cancer in the lymph system, current guidelines are as follows:
For patients undergoing a lumpectomy and having a positive sentinel node for cancer:
When the sentinel node is found to contain cancer, the standard of care was changed in mid-2012 to require women with early-stage breast cancer no longer to have a full dissection and removal of the lymph nodes under the arm. This applies to postmenopausal women over 70 who have oestrogen receptor-positive cancer. Treatment includes radiation to the underarm area and upper chest wall.
Patients undergoing mastectomy and having a positive sentinel node:
The standard of care for these women remains node removal and dissection of the axillary (or underarm) nodes. The pathologist will examine the additional nodes removed during the breast cancer surgery in the coming days to determine whether or not those beyond the sentinel node contained cancer. Other cancer treatments will be considered if cancer cells are found in those lymph nodes.
What Exactly Is Lymphedema?
Lymphedema is a chronic condition caused by a disruption or damage to the lymph node’s normal drainage pattern. It most commonly causes arm swelling but can also affect the breast, chest, and, in some cases, the legs. Lymphedema is a swelling caused by an abnormal accumulation of too much fluid. The removal of the axillary lymph nodes increases your chances of developing lymphedema.
Because the risk of developing lymphedema lasts the rest of your life, you must be aware of these dangers. Learning about lymphedema prevention measures before surgery is often preferable so that you are aware of the signs and symptoms to look for and can discuss treatment options with your doctor.
Some strategies for lowering the risk of developing lymphedema after a lymph node surgical removal or radiation to the lymph node area under the arm include:
- Wearing tight rings, watches, or other jewellery on the affected arm is not advised.
- No needle sticks or blood pressure checks should be on the affected arm.
- When a minor injury occurs, such as a small cut on the finger or arm, wash the area immediately, apply antibiotic ointment, and cover it with a bandage.
If you experience unusual and painful swelling after lymph node surgery, notify your doctor right away so that it can be monitored. Lymphedema has no cure, but your doctor can help you reduce swelling and keep it down. You may reduce the effects of lymphedema with proper health care, good nutrition, and exercise.
