Lymph Node Surgery

Lymph nodes are small lumps of tissue found in various parts of your body, including your neck, groin and armpits. Part of the lymphatic system, lymph nodes help protect you from infection. They contain white blood cells and are an important part of your body’s immune system. Lymph nodes help fight infection by destroying germs carried in by the lymph fluid. If your lymph nodes swell this can be a sign of a serious illness, such as cancer. 

The total number of lymph nodes in the axilla varies from person to person, ranging from around 10-40 nodes. The number of nodes that are removed is based on a number of factors. The main one is determining which axilla procedure is required. To a large degree, this decision is dictated by what we know about the patient’s lymph nodes prior to surgery, from the scans and sometimes lymph node biopsies that have been performed. Swollen lymph nodes will need to be removed, but other lymph nodes might be taken, depending on the type of procedure being carried out.

Lymph nodes are located throughout your body, so removing some lymph nodes located in your armpit won’t mean you have no lymph nodes at all. Even if you have all the lymph nodes removed from your one armpit, there are still many others across your body, including in your groin, neck and under your chin. As such, while you might find you have to deal with additional infections, you have more lymph nodes located in other parts of your body than the ones removed from your axilla.

A Sentinel Lymph Node Biopsy is the most commonly performed axilla procedure in breast cancer patients in the UK. In the majority of patients with a new diagnosis of breast cancer, the ultrasound scan of their axilla is normal, suggesting that there is no clear evidence of cancer in the lymph nodes. However, the ultrasound is not always a reliable test for confirming cancer spread to lymph nodes. In a sentinel lymph node biopsy procedure, also known as regional or selective lymphadenectomy, the surgeon uses a radioactive or coloured dye to highlight the nodes that the abnormal cells would theoretically spread to first. These lymph nodes (usually 2-4 nodes) are surgically removed via a small incision under the arm. They are then sent off to the lab for analysis to confirm whether there is any evidence of cancer spread to the lymph nodes. 

A Targeted Axilla Dissection is still a relatively new procedure and has not yet been carried out at all medical institutions. Historically, an axillary lymph node clearance was performed in all cases where the patient was confirmed to have spread to at least one node, demonstrated on scans pre-operatively. With a targeted axillary dissection, patients with only 1-2 nodes seen to contain cancer on pre-operative tests can preserve the majority of the lymph nodes, reducing their risk of lymphoedema when compared to an axillary clearance. This is achieved by using a tracer to locate and remove the nodes that are known to be cancerous and then also performing a sentinel node biopsy to confirm that there are no further nodes containing cancer that had not been detected on the scans pre-operatively.

Your breast cancer surgeon will help you understand the different types of lymph node removal and choose the right surgical procedure for you. They will take into account a variety of factors and find a way to remove cancerous cells and test for further spread of the cancer.