Lymph Node Surgery
Lymph Node Surgery in Breast Cancer
Breast cancer can spread from the breast tissue to the lymph nodes in the armpit, known as the axilla in medical terminology. In the majority of patients with an invasive breast cancer, aside from having an operation on their breast to remove the cancer, they will also undergo a procedure to remove some lymph nodes from their armpit.
Breast cancer can spread from the breast to other parts of the body. Often the first place breast cancer spreads is to the lymph nodes in the axilla. The main reason for taking some lymph nodes from the axilla is to establish whether or not the breast cancer cells are seen in the nodes under microscopic assessment. This information helps to guide decision making about non-surgical cancer treatments such as chemotherapy, radiotherapy and endocrine therapy.
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…
Sentinel Lymph Node Biopsy (SLNB)
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, the surgeon uses a radioactive or coloured dye to highlight the nodes that cancer 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.
Axillary Lymph Node Clearance (ALNC)
Axillary Lymph Node Clearance, also known as axillary lymph node dissection is a procedure to remove all of the nodes in the armpit. This is performed in patients where pre-operative scans and biopsies have proven cancer spread to multiple lymph nodes in the armpit. The main issue with this procedure is that it carries a 30-40% lifetime risk of developing some degree of lymphoedema in the arm. Lymphoedema is a chronic problem where the arm can become swollen and painful and it can be difficult to treat. Patients who have undergone an axillary clearance are therefore advised to try to protect the arm on this side from injury (including injections and blood taking) in the future as this can increase the risk of lymphoedema onset.
Targeted axilla Dissection (TAD)
A Targeted Axilla Dissection is still a relatively new procedure and is not yet practiced at all 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 perform a sentinel node biopsy to confirm that there is no further nodes containing cancer that had not been detected on the scans pre-operatively.
It is important to make sure that you get your information from reputable sources when doing your own research on breast cancer and treatments.
For more detailed information about mastectomy surgery, here are some excellent resources: