Breast Cancer: Lymph Node Surgery
To determine the spread of breast cancer to the axillary lymph nodes, one or more lymph nodes are taken and examined under a microscope.
Sentinel Node Biopsy: Breast Cancer Lymph Node Surgery
Lymph Node Surgery
To determine the spread of breast cancer to the axillary lymph nodes, one or more lymph nodes are taken and examined under a microscope. This examination is important for staging the cancer, determining the treatment and its outcomes. If cancer cells are found in the lymph nodes, there is a high chance of the cancer spreading to other parts of the body through the bloodstream. Presence of cancer cells in the armpit lymph nodes, if necessary, what kind of treatment will be applied after surgery
Underarm lymph node dissection: In this procedure, approximately 10-40 (usually less than 20) lymph nodes are removed from the armpit area to control the spread of cancer. Axillary lymph node dissection can be performed simultaneously with breast-conserving surgery or mastectomy as a second operation. This is the most commonly used method for monitoring the spread of breast cancer to nearby lymph nodes and is still used in some patients. For example; Axillary lymph node dissection can be performed in patients with cancer cells detected in one or more axillary lymph nodes in the previous biopsy.
Sentinel lymph node biopsy: Although axillary lymph node dissection is a safe surgical method with fewer side effects, removal of many lymph nodes will increase the patient’s chance of lymphedema after surgery (these side effects are explained below). Specialists can search for cancer in lymph nodes by performing sentinel lymph node biopsy to reduce the risk of lymphedema. With this method, information about the spread of cancer to the lymph nodes can be obtained without removing many lymph nodes.
In this process, the lymph node thought to be the first to invade the tumor is the sentinel lymph node. In the biopsy, this lymph node is found and removed. If the cancer has started to spread, the cancer cell is most likely detected in the sentinel lymph node. In this procedure, a radioactive material and/or blue dye is injected into the tumor, around it, or into the area around the nipple. The lymphatic vessels will transport these substances to the sentinel lymph node or glands. Using a special instrument, the radioactivity in the lymph nodes, which turn blue or where the radioactive material flows, is checked. These are separate pathways used to expose the sentinel lymph node. However, they are methods that are often used together to double-check. The lymph node that is detected to be stained (or radioactive) is removed. Afterwards, the lymph nodes taken are examined by a pathologist in a laboratory environment. In this method, compared to axillary lymph node dissection, fewer lymph nodes are examined more closely to detect cancer.
From time to time, the presence of cancer in the lymph node can also be checked during surgery. If cancer is detected in the sentinel lymph node, it may be possible to remove the entire axillary lymph nodes. If no cancer cells are found in the lymph node during surgery or if the sentinel lymph node is not checked, the lymph nodes will be examined more closely after a few days. If cancer is detected in the lymph node, then a dissection of the entire axillary lymph node may be recommended.
If cancer is not found in the sentinel lymph node, it is unlikely that the cancer has spread to other lymph nodes. For this reason, there is no need for another lymph node surgery. Thus, the patient does not face any side effects due to axillary lymph node dissection.
Until this time, when cancer cells were detected in the sentinel lymph node, whole axillary lymph node dissection was performed to determine how many lymph nodes were cancerous. However, research in recent years has shown that this method may not always be necessary. In some cases, it may be safe to leave non-cancerous lymph nodes. This depends on a number of factors, such as what type of surgery is performed to remove the tumor, the size of the tumor, and what treatment is planned after surgery. In studies on this subject, it has been seen that axillary lymph dissection may not be applied in patients with tumors of 5 cm or less, who have undergone breast-conserving surgery and then radiotherapy. However, it cannot yet be said that it is safe not to remove axillary lymph nodes in female patients who have undergone mastectomy. Research on this subject is ongoing.
Sentinel lymph node biopsy is done to detect the spread of breast cancer to nearby lymph nodes. This procedure is not performed without knowing that the lymph nodes contain cancer. When any lymph node around the armpit or collarbone becomes swollen, the spread of cancer in the involved lymph node can be directly controlled. Most often, a needle biopsy (either a fine-needle biopsy or a coarse-needle biopsy) is done. In this procedure, a small amount of tissue sample is taken by inserting the needle into the lymph node and examined under a microscope. If cancer cells are found as a result of the examination, whole axillary lymph node dissection is recommended.
Although sentinel lymph node biopsy is a frequently used method, it would be appropriate to perform it by an experienced surgeon who is an expert in his field and has used this technique before.
Possible Side Effects: Pain, swelling, bleeding and infection are possible side effects of surgery. The long-term possible side effect of the removal of the armpit lymph nodes is lymphedema (swelling in the arm). Excess fluid in the arm normally returns to the bloodstream via the lymphatic system. However, removal of lymph nodes sometimes prevents drainage from the arm, causing fluid to accumulate and the arm swells as a result.
Lymphedema develops in approximately 30% of breast cancer patients with entire axillary lymph node dissection. In addition, approximately 3% of patients with sentinel lymph node biopsy also have lymphedema. This condition is more common in patients receiving post-surgical radiotherapy. In some cases, the swelling may disappear after a few weeks from time to time, while in some cases it may persist for a long time. If you have swelling, tension or pain in your arm after lymph node surgery, consult your doctor immediately. The point to remember is that lymphedema is a side effect that can be eliminated with various massage techniques and special bandages.
Apart from that, you may have difficulty moving your arm and shoulder after surgery. This is more common after axillary lymph node dissection than sentinel lymph node biopsy. Some exercises may be given to the patient to ensure that there is no permanent movement problem (frozen shoulder). Another common side effect is numbness on the upper and inner parts of the arm, due to nerves that control sensitivity by circulating in the lymph node area.
In some female patients, a rope-like structure appears that starts from the armpit and extends to the elbow. This is called axillary web syndrome or lymphatic cord and is more common in axillary lymph node dissection than sentinel lymph node biopsy. Symptoms may not appear for weeks or even months after surgery. However, later on, movement in the arm and shoulder is restricted and causes pain. Although some patients believe that physical therapy helps, these symptoms may go away without treatment.
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