A Fox Chase Women's Cancer Center Program

Lymph-Node Surgery for Breast Cancer

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Fox Chase surgeons perform sentinel and axillary
lymph node surgery for breast cancer.

Sentinel Node Biopsy

Due to improved screening and increased awareness of breast cancer, more breast cancers are being diagnosed at an early stage. In about 80% of the patients whose cancers are 2 centimeters or less in size, the lymph nodes are free of cancer. Rather than removing all the lymph nodes in the armpit, Fox Chase physicians offer a procedure called sentinel node biopsy. In this procedure, only the lymph nodes most likely to contain cancer are removed.

In the past, there was only one way to determine whether lymph nodes were involved with cancer - through a procedure called axillary dissection. This operation involves removing all or most of the underarm lymph nodes. It is of no benefit to women whose nodes are cancer free and it exposes them to side effects.

In sentinel lymph-node biopsy, the surgeon identifies the sentinel node(s) by injecting a dye, a very low dose of radioactivity or a combination of both into the breast. A small incision or cut is made at the edge of the underarm hair. The node(s) that contain the dye or radioactivity is identified as the sentinel node. These nodes are removed and examined under a microscope during surgery to see if cancer is present. If no cancer is seen, no further surgery on the lymph nodes is necessary. If cancer is present, additional nodes are removed with an axillary dissection.

Most women are candidates for sentinel node biopsy. Advantages of sentinel lymph-node biopsy:

  • Reduces the chances of developing lymphedema (arm swelling)
  • Can be performed on an outpatient basis
  • Does not require a drain tube to be inserted after surgery
  • Is less painful than traditional surgery
  • Results in a more rapid return to full activity

Axillary Node Dissection (Removal of the Lymph Nodes)

An axillary node dissection is performed on patients who are not candidates for sentinel node biopsy, including:

  • Pregnant women
  • Women who have had previous major axillary surgery or breast reduction surgery
  • Women with locally advanced breast cancer (that has spread to the lymph nodes)
  • Women with multi-focal breast cancer (cancer in many areas of the breast)
  • Women who have previously undergone radiation therapy to the breast

The lymph nodes are buried in fat and cannot be seen during surgery. Most women have 10-30 underarm lymph nodes. In axillary dissection, the surgeon removes the pad of fat containing these lymph nodes. Following surgery, the tissue is examined under a microscope to determine how many lymph nodes were removed and whether any contain cancer cells (this takes about 5 days). After axillary dissection, a small drain tube is left in place to collect the lymph fluid that forms after surgery. This drain tube is removed in the doctor's office once the drainage has decreased to a minimal amount.

Axillary dissection is an effective method to control the growth of cancer in underarm lymph nodes. Side effects after the procedure include stiffness and pain raising the arm, numbness in the upper, inner part of the arm and lymphedema (underarm swelling). For women who have this surgery, exercises are used to reduce stiffness and pain and information is provided on ways to reduce the risk of lymphedema.

Although the side effects of axillary dissection are of concern to many women, the procedure results in a much better quality of life than allowing the cancer to grow in the lymph nodes.

For more information about breast cancer treatment and prevention at Fox Chase Cancer Center or to make an appointment, call 1-888-FOX CHASE (1-888-369-2427). The breast cancer scheduling department can be reached at 215-728-3001.

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