Breast cancer surgery may include the removal of lymph nodes for further examination in a lab. This procedure is done to see if the cancer has spread (metastasized) beyond the breast.
Examination of the lymph nodes is important because the presence or absence of cancer in the lymph nodes helps your oncologist understand how your disease might progress. The information gained from the lymph nodes helps you and your health care team make informed decisions about your treatment plan.
There are two procedures that can be performed to remove lymph nodes:
Sentinel node biopsy. In this procedure, the surgeon removes a sentinel node(s), which is the first node(s) that lymph fluid from the breast drains into. Removing sentinel nodes and examining them for cancer cells is a very accurate way of finding out whether the breast cancer has started to spread. In this procedure, few lymph nodes are removed for testing. This results in an easier recovery after surgery and less likelihood of complications
If cancer cells are found in the sentinel node(s), an axillary node dissection may also needed.
Axillary node dissection. This refers to the removal of a number of lymph nodes from the armpit area (also known as the “axillary”). After removal, these nodes are examined under a microscope to see if there are any visible cancer cells.
Some of the possible side effects of lymph node removal include paresthesia, shoulder pain, weakness or stiffness of the underarm or shoulder areas, and axillary web syndrome. A life-long risk and possible long-term side effect is lymphedema.
Benefits of sentinel node biopsy over axillary node dissection
In 2011, the American College of Surgeons Oncology Group reported on a clinical trial that compared axillary node dissection with no axillary node dissection in women with early stage invasive breast cancer and signs of metastasis in their sentinel nodes (found by sentinel node biopsy). All patients in the trial had surgery by lumpectomy followed by radiation therapy. Some also had systemic therapy.
The study found that the use of sentinel node biopsy (SNB) alone compared with SNB followed by axillary node dissection led to similar survival rates along with fewer side effects. This research is expected to influence changes in clinical guidelines and is anticipated to lead to fewer axillary node dissections.
For some breast cancer patients, axillary node dissection will remain standard practice when cancer cells are found by sentinel node biopsy.
Ask your health care team about the benefits, limitations and possible side effects of lymph node removal to help you make an informed decision about your treatment.
Giuliano, A. E, et al. (2011). Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis. A randomized clinical trial. In Journal of American Medical Association, February 9, 2011 – Vol 305, No. 6 (pp. 569-575).