Removing lymph nodes
The lymph nodes in the armpit (axillary lymph nodes) are often the first place breast cancer cells spread to outside the breast. Removing some or all of the lymph nodes helps check for spread.
The operation to remove lymph nodes is called axillary surgery. It is usually done during breast surgery but may be done in a separate operation. There are two main types of axillary surgery — sentinel node biopsy and axillary dissection (clearance).
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When breast cancer first spreads beyond the breast, it is likely to go to particular lymph nodes in the armpit or sometimes near the breastbone (sternum). These are known as the sentinel nodes. A sentinel node biopsy finds and removes them so they can be tested for cancer cells.
If there are no cancer cells in the sentinel nodes, no other lymph nodes will be removed. If there is more than a small amount of disease in the sentinel nodes, you may have axillary dissection or radiation therapy.
If cancer is found in the lymph nodes, then most or all of the axillary lymph nodes (usually 10–20) will be removed to minimise the risk of the cancer coming back (recurrence) in the armpit. The results will also guide what other treatments your doctor recommends.
These may include arm or shoulder stiffness; numbness in the arm, shoulder, armpit and parts of the chest; seroma (fluid collecting near the surgical scar); lymphoedema; and cording. Side effects are usually worse after axillary dissection because more lymph nodes are removed.
Finding the sentinel nodes
To work out which lymph nodes are the sentinel nodes, you may have a combination of the following:
1. Lymphatic mappingThis is done either the day before or the day of the biopsy. A small amount of a radioactive material is injected into the skin over the tumour. A scan is taken to show which nodes the substance flows to first. These are likely to be the sentinel nodes.
2. Blue dye injection (not always used)For the biopsy, you will have a general anaesthetic. If dye is being used, it will be injected into the breast. The dye moves into the lymphatic vessels and stains the sentinel nodes blue first. Because of the dye, you will have blue-green urine and bowel movements the next day, and may have a blue patch on the breast for some weeks or months. You may also notice that your skin looks
3. Hand-held probeAs well as looking at where the blue dye travels to first, the surgeon uses a small hand-held device called a probe during the operation to detect the radioactive substance that was injected during the lymphatic mapping. This helps to confirm that the correct sentinel nodes have been identified and the surgeon can then remove them for testing.
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Prof Bruce Mann, Professor of Surgery, The University of Melbourne, and Director, Breast Tumour Stream, Victorian Comprehensive Cancer Centre, VIC; Dr Marie Burke, Radiation Oncologist, and Medical Director GenesisCare Oncology, QLD; Dr Susan Fraser, Breast Physician, Cairns Hospital and Marlin Coast Surgery Cairns, QLD; Ruth Groom, Consumer; Julie McGirr, 13 11 20 Consultant, Cancer Council Victoria; A/Prof Catriona McNeil, Medical Oncologist, Chris O’Brien Lifehouse, NSW; Dr Roya Merie, Staff Specialist, Radiation Oncology, Liverpool Cancer Therapy Centre, Liverpool Hospital, NSW; Dr Eva Nagy, Oncoplastic Breast Surgeon, Sydney Oncoplastic Surgery, NSW; Gay Refeld, Clinical Nurse Consultant – Breast Care, St John of God Subiaco Hospital, WA; Genny Springham, Consumer.
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