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Breast Cancer (Expert Forum)
axillary node dissection
Questions posted in the Breast Cancer Forum are answered by medical professionals from The Cleveland Clinic. Topics include Breast Biopsy, Chemotherapy, Hormone Therapy, Lumps, Lumpectomy, Lymph node dissection, Lymphedema, Mammograms, Mastectomy, Radiation Therapy, Reconstruction, Self Breast Exam, and Surgery.
Doctor's Answer
by CCF-RN,MSN-JS, Jul 20, 2001 12:00AM
Dear Gretta, An axillary lymph node dissection involves removing the lymph nodes under the arm, in order to check them for cancer. This procedure is done usually at the time of mastectomy or lumpectomy. An incision is made about 2 inches across the armpit, and the surgeon removes the section of fat in the hollow of the armpit, which contains many of the lymph nodes. A pathologist then examines the lymphnodes in the specimen.
The sentinel lymph node (SLN) is the first lymph node to drain the primary tumor. The theory is, if the SLN does not contain cancer then the lymph nodes “down stream” of the SLN would also not contain cancer. A SLN biopsy involves removing the lymph node that specifically drains the cancer in the breast. This involves injecting a small amount of blue dye and radioactive tracer in and around the tumor. The SLN is then identified under the arm using a hand-held Geiger counter and is removed. The SLN is then examined under the microscope, if no cancer is found there is no need for further surgery to remove the other lymph nodes. If cancer is found in the SLN, the cancer may be in others as well, thus requiring removal of the remaining lymph nodes. In breast cancer, many studies have shown that the SLN is accurate in predicting the absence of nodal metastasis for early stage breast cancers. The use of SLN biopsy is to possibly avoid removal of all of the lymph nodes thus avoiding the potential problems of that procedure.
The possible complications of lymph node surgery are: numbness in the back part of the arm, fluid under the armpit, very rarely; hematoma (bruising) that can cause soreness or bruising for several weeks after surgery. The surgical dressing tape can cause a rash or “tape burn”. An early problem (within 3-4 days after surgery) can be phlebitis in one of the arm veins which is generally treated with ice and aspirin. A major complication but an uncommon one is lymphedema.
The sentinel lymph node (SLN) is the first lymph node to drain the primary tumor. The theory is, if the SLN does not contain cancer then the lymph nodes “down stream” of the SLN would also not contain cancer. A SLN biopsy involves removing the lymph node that specifically drains the cancer in the breast. This involves injecting a small amount of blue dye and radioactive tracer in and around the tumor. The SLN is then identified under the arm using a hand-held Geiger counter and is removed. The SLN is then examined under the microscope, if no cancer is found there is no need for further surgery to remove the other lymph nodes. If cancer is found in the SLN, the cancer may be in others as well, thus requiring removal of the remaining lymph nodes. In breast cancer, many studies have shown that the SLN is accurate in predicting the absence of nodal metastasis for early stage breast cancers. The use of SLN biopsy is to possibly avoid removal of all of the lymph nodes thus avoiding the potential problems of that procedure.
The possible complications of lymph node surgery are: numbness in the back part of the arm, fluid under the armpit, very rarely; hematoma (bruising) that can cause soreness or bruising for several weeks after surgery. The surgical dressing tape can cause a rash or “tape burn”. An early problem (within 3-4 days after surgery) can be phlebitis in one of the arm veins which is generally treated with ice and aspirin. A major complication but an uncommon one is lymphedema.
