Breast cancer can spread to other parts of the body, often through the lymphatic system. This system includes lymph nodes, particularly those in the armpit (axilla), which act as filters and are often the first place cancer cells travel from the breast. When cancer cells are found in these axillary lymph nodes, it indicates the cancer has extended beyond its original site. Axillary Lymph Node Dissection (ALND) is a surgical procedure to remove these lymph nodes from the armpit as part of breast cancer treatment.
Understanding Axillary Lymph Node Dissection
Axillary Lymph Node Dissection (ALND) involves removing 10 to 40 lymph nodes from the armpit. These nodes are divided into three levels: Level I (low axilla), Level II (mid axilla), and Level III (high axilla). Surgeons primarily focus on removing lymph nodes from Levels I and II during ALND.
The procedure determines if cancer has spread beyond the breast, providing accurate staging information. This staging helps understand the cancer’s aggressiveness and extent, guiding subsequent treatment decisions like chemotherapy or radiation therapy. ALND also achieves local control by removing cancerous nodes in the armpit, aiming to prevent further regional spread of the disease.
The Surgical Process of ALND
Before ALND, patients receive pre-operative instructions, which often include fasting and hospital admission on the day of surgery. The surgery is performed under general anesthesia, ensuring the patient is unconscious and experiences no pain.
The surgeon makes an incision in the armpit to access the axillary lymph nodes. Through this incision, the surgeon carefully removes the lymph node tissue, which may also include some surrounding fatty tissue. The removed tissue is then sent to a pathologist for examination under a microscope to determine the presence and extent of cancer cells within the nodes. After the lymph nodes are removed, a surgical drain may be placed in the incision site to collect any fluid that accumulates. Finally, the incision is closed with sutures or surgical staples.
Managing Life After ALND
Following an ALND, recovery involves managing pain, caring for the surgical wound, and potentially managing a surgical drain. Pain can be managed with prescribed medications, and the incision site requires careful cleaning and monitoring for signs of infection, such as redness, swelling, or discharge. If a drain is placed, patients receive instructions on how to empty and measure the fluid output, and it is typically removed by a healthcare provider once drainage decreases.
A common long-term side effect of ALND is lymphedema, swelling in the arm, hand, or chest on the side of the surgery due to fluid buildup. This occurs because the removal of lymph nodes disrupts the normal flow of lymphatic fluid. Signs of lymphedema include a feeling of heaviness or tightness, visible swelling, or aching in the affected limb. Early detection and management are important, often involving compression garments, manual lymphatic drainage by a physical therapist, and specific exercises to encourage fluid movement.
Many patients also experience numbness, tingling, or persistent pain in the arm, armpit, or chest area. These sensations result from nerve disruption during the surgical removal of the lymph nodes. Another potential issue is the formation of a seroma, a collection of fluid under the skin near the incision site, which may require aspiration by a healthcare professional. Restricted arm and shoulder movement is common after ALND, making physical therapy and gentle exercises important for regaining full range of motion and strength. Psychological support is also an important part of recovery, as patients navigate the physical changes and emotional impact of their cancer treatment.
Advancements in Lymph Node Management
While Axillary Lymph Node Dissection remains a standard procedure for certain breast cancer cases, medical understanding and surgical techniques for assessing lymph nodes have advanced. A less invasive alternative, the Sentinel Lymph Node Biopsy (SLNB), is now often performed first to identify cancer spread to the initial lymph nodes that drain from the breast. This procedure involves injecting a dye or radioactive tracer to locate the “sentinel” nodes, which are then removed and examined.
If the sentinel lymph nodes are found to be clear of cancer, a full ALND may not be necessary, potentially reducing the risk of side effects like lymphedema. However, ALND is still necessary in specific situations, such as when SLNB indicates extensive cancer involvement in the sentinel nodes, or in particular types or stages of breast cancer. The trend in breast cancer treatment is towards personalized plans, aiming to minimize the extent of surgery and its associated side effects while ensuring effective cancer control. Ongoing research continues to refine these approaches, seeking to improve patient outcomes and quality of life.