Lymph nodes are small, bean-shaped organs that function as part of the body’s immune system. The removal or assessment of these nodes is a standard procedure in breast cancer treatment. This surgical step is performed to gather crucial information about the cancer’s potential for spread and to potentially remove the disease. Understanding the status of these nodes determines the subsequent steps in a person’s treatment plan.
Understanding the Metastasis Pathway
Cancer spreads through metastasis, where cells break away from the original tumor and travel via the bloodstream or the lymphatic network. The lymphatic system acts as a drainage highway, carrying lymph fluid and stray cells, including cancer cells, toward the nodes for filtration. The axillary nodes in the armpit are the first major collection point for fluid draining from the breast. If cancer cells multiply within a node, they establish a new tumor site. The presence of cancer in these nodes signals that the disease has accessed the lymphatic system and may travel to distant organs.
Guiding Treatment Decisions Through Node Assessment
The status of the lymph nodes is a defining factor in classifying the stage of breast cancer, which directly guides subsequent medical decisions. The pathology report details whether the nodes contain cancer and specifies the number of nodes involved. This information is combined with tumor size and biological markers to assign a stage to the disease. Finding cancer cells in the axillary nodes suggests a higher likelihood that microscopic disease exists elsewhere. This finding increases the intensity of recommended adjuvant therapy, such as chemotherapy or targeted therapy, given after surgery to eliminate remaining cancer cells. The number of positive nodes also influences the use of radiation therapy to surrounding lymph node regions, tailoring the treatment plan to reduce the risk of recurrence.
Methods of Lymph Node Removal
Surgeons use two primary procedures to assess or remove the axillary lymph nodes. The most common approach is the Sentinel Lymph Node Biopsy (SLNB), typically performed when there is no clinical evidence of cancer spread to the nodes before surgery. This procedure involves injecting a radioactive tracer or blue dye into the breast tissue, which travels along the lymphatic pathways to identify the sentinel nodes—the first one to three nodes draining the tumor site. The surgeon removes only these identified sentinel nodes for pathological examination. If these nodes are free of cancer cells, no further lymph node surgery is needed, preserving the remaining nodes.
Conversely, if the sentinel nodes contain cancer, the patient may require an Axillary Lymph Node Dissection (ALND), which is a more extensive operation. ALND involves removing a larger number of nodes from the armpit area. This procedure is generally reserved for cases where pre-operative imaging shows clear involvement or when the SLNB reveals extensive disease. The choice between SLNB and ALND balances the need for accurate staging against the potential for surgical side effects.
Addressing Post-Surgical Side Effects
Removing lymph nodes can disrupt the network responsible for draining lymph fluid from the arm, leading to lymphedema. This condition is characterized by chronic swelling, typically in the arm, hand, or chest wall, due to fluid accumulating in the tissue. The risk of developing lymphedema is significantly lower with the Sentinel Lymph Node Biopsy (about three percent) compared to the Axillary Lymph Node Dissection, which carries a substantially higher risk.
Patients may also experience temporary or long-term issues like numbness, tingling, or a burning sensation in the armpit and upper arm, known as neuropathic pain. This occurs because the nerves supplying the arm are located close to the lymph nodes and can be affected during the surgical removal process. Management of lymphedema focuses on restoring fluid flow through specialized physical therapy, manual lymphatic drainage massage, and the use of custom-fitted compression garments. Patients are often taught self-monitoring techniques and precautions to minimize the risk of infection or injury to the affected limb.