Lymph Node Surgery

The lymph nodes under the arm, called axillary nodes, are the major drainage sites for the lymphatic system of the breast. During breast surgery, the doctor usually removes one or more of the nodes, which a pathologist then examines under a microscope to see if cancer cells are present. In general, the fewer the nodes that are positive (containing cancer cells), the earlier the stage. If any lymph nodes are positive, the chance that the cancer has metastasized is greater than if none is positive. This is because one way that cancer cells metastasize is through the lymphatic system. If all the nodes are negative, metastasis is less likely - although not impossible, as cancer cells can also spread by way of the blood vessels.

Doctors can choose from two procedures to examine the axillary lymph nodes. The newest, least invasive procedure is a sentinel node biopsy, in which only the first node to receive lymphatic drainage from the site of the primary tumor - the sentinel node - is removed and analyzed. If the sentinel node contains cancer cells, a more extensive procedure called axillary dissection is done to remove another 10-20 lymph nodes for laboratory analysis.

Not all women can opt for sentinel node biopsy. This procedure is not appropriate if there is cancer in more than one area of the breast; if a swollen, suspicious node can be felt under the arm; if you have had neoadjuvant chemotherapy or prior lymph node surgery; or if you are pregnant or nursing.

Not all surgeons have received specialized training to perform sentinel node biopsies. Many studies have correlated the effectiveness of this procedure with the actual experience of the surgeon performing the sentinel node biopsy. It is important to ask if your surgeon has had specialized training in performing this procedure.

If you have an axillary dissection, the doctor will place a drain at the site of the surgery to prevent lymphatic fluid from building up there. (Also see Lymphedema.) You will need to empty the drain at least twice a day. The drain can be removed after about a week. Sometimes during axillary dissection sensory nerves are divided, and you might experience numbness or a burning sensation under the arm. Surgical scarring may result in limited shoulder movement.

Next >> Radiation Therapy

In This Article:
Treating Breast Cancer
Local and Systemic Treatments
Breast Surgery
Mastectomy
Surgeries That Conserve the Breast
Lymph Node Surgery
Radiation Therapy

From the Harvard Health Publications Special Health Report, Breast Cancer: Strategies for Living. Copyright 2004 by the President and Fellows of Harvard College. Illustrations by Harriet Greenfield, M.A., and Jesse Tarantino. All rights reserved. Used with permission of StayWell. Harvard Medical School does not endorse products.
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