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Treatment

 
Treatment

Chapter: 6 - Treatment

Subchapter: 6 - Lymph Node Removal

In addition to your surgical procedure, your doctor may wish to remove and examine lymph nodes; this is to determine whether the cancer has spread and to what extent. Your doctor will perform a Sentinel Lymph Node Biopsy and/or an Axillary Node Dissection. Let’s discuss both methods.

Sentinel Lymph Nodes and Sentinel Node Biopsy
While it is not easily controlled, the spread of cancer is sometimes predictable. The cancer cells spread through a customary path, out from the tumor and into the surrounding lymph nodes, before they progress throughout the body.

To be able to identify the sentinel lymph node, the surgeon will inject dye or a radioactive tracer into the tissue near the tumor; the lymph nodes that are the most susceptible to the cancer’s spread will be marked by the dye or a radioactive tracer. During surgery, the lymph nodes will be removed and checked for the presence of cancer cells.

Axillary Node Dissection
To determine if the cancer has spread to the lymph nodes, examinations can be performed with ultrasound and more carefully by removing one or more of the first draining lymph nodes with sentinel lymph node biopsy. Patients with a tumor that has spread to these lymph nodes may require complete removal of the lymph nodes in the armpit, a procedure known as an axillary lymph node dissection. An axillary dissection is generally performed subsequent to a sentinel lymph node biopsy, unless a woman has had a positive fine needle aspirate of a lymph node.

A mastectomy or lumpectomy operation often includes a sentinel node biopsy and/or an axillary node dissection; both procedures involve a separate incision for lumpectomy patients. Following surgery, the pathologist will test the lymph nodes to determine whether the cancer has spread to the lymph nodes.

Lymphedema
Removing lymph nodes raises your risk for developing Lymphedema, a condition that may cause abnormal swelling of the arm, breast, axilla, or chest wall on the side of your cancer. Swelling up to one month after surgery is not unusual and does not indicate the presence of lymphedema. However, if you experience new or persistent swelling in these areas after one month has elapsed since your surgery, you should notify your doctor.

Related Questions

  • Thumb avatar default

    If it was really bad do you think my team would tell me? I'm waiting to get information on my cancer stage as I'm having chemo first. I do know that the grade is 2 and I have at least 1 node affected, a mixed dx in the same breast. My CT scan is clear.

    Asked by anonymous

    Patient
    about 7 years 5 answers
    • View all 5 answers
    • Sharon Danielson Profile
      anonymous
      Survivor since 2007

      Now I understand why your team is putting off the staging until after your preliminary treatment as they are expecting the tumor to shrink. It makes perfect sense. Hang in there and hopefully that tumor will get a whole lot smaller. Please keep in touch with us. Big hugs and take care, Sharon

      Comment
    • Sharon Danielson Profile
      anonymous
      Survivor since 2007

      There are actually different circumstances where oncologists would recommend chemo 1st. Many, many, reasons that don't paint a bleak picture in the least. As for hiding something from you.... I do not think they do that. When I was having my biopsy, the doctor told me to "expect this to come...

      more

      There are actually different circumstances where oncologists would recommend chemo 1st. Many, many, reasons that don't paint a bleak picture in the least. As for hiding something from you.... I do not think they do that. When I was having my biopsy, the doctor told me to "expect this to come back as breast cancer..." There was nothing "warm and fuzzy" about her statement.
      The next time you have an appointment with him/her, take a friend, or relative with you. They can be your scribe and take notes. Your job is to ask questions and get answers. I really believe lack of information is the most terrifying thing about having breast cancer. I remember when I heard all of the facts, including the pathology report, I finally knew all the answers to all my questions. I knew how we were going to proceed and the treatment plan was in full view. There was something much more reassuring and almost comfortable in finally having that knowledge. Please stay in touch with us here. We have all been where you are and really want to support our sisters in this journey. You will be ok... it is just one foot in front of the other and one appointment at a time.
      Take care, Sharon

      Comment
  • Thumb avatar default

    What is the significance of isolated tumor cells in a single lymph node? (a small five cell cluster of about 1mm)

    Asked by anonymous

    Learning About Breast Cancer
    over 7 years 3 answers
    • Thumb avatar default
      anonymous
      Stage 2A Patient

      Although the amount of cells seems small, the significance lies in the fact that the cancer moved into the lymph nodes. Chemotherapy will insure that any cell that got free will be killed and your chance of recurrence will be reduced.

      Comment
    • Nancy L Profile
      anonymous
      Learning About Breast Cancer

      I suggest speaking to your surgeon and to an oncologist, perhaps even requesting the Oncotype Dx testing of the cells. I was faced with a similar situation - two microscopic cancer cells in my nodes - and after a great many sleepless nights, chose to follow my surgeon's advice. He said the cells...

      more

      I suggest speaking to your surgeon and to an oncologist, perhaps even requesting the Oncotype Dx testing of the cells. I was faced with a similar situation - two microscopic cancer cells in my nodes - and after a great many sleepless nights, chose to follow my surgeon's advice. He said the cells were too small to test further and chemo would only increase my survival chances by approx. 2%, so I chose no chemo. After 4 years of Arimidex, I'm still going strong. Your situation may be different, certainly, so the advice of your doctors is critical. Ask lots of questions. Best of luck to you.

      Comment
  • nancy  wilcox Profile

    Did anyone experience tingling in their fingers when your axillary nodes were inflamed?

    Asked by anonymous

    Learning About Breast Cancer
    about 7 years 3 answers
    • Coco Smith Profile
      anonymous
      Learning About Breast Cancer

      Julie,

      yes with the finger tingles [tended to be thumb and next two fingers] however mine was related to after effects of Sentinel Node Biopsy. I had sentinal node under right armpit removed during surgery and tested for cancer cells while still under anethethic. No cancer cells were found so no...

      more

      Julie,

      yes with the finger tingles [tended to be thumb and next two fingers] however mine was related to after effects of Sentinel Node Biopsy. I had sentinal node under right armpit removed during surgery and tested for cancer cells while still under anethethic. No cancer cells were found so no further lymph nodes were removed.

      I found in weeks after surgery the rotation/range of motion in right shoulder got more and more limited and the finger tingles started. The physiotherapist i consulted said the finger tingles were related to nerves that had been disturbed/injured during the sentinel node surgery. I had a series of exercises to retain full range of motion in right shoulder and stretching exercises that ensured the lines of nerves etc in my right arm did not tighten and contract. My persisting with these physiotherapy exercises, the tingling would intensify immediately around the exercise period, but over a few months it gradually reduced to the point where it rarely happens these days. The physiotherapist said it was good I had come in within weeks of surgery when the problem first happened as it meant I was able to stretch scar tissue and nerves so they did not "set" in a tight position that caused irritation. Softening scars and lengthening nerves is harder work the longer you leave it.
      Tingles in right arm and right fingers can be associated with heart disease.
      Tingles in fingers especially in your dominant hand can be associated with carpel tunnel syndrome [over use by repetitive actions often cause it].
      Just reminding you that finger tingles can be associated with other things such as that or even constant sleeping on one side to ease pressure on breast cancer surgery side can also cause nerve compression and finger tingling if you are heavy, or even if you aren't, if you are constantly sleeping on one shoulder.

      Comment
    • Julie Dalton Profile
      anonymous
      Learning About Breast Cancer

      Hello Nancy,
      I'm not sure whether I can be of any help, but I'll certainly try. Since I don't know how far you are on with your Chemo and/or Radiotherapy sessions I'm not able to form a proper judgement, but on what little I've read about tingling in your fingers when your Axillary nodes are...

      more

      Hello Nancy,
      I'm not sure whether I can be of any help, but I'll certainly try. Since I don't know how far you are on with your Chemo and/or Radiotherapy sessions I'm not able to form a proper judgement, but on what little I've read about tingling in your fingers when your Axillary nodes are inflamed all I can tel you is this; I had a mastectomy with 10 nodes removed last October. I did all the Exercises that they tell you to do after the Op in order to keep a full range of motion in the shoulder and arm area. Three months later, and during my Chemo sessions I discovered I had the condition they call Lymphoedema. This is brought on by loss of the Lymph nodes as I'm sure you know. Anyhow all I can tell you is that my hand is quite severely numb and tingly all of the time so obviously the nodes and the lymph and hand area are all connected and very very complimentary to each other. More than we realise I think. If you'd like to keep in touch or have any more questions then I'd be only too pleased to hear from you - my email address is; daltonfox@btinternet.com and my name is Julie. Bye for now. Take care, Julie

      1 comment
  • Connie Demarest Profile

    Is chemotherapy (except aromotase inhibitors) used for stage 1 lymph node negative breast cancer?

    Asked by anonymous

    Learning About Breast Cancer
    almost 8 years 3 answers
    • Betsy Chapin Profile
      anonymous
      Survivor since 2010

      Hi Connie,
      You have a lot happening this week. You will get through this. Sometimes the toughest part of treatment Is waiting. I believe you will have answers when you see your oncologist this week. Stay strong.

      Comment
    • Betsy Chapin Profile
      anonymous
      Survivor since 2010

      Yes one could have chemotherapy with a stage one diagnosis. I was stage one and had chemotherapy with no lymph node involvement due to the fact that my cancer was HER2 positive.

      Comment

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