Lymph Node Surgery for Breast Cancer

Lymph node surgery is a common component of breast cancer diagnosis and treatment, especially when determining the extent and stage of the cancer. There are two primary types of lymph node surgery for breast cancer: sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND).

Sentinel lymph node biopsy is a minimally invasive procedure to determine if cancer has spread to the nearby lymph nodes. It is typically done for early-stage breast cancer.

The "sentinel" node is the first lymph node or group of nodes that cancer cells are likely to reach if they spread from the breast. These nodes are identified using a radioactive tracer and/or a blue dye. The substance is injected into the tumor or area around the tumor, traveling along the lymph vessels that are likely to be taken by the cancer as well. The first lymph node(s) the substance reaches will be identified as the sentinel nodes.

During an SLNB, the surgeon removes one or a few sentinel nodes, and a pathologist then examines these nodes to check for the presence of cancer cells, sometimes during the surgery itself. If cancer is not found in the sentinel nodes, it is less likely to have spread to other nodes in the axilla (armpit) and no further surgery will be needed.

If cancer is detected in the sentinel nodes, additional lymph nodes may need to be removed through an ALND. Alternatively, it is possible for some people to have radiation therapy instead of surgery to kill the remaining cancer cells.

SLNB provides a more accurate assessment of lymph node involvement, helping doctors stage the cancer more precisely. From this, doctors are also able to estimate how likely the cancer will spread to other parts of the body.

SLNB is a less invasive procedure compared to complete ALND, which involves the removal of more lymph nodes. This means a lower risk of complications such as lymphedema and decreased arm mobility. This also means that patients typically recover faster after SLNB compared to ALND.

Axillary lymph node dissection is a surgical procedure in which a larger number of lymph nodes in the axilla (armpit) are removed. It is typically performed when cancer is found in the sentinel nodes during SLNB or when there is a higher likelihood of lymph node involvement based on the tumor characteristics.

During ALND, multiple lymph nodes are removed, and they are examined by a pathologist to determine if cancer has spread to the axillary lymph nodes. While ALND provides more information about the extent of lymph node involvement, it has a higher chance of leading to potential complications such as lymphedema (swelling of the arm), decreased arm mobility, and sensory changes.

SLND and ALND both have side effects. However, as SLND is a minimally invasive procedure, its side effects are less common. These are some of the side effects that you may experience after lymph node surgery:

• Lymphedema in the arm or hand

Lymph vessels drain away excess fluid from tissue. As lymph nodes are removed, a blockage may be formed, preventing the excess fluid from draining away. This sometimes causes a build-up of fluid, which shows up as swelling. 5% to 8% of those who have gotten an SLNB are at risk of getting lymphedema, while 25% to 30% of those who have gotten an ALND are at risk of getting lymphedema. The swelling may go away on its own after a few weeks, but some people experience it for much longer.

• Stiff shoulders

You may have stiff and painful shoulders after lymph node surgery. Physiotherapy may help with this side effect. A nurse or physiotherapist will show you exercises to do after the operation.

• Scar tissue in the armpit (cording)

Aside from the limited arm movement caused by stiff shoulders, some women develop scar tissue in the armpit that looks like a rope, which begins in the armpits and extends past the elbow. Some may even reach all the way to the wrist or thumb. This is known as cording or axillary web syndrome. This may appear weeks or months after the surgery and often goes away on its own, but it can limit shoulder and arm movement while it is there. This is more common after an ALND than an SLNB.

• Numbness or soreness

As the nerves heal, you may feel numb or sore near the incision site. This should improve over time.

The choice between SLNB and ALND depends on factors such as the size and stage of the breast cancer, the presence of lymph node metastasis on imaging or during biopsy, and individual patient characteristics. In recent years, there has been a trend toward reducing the extent of lymph node surgery in cases where cancer is unlikely to have spread to the lymph nodes in order to minimize side effects and complications.

It's essential to have a thorough discussion with your healthcare team, including your surgeon and oncologist, to determine the most appropriate lymph node surgery approach for your specific breast cancer diagnosis. Your treatment plan will be tailored to your individual needs and the characteristics of your cancer, ensuring that you receive the most effective care possible.