Lymph node Surgery

Because breast cancer sometimes spreads to the lymph nodes, most people will have lymph node surgery.

Some tests and checks will be done before your breast cancer surgery to find out if there are cancer cells in your lymph nodes. A fine needle aspiration is most commonly used to test for any cancer cells in the nodes, but you may also be offered a microbubble test. If these tests and checks show up cancer cells, you will usually have all the lymph nodes taken out from under your arm at the same time as you have your breast surgery.
Sometimes the only way to tell for sure if there are breast cancer cells in your lymph nodes is to take one or two of them during your breast cancer surgery. They are looked at under a microscope. If breast cancer cells are seen, you might need another operation to take out some or all of your lymph nodes.

There are 2 main types of lymph node surgery:

1. Sentinel lymph node biopsy – removal of one or two lymph nodes.
2. Axillary node clearance – removal of all lymph nodes in the armpit.

What is the Sentinel Node?

The sentinel lymph nodes (glands) are the first lymph nodes in your armpit to which breast cancer can spread.

What is Sentinel Lymph Node Biopsy (SLNB)?

Sentinel lymph node biopsy is widely used to for people whose tests before surgery show no evidence of cancer in the lymph nodes and identify whether or not the first, or sentinel, lymph node (or nodes) is clear of cancer cells. This is important information as it helps us to advise you about the stage of your cancer and the best type of treatment for you. Studies have shown that to decide if there is breast cancer spread to the armpit lymph nodes, removal of the sentinel node is just as safe and accurate as traditional armpit surgery, which removes more nodes.

Finding the sentinel node

Before your breast cancer surgery, your doctor will inject a small amount of radioactive liquid into the breast, close to the cancer. The fluid travels to the sentinel lymph node. This procedure is usually carried out in the specialist x-ray department.
During the operation, as an additional method to identify the sentinel node, your surgeon injects a small amount of blue dye into the breast, which also travels to the sentinel node. The surgeon, using a special radiation detection probe, can then find the sentinel node which is also blue. The sentinel node(s) is then removed so it can be examined under a microscope to see if it contains any cancer cells.

Very rarely it is not possible to identify the sentinel node in which case your surgeon may have to carry out traditional armpit surgery.

What happens next?

The pathologist will examine the sentinel lymph nodes under the microscope; this may take 3-4 weeks. If the sentinel node contains cancer cells, your cancer team will discuss the best management plan and you may require further surgery to your armpit to remove the remaining lymph nodes (axillary clearance).

What are the advantages of Sentinel Lymph Node Biopsy?

• Less discomfort and earlier mobility in the shoulder/arm
• Less risk of lympheodema
• Shorter hospital stay and quicker recovery (often the surgery is done as a day case)

What are the disadvantages of Sentinel Lymph Node Biopsy?

• The blue dye may discolour urine, stools, tears etc for a few days
• The breast skin may be discoloured for up to a few months and very occasionally longer
• Allergic reaction to the blue dye can occur but it uncommon (less than 1% of patients). This can be treated.
• Injection of radioactivity into the breast may give slight discomfort
• If the pathologist finds the sentinel lymph nodes contain cancer, you may require a second operation to the armpit
• False positive and false negative failure rate of the sentinel node procedure is less than 10%

Most of these reactions are not serious, but occasionally severe reactions can occur that could be life threatening.

An anaesthetist will be looking after you in theatre and will take all possible steps to keep you safe.

Axillary Node Clearance

This involves the removal of all the nodes in the armpit.

The possible short term side effects of axillary node clearance are:

• Pain and difficulty moving your arm
• Collection of fluid in the armpit (seroma)
• Increased risk of infections

Long Term side effects include:

• Increased risk of Lymphoedema (swelling of the arm) – this risk is greater with an axillary node clearance than with a sentinel lymph node biopsy
• Permanent numb area of skin under the armpit and inside top of the arm
• Reduced mobility of the shoulder

If you wish to discuss this procedure further, please contact your Breast Care Nurse who will be happy to answer any questions.

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