What are the types of axillary lymph node surgery for breast cancer?
Sentinel lymph node biopsy (SLNB)
A sentinel lymph node is described as the first lymph node(s) that cancer cells would travel to, if the cancer has spread to the axilla. The way these nodes are identified at the operation, is by injecting 2 different types of tracers (dye) into the breast. The first dye is a radioactive dye that gets injected in the radiology department prior to surgery, which is followed by a special scan (lymphoscintigraphy) to see which nodes light up (hot nodes). The second dye is a blue dye (Patent V Blue) that gets injected at the start of the operation, and temporarily colours the sentinel nodes blue. During the operation, the “hot” nodes are identified with a gamma probe, that reacts to the radioactive dye. All hot and blue nodes (sentinel nodes) are removed and sent to the pathology lab to check for the presence of cancer cells.
Axillary lymph node dissection (ALND)
An axillary lymph node dissection (also called axillary clearance) refers to the removal of the lymph nodes from the armpit that are involved in draining the breast. In this operation a significantly larger number of lymph nodes will be removed compared to a sentinel lymph node biopsy. This procedure is recommended for patients that have known cancer cells in the lymph nodes, either found pre-operatively on imaging or after having undergone a sentinel lymph node biopsy.
What are the risks of axillary lymph node surgery?
The general risks include bleeding, infection, damage to the nerves in the axilla, fluid collection (seroma) and lymphoedema (swelling of the arm). Rarely, patients will experience an allergic reaction to the blue dye, which may require further management. The risks are higher with an axillary lymph node dissection compared to a sentinel lymph node biopsy. Patients who undergo an axillary lymph node dissection will routinely have a drain inserted, which will be removed once the output decreases. Dr Bastola will discuss your risks with you at the time of consultation, as well as some strategies to minimise the chances of getting lymphoedema.
What are the treatments for breast cancer?
Breast cancer management consists of a multimodality treatment, which means that different specialists use a variety of treatments to treat the same cancer. The broad categories are:
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Breast cancer surgery, which Dr Bastola will perform
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Radiation treatment (Radiotherapy), under the care of a Radiation Oncologist
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Systemic treatment (including hormonal therapy, chemotherapy and Herceptin administration), under the care of a Medical Oncologist
All these specialists are part of a multidisciplinary team that comes together to optimise your individual cancer treatment pathway.
There is a lot of research happening in the field of breast cancer, which means that we can continue to offer better treatments and improve the survival rates amongst breast cancer patients.
In what order are the breast cancer treatments performed?
Breast cancer surgery is usually the first treatment, whilst the other treatments are known as adjuvant treatments (additional treatments to surgery). However, sometimes we recommend starting breast cancer treatment with chemotherapy, followed by surgery. This is referred to as neoadjuvant chemotherapy.
What are the surgical aims of breast cancer treatment?
There are 2 surgical aims for breast cancer surgery:
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To remove the breast cancer with a rim of normal breast tissue (clear margins). This can either be performed with breast conserving surgery or a mastectomy.
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To find out if the cancer has spread to the lymph nodes (stage the axilla). This will either be apparent on pre-operative imaging and confirmed with a biopsy or assessed at the time of surgery with a sentinel lymph node biopsy.
