August 28, 2018
Before the 1990s, any woman undergoing breast cancer surgery had to have all of her armpit lymph nodes removed at the time of her surgery. This sometimes resulted in a painful swelling condition of the arm, called lymphedema. Today, due to advances in breast surgery, women with early breast cancer can decrease their chance of developing lymphedema. This is a big win for women!
Axillary Dissection and Breast Cancer Surgery
Until the mid-1990s, women undergoing breast cancer surgery would automatically have a procedure called an axillary dissection. The procedure–which involves removing all of the lymph nodes in the armpit region—allows doctors to determine if the cancer has spread to the lymph nodes, and if so, how many lymph nodes are affected.
While this information is important for properly staging the cancer, an axillary dissection is a big operation with some potentially serious side effects, including lymphedema. Lymphedema, which is caused by impaired flow of the lymphatic system, can be permanent, resulting in debilitating, chronic pain.
In addition, many women who had an axillary dissection were found to have normal, benign lymph nodes. They went through a major operation without any benefits.
Surgeons Search for a Better Technique
In the mid-1990’s, surgeons developed the sentinel lymph node biopsy–a new method for assessing a woman’s lymph nodes for cancer. Instead of removing all of the lymph nodes from the armpit, surgeons remove one to three lymph nodes in the chain of lymph nodes known as the “sentinel” nodes. They are then checked for cancer by a pathologist. If no cancer is found, there is no reason to remove any more lymph nodes.
This procedure rapidly became the standard of care for lymph node management, and is still performed today. The benefit? Very few women develop arm swelling or chronic pain when only a few lymph nodes are removed.
What If The Sentinel Lymph Nodes Contain Cancer?
For many years, if the sentinel nodes had cancer, surgeons would go on to perform an axillary dissection, removing all the of armpit lymph nodes. Over time, however, we started to wonder if removing all the lymph nodes had any benefit, even in women who had cancer in one or two sentinel nodes.
In 2011, a major study called ACOSOG Z0011 answered the question. For women going through a lumpectomy and expected to receive radiation and systemic therapy (chemotherapy or endocrine therapy), there is no survival benefit to removing all the lymph nodes. The idea is that even if a little bit of cancer is left behind in the axillary lymph nodes, the additional treatments help eliminate it.
Understand that sometimes axillary dissection still must be performed. If a woman has advanced disease, inflammatory breast cancer, abnormally enlarged lymph nodes, or three or more sentinel nodes with cancer, all armpit lymph nodes are removed to provide the best possible outcome. But luckily, for most women with early breast cancer, we can safely avoid axillary dissection and the likelihood of permanent arm swelling.
If you are facing breast cancer surgery, talk with your doctor about the best treatment options for you.
To learn more about Lancaster General Health’s breast cancer services visit www.lghealth.org/breastcancer.