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Axillary Staging

The purpose of lymph node surgery in breast cancer is to determine if the cancer cells have spread to the lymph nodes under the arm (also called “axilla”).  If you have invasive breast cancer, it will be important for your surgeon to examine your lymph nodes to help determine the extent of cancer involvement.  Routine lymph node surgery is generally not indicated for non-invasive breast cancer (DCIS).

Sentinel lymph node biopsy
The sentinel nodes are identified at the time of surgery in the operating room by using a combination of dyes. In most cases, a radioactive dye is injected in the breast several hours before surgery and given time to travel to the sentinel nodes. In some cases, the surgeon will also inject some blue dye into the breast tissue (see illustration). In the operating room, a machine (gamma probe) is used to identify the radioactive nodes. Together, the radioactive dye and blue dye help the surgeon identify the sentinel nodes.

Sentinel lymph node biopsy
The sentinel nodes are the first nodes to receive the drainage from invasive breast tumors, and therefore the first place cancer cells will travel. On average, women have 1-3 sentinel nodes, though this can vary. If a sentinel is removed, examined, and found to be negative (no cancer found), the chance of finding cancer in any of the remaining nodes is small and no other nodes need to be removed. This spares many women the need for a more extensive operation and greatly decreases the risk of side effects.

Axillary lymph node dissection
A more extensive lymph node surgery where 10-20 lymph nodes are removed from the axilla (underarm). This is indicated in women who have obvious bulky lymph nodes identified either pre-operatively or during surgery. It may also be performed in certain cases where the sentinel node is found to have cancer at the time of surgery. Side effects of axillary lymph node dissection include numbness, hypersensitivity to touch, discomfort, limited range of motion, and arm swelling (lymphedema).

For information on the different types of breast surgery, please click HERE

For information on breast reconstruction, please click HERE


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