Either of the surgery options is likely to include an axillary node dissection, in which some of the nodes under your arm are removed by your surgeon to be studied by the pathologists). The pathologist’s examination of these tissues gives information about the stage and prognosis of the breast cancer. This information is considered in making additional treatment decisions, such as chemotherapy and hormonal therapy and possible radiation treatments to the axilla (armpit) and breast or chest wall. Side effects of an axillary dissection vary among individual women, but may include discomfort, numbness, and/or swelling.
In order to minimize the surgery to be done in the axilla and to diminish possible, unpleasant physical changes, a less invasive surgery has been developed. This procedure is called selective lymph node dissection (SLND) and resection of the sentinel node. This smaller surgery has been offered in some hospitals for several years and has been found to provide all the same important information as the more invasive standard axillary node dissection does.
The sentinel node is the first draining node of a regional lymph node basin. For women with breast cancer, this is most commonly the axilla or underarm area. The theory is that the sentinel node is the first node where cancer cells would lodge if they have traveled through the lymphatics. By removing and testing a sentinel node for cancer cells, your medical team can determine if further surgery is necessary. This is done at the time of definitive surgery for breast cancer. There are two ways the sentinel node can be located. Some surgeons perform one technique or the other, and some use a combination of the two. The first technique uses a radioactive material called technetium (the same tracer used for bone scans), which is injected at the site of the breast tumor. The tracer is then taken up into the lymphatic channels and accumulates in the sentinel node. The surgeon then uses a handheld probe that detects signals from the tracer to locate and identify the node.
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