Not All Women Should Undergo Axillary Lymph Node Surgery

The lymph nodes function as filters for the body’s lymphatic drainage system. As a result, the lymph nodes are likely to collect or filter out cancer cells that may be floating among the fluid that is draining from the cancerous area of the breast.

If the pathologist detects cancer cells in the sentinel node, it likely means that the cancer cells have spread beyond the breast region. Until only recently, physicians believed that additional treatment was necessary to lower the risk of cancer returning, including the removal of other underarm lymph nodes; a procedure known as axillary node surgery.

However prior research has demonstrated that women have received a diagnosis with early-stage breast cancer with only one or two several nodes that have lumpectomy and radiation do have similar outcomes when compared to women who undergo the full axillary node surgery.

Now the American Society of Clinical Oncology (ASCO) has released new guidelines on the use of sentinel node biopsy for individuals diagnosed with early-breast cancer. The new rules were published in the Journal of Clinical Oncology.

Previous ASCO guidelines from 2005 recommended that anyone receiving an early-breast cancer diagnosis with one or more positive sentinel lymph nodes undergo axillary node surgery.

The new guidelines are more specific and explain when and if women should receive axillary node surgery.  The guidelines state that women with no positive sentinel node biopsies should undergo axillary node surgery. In addition, women who have one or two positive sentinel nodes who also intend to receive lumpectomy with radiation also do not need to undergo axillary node surgery. Only women who intend to undergo mastectomy without radiation should receive axillary node surgery.

One of the advantages of only receiving sentinel node biopsy and not axillary node surgery is a greatly reduced risk of lymphedema. This condition causes the accumulation of lymph fluid in the soft tissues of the body, most commonly in the arm and hand in women who have received breast cancer surgery. Other areas where lymphedema can occur includes the breast, underarm, chest, trunk, and back. The effects of the condition can lead to swelling, arm weakness and numbness, in addition to shoulder pain.

However, there are things you can do to alleviate lymphedema symptoms. Therapeutic massage and pressure wraps can offer some relief. Your axillary skin may be numb or less sensitive to touch following surgery due to the nerves in the region being damage during the operation. Your arm and shoulder range of motion could also be impacted, so it’s important to ask for physical therapy to help you make a full recovery.

Axillary lymph node surgery may be a necessary part of your complete cancer diagnosis and staging. Having sentinel nodes clear of cancer and a smaller tumor size will require less treatment because the risks of metastasis are low.

However, it’s critical to understand how many nodes are involved with cancer so additional testing can determine if and where the cancer may have spread to. This information is crucial for a doctor to determine your best treatment options and planning the right course of course of action for you.

Written by Stuart Diamond, Empowered Doctor Editor-In-Chief