Checking the lymph nodes for breast cancer in women
Your surgeon may remove some or all of the lymph nodes in your armpit to check them for cancer cells.
This serves two purposes:
It gets rid of any cancerous lymph nodes (you may need more treatment if only some nodes were removed).
It gives information about the stage of the cancer, which helps when making decisions about having other treatments.
There are different types of lymph node surgery.
Sentinel lymph node biopsy (SLNB)
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This may be done if you had a small cancer and the ultrasound of your armpit was normal. SLNB isn’t suitable for everyone – your surgeon will explain if it’s an option for you.
A sentinel lymph node biopsy is a way of checking the smallest possible number of lymph nodes (usually 1–3) in the armpit to see if they contain cancer cells. The sentinel nodes are the first ones that lymph fluid drains to from the breast, so they are the most likely to contain any cancer cells. If the sentinel nodes don’t contain cancer cells, you won’t need surgery to remove more lymph nodes.
Removing only the sentinel lymph nodes reduces the risk of side effects that can occur after lymph node surgery. These include swelling of the arm known as lymphoedema and stiffness of the arm.
How an SLNB is done
The doctor injects a tiny amount of radioactive liquid, which is harmless, into your breast, usually around the nipple. You have this done on the day of surgery or sometimes the day before. During the operation, the surgeon also injects a blue dye into your breast, which stains the lymph nodes blue. The sentinel lymph nodes absorb the radioactivity or become blue first.
The surgeon uses a small handheld instrument to find the lymph nodes that have picked up the radioactivity. They only remove the blue or radioactive nodes (sentinel nodes), which are tested to see if they contain cancer cells.
Removing some lymph nodes (sampling)
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Sometimes the surgeon removes four or more lymph nodes in the armpit. This is called sampling. You may have it done with a blue dye injection (see SLNB above).
If any nodes from the SLNB or sampling contain cancer cells, you will usually have another operation to remove the remaining lymph nodes. Some women have radiotherapy to the rest of the lymph nodes instead of more surgery.
Removing all the lymph nodes
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In some cases, the surgeon will want to remove all the lymph nodes in the armpit. This is called an axillary lymph node dissection (ALND). It gets rid of any nodes that contain cancer cells. If you have an ALND, you won’t need radiotherapy to the nodes afterwards.
An ALND is usually done when:
the lymph node ultrasound is abnormal
the fine needle aspiration (FNA) of the lymph nodes is positive
the SLNB or sampling shows there are cancer cells in the nodes.
There’s an increased risk of developing swelling of the arm called lymphoedema after having an ALND.