Checking the lymph nodes
Your surgeon may remove some or all the lymph nodes in your armpit to check if there are any cancer cells there. This provides more information about the stage of the cancer and helps your cancer specialist decide if you need further treatment to reduce the risk of the cancer coming back.
There are different ways of checking and removing the lymph nodes:
If the cancer is small and the ultrasound of the armpit was normal, you’ll usually have a procedure to check the lymph nodes called a sentinel lymph node biopsy (see below).
If the ultrasound or fine needle aspiration (FNA) are positive or if there’s a high risk the cancer has spread to the lymph nodes, you may have all the lymph nodes removed. This is called an axillary lymph node dissection (ALND).
Sentinel lymph node biopsy (SLNB)
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The sentinel node or nodes (there may be more than one) is the first node that lymph fluid from the breast drains to. So, if any cancer cells have spread, they’ll most likely to go to the sentinel node. An SLNB involves finding the sentinel node, removing it and then testing it for cancer cells. SLNB isn’t suitable for everyone - your surgeon will explain if it’s an option for you.
If the sentinel node or nodes don’t contain cancer cells, you won’t need surgery to remove more lymph nodes.
SLNB reduces the risk of side effects, such as arm stiffness and swelling (lymphoedema) of the arm, which you can get after surgery to the lymph nodes.
How it’s done
A tiny amount of radioactive liquid is injected into the area around the nipple before the operation. During the operation, a blue dye is injected close to the area of the cancer. After a few minutes the dye drains into the lymph nodes. The surgeon uses a scanner to find the lymph node or nodes containing the radioactive substance, and looks for the ones that are stained blue. The nodes that become blue or radioactive first are the sentinel nodes. Your surgeon removes these through a small cut in the skin (incision). They are then examined under a microscope by a pathologist to see if they contain cancer cells.
If any of the nodes contain cancer cells, you’ll need an operation to remove all the lymph nodes (axillary lymph node dissection). Some women may have radiotherapy to the lymph nodes instead of surgery.
Removing some of the lymph nodes (sampling)
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Sometimes four or more lymph nodes in the armpit are removed. This is called sampling and you may have it done with a blue dye injection (see above). If any nodes contain cancer cells you’ll need another operation to remove all the lymph nodes (see ALND below). Some women may have radiotherapy to the lymph nodes instead of surgery.
Axillary lymph node dissection (ALND)
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This procedure involves removing all the lymph nodes in the armpit. It provides information about the stage of the cancer and treats the area by removing lymph nodes that contain cancer cells. You won’t need radiotherapy to the nodes afterwards.
It’s usually done when:
the ultrasound of the lymph nodes is abnormal
fine needle aspiration (FNA) of the lymph nodes is positive
the sentinel node biopsy or sampling shows there are cancer cells in the nodes.
There’s an increased risk of developing swelling of the arm called lymphoedema after ALND. You can read more in our section on lymphoedema and taking care of your arm.