Managing Lymph Nodes

If you have an invasive breast cancer your surgeon will discuss with you lymph node surgery which usually involves removing one or more of the lymph nodes from under the armpit (or axilla).  If the cancer has started to spread away from the breast it is most likely to have moved through the lymphatic system to an axillary lymph node or nodes.

When we have evidence before surgery that the cancer has spread to a lymph node you are likely to be advised to have an axillary dissection (or clearance) of the lymph nodes, which will remove the diseased nodes and give your specialists more information that can help in later treatment. This is a bigger operation and will usually result in having a drain tube in after surgery to remove any fluid build-up, and can lead to post-operative problems with numbness, discomfort in the armpit and the risk of developing long-term swelling of the arm (lymphoedema).

If there is nothing abnormal about the lymph nodes prior to surgery then your surgeon is likely to advise you to have a sentinel node biopsy at the same time as the cancer is removed. A sentinel node biopsy involves using some dye injections on the day of surgery to identify the first lymph node (sometimes there is more than one) that the breast filters through, and then removing that node or nodes to have them thoroughly checked by the pathologist to see if any microscopic cancer cells have spread to them. It is a very accurate technique and is unlikely to cause any of the post-operative problems that can potentially occur after axillary lymph node dissection.

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