Lymph Node Dissection in Breast Cancer

Results set the stage for the creation of your treatment plan

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Sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) are procedures done to sample the cells in lymph nodes so they can be examined for the presence of cancer. Often used to evaluate breast cancer, this may be done during breast surgery or as a separate procedure.

Cancer cells in the lymph nodes near your breast and arm have the potential to spread (metastasize) to other areas of your body, increasing your risk of metastatic breast cancer. Lymph nodes contain immune cells and immune proteins, and they are present throughout your body.

Sentinel Lymph Node Biopsy (SLNB)

what to expect during a sentinel node biopsy
 Verywell / Emily Roberts

This is a diagnostic procedure that's often done as part of breast cancer staging to determine whether cancer has spread to your lymph nodes.SLNBs may be done on an outpatient basis or may require a short stay in the hospital.

Before this procedure, a blue dye that's bound to a weak radioactive agent is injected into the breast tumor. With imaging assistance, the dye and radioactive substance can be detected. The first node that exhibits evidence of dye is called the sentinel node; this is the lymph node that cancer cells are most likely to reach first.

Once the sentinel lymph node is identified, your surgeon will make a small incision to remove the node. A pathologist will examine this tissue under a microscope to look for the presence of cancer cells. If cancer is found, your surgeon may remove additional lymph nodes, either during the same biopsy procedure or during a follow-up surgical procedure.

Axillary Lymph Node Dissection (ALND)

If cancer is found during your sentinel node biopsy, your surgeon may remove some or all of your axillary lymph nodes—those in the area of your armpit—for additional testing.

ALND may be done as part of a lumpectomy or mastectomy. As few as 10 or as many as 40 lymph nodes may be removed. These will be sent to the pathology lab where they will be carefully examined for cancer cells.

Your pathology report will detail how many nodes were removed and which of them, if any, contained cancer cells. This important information affects the staging of your cancer and influences your treatment options.

Side Effects

The most common side effect of a lymph node dissection is lymphedema, in which the arm swells, sometimes significantly. Since you'll have fewer lymph nodes under your arm to process lymphatic fluid, the fluid may build up and cause swelling along your arm, and sometimes your hand.

If just a few nodes are removed, there's a lower risk of lymphedema. Sometimes the condition is temporary, but it can be a long-lasting problem. Therapeutic massage and compression garments can help.

Other side effects of lymph node removal may include:

  • Loss of sensation/numbness in the breast or axilla due to procedure-related nerve damage
  • Limited arm mobility
  • Muscle weakness
  • Reduced arm and shoulder range of motion

Women are typically advised to avoid lifting heavy objects and unnecessarily straining the area for up to six weeks after surgery. Light lymphedema exercises, however, may be recommended to help reduce swelling.

Participating in physical therapy may help you regain your motion and strength.

How Lymph Node Status Affects Treatment

Based on the number of positive nodes, your lymph node involvement will be given a rating from N0 to N3. This rating is an important part of your complete diagnosis, as well as what treatments will be considered.

Understanding Lymph Node Status
Lymph Node Rating Definition
N0 Negative, or clean: Nodes contain no cancer or micrometastases.
N1 Positive: Cancer is found in 1 to 3 lymph nodes under the arm or in the breast.
N2 Positive: Cancer is found in 4 to 9 lymph nodes under the arm or in the breast.
N3 Positive: Cancer is found in 10 or more lymph nodes under the arm or has spread under or over the collarbone. It may have been found in the underarm nodes as well as lymph nodes within the breast.

Clear nodes and a small tumor may not require further treatment with chemotherapy or radiation because the chance of metastasis is low, while a larger tumor and/or positive nodes may be followed up with chemotherapy, radiation, or both.

A Word From Verywell

Always check your underarm area during your monthly breast self-exam to keep tabs on your axillary lymph nodes. Swollen axillary lymph nodes can be a sign of breast cancer.

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