Surgery for breast cancer always involves removal of the tumour and a procedure to the axillary lymph nodes (the lymph glands under the arm).
In the situation where the lymph glands are shown to contain cancer cells before the operation (positive axillary lymph nodes), the patient will undergo an axillary lymph node dissection at the time of surgery to remove the breast cancer.
The axillary lymph glands are the most likely location to which the breast cancer cells may travel. Lymph nodes are used to filter bacteria and viruses and are places where cancers are caught. If cancer cells are found in the lymph nodes, it means that the disease has gained the ability to leave the breast and travel to other parts of the body. Cancer cells do lodge in the lymph gland. This may cause a lump under the arm and therefore it is important when patients are examining their breasts that they always include the armpits in their examination. The number of lymph nodes that are removed at the time of surgery varies from patient to patient. There may be as few as 10 lymph nodes or as many as 40 lymph nodes. The axillary lymph node dissection is performed in order to adequately stage the patient’s cancer.
Small cancers and cancers with clear nodes (negative lymph nodes) will require less postoperative treatment than those that have multiple nodes involved and are associated with large breast cancers.Thus the number of nodes involved will impact on what additional treatment is required postoperatively. The results of the axillary lymph node dissection will have implications for whether or not chemotherapy or radiotherapy is required and the type and duration of the chemotherapy regime and the site and duration of the radiotherapy.
Complications of an Axillary Lymph Node Dissection
It can be associated with lymphoedema (swelling of the arm). This may be a temporary or permanent problem. There may be also some loss of sensation to the side wall of the chest or to the upper limb. There may be some restriction in arm and shoulder range of motion and it may be associated with post operative infection and bleeding. There are also specific nerves in the axilla ( the thoracodorsal nerve and the long thoracic nerve) which can affect movement of the upper limb and shoulder and every attempt is made to ensure that they are not damaged during the axillary lymph node dissection. Patients who have had an axillary lymph node dissection will be referred for postoperative physiotherapy and ladies who have post operative lymphoedema may be required to wear a pressure garment or have some therapeutic massage.
Patients that have an axillary lymph node dissection will usually have a drain tube inserted at the time of surgery which will be removed a few days after the operation. The procedure is performed under a general anaesthetic and an overnight stay is required. A small incision is placed under the armpit in order to remove the lymph glands. In some circumstances patients who have positive sentinel lymph nodes ( cancer cells in the sentinel lymph nodes) will be required to return to the operating theatre to have an axillary lymph node dissection.