|Axillary Lymph Nodes, Close Up
Art © A.D.A.M.
Lymph node status is part of your breast cancer diagnosis - and many patients have had large numbers of nodes surgically removed - so these can be examined for the possible spread of cancer. Having the greater the number of lymph nodes removed via axillary lymph node dissection results in a swelling called arm lymphedema. But a new study shows that patients with early stage breast cancer - tumors less than 2 inches and lymph nodes that appear unaffected - can safely opt for sentinel node biopsy: the removal of only two or three lymph nodes.
This Phase 3 trial study was designed by The American College of Surgeons Oncology Group and was set at 115 different locations across America. Patients had similar diagnoses and treatments: lumpectomy, and whole-breast radiation. One group had axillary lymph node dissection and the other group had sentinel node biopsy. Patients in both groups had similar 5-year overall survival rates. The study concluded that Sentinel Node Biopsy is all that is needed for early stage breast cancer.
Axillary lymph node dissection (ALND) and arm lymphedema will not go away altogether. For breast cancer patients with tumors over two inches, or with swollen lymph nodes, the removal of extra lymph nodes will be needed to determine the risk of metastasis.
This news will change the way that breast surgeons and oncologists diagnose and treat early-stage breast cancer. While some surgeons already confine lymph node removal to a targeted 2 or 3 nodes, it has long been standard surgical practice to remove between 15 and 40 nodes - putting patients at higher risk for arm swelling. Women who have arm lymphedema must take special care of their arm for the rest of their lives - using compression garments, preventing cuts, even small burns, and sometimes requiring lymphatic massage to get relief. Now that more patients may be able to avoid the risk of arm lymphedema, dealing with breast cancer survival will become easier.
Source: Axillary Dissection vs No Axillary Dissection in Women With Invasive Breast Cancer and Sentinel Node Metastasis. Armando E. Giuliano, MD; Kelly K. Hunt, MD; et. al. JAMA. 2011;305(6):569-575.
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