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Axillary Lymph Node Dissection - Types of Surgery and Effect on Treatment Plans

Your Lymph Node Status and Cancer Staging

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Updated May 12, 2009

Axillary Lymph Nodes

Axillary Lymph Nodes and Breast Tissue

Illustration © A.D.A.M.
A breast tumor can shed cancer cells into your lymph system. Those cells may get trapped in nearby lymph nodes, usually your axillary nodes. Your surgeon may remove some lymph nodes so they can be examined under a microscope. If cancer cells are present in your lymph nodes, your risk for metastatic breast cancer rises. The procedure for underarm lymph node removal is called axillary lymph node dissection.

Axillary Lymph Node Dissection (ALND)

Axillary lymph node dissection may be done as part of a lumpectomy or mastectomy. Your surgeon may remove a small group of nodes or all of the nodes in your axilla. These will be sent to the pathology lab where they will be carefully examined for cancer cells. You will need to know if your lymph nodes are negative (clear of cancer) or positive (contain cancer). This important information affects the staging of your cancer and influences your treatment options.

Importance of Lymph Nodes

Although lymph nodes are present in groups throughout your body, your axillary nodes are the most likely location to which breast cancer cells may travel. Lymph nodes work as filters where bacteria, viruses or cancer cells are caught. When cancer cells are present in your nodes it means that the disease has gained the ability to leave your breast and travel to other parts of your body.

If cancer cells do lodge in a lymph node, it may swell. You should always check your underarm area during your monthly breast self-exam to keep tabs on your axillary lymph nodes.

Types of Lymph Node Dissection

Lymph nodes may be removed as part of breast surgery, or as a separate procedure. Here are different types of lymph node dissection surgeries:
  • Sentinel Lymph Node Biopsy (SLNB): This is a diagnostic procedure done to remove a small sample of lymph nodes to which the cancer may be draining. These sentinel nodes are thought to be the first nodes to which cancer cells must travel before going any further. A blue dye and a weak radioactive agent will be used to help your surgeon locate the specific nodes. This procedure removes the least number of lymph nodes.

  • Axillary Lymph Node Dissection (ALND): This procedure is usually done as part of a radical or modified radical mastectomy or a lumpectomy. As few as 10 or as many as 40 lymph nodes may be removed for testing.

  • Full Axillary Lymph Node Dissection:
    If cancer is found during your sentinel node or axillary node biopsy, your surgeon may go ahead and remove all of your axillary lymph nodes, so that all of the nodes can be examined for possible metastasis.

Risks and Side Effects of Axillary Lymph Node Dissection

The most common side effect of a lymph node dissection is lymphedema (swelling of the arm). Since, after surgery, you 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, lymphedema may be a temporary condition, but if most of your lymph nodes were removed, it may be a long lasting problem.

Therapeutic massage and pressure garments can help with lymphedema. Your axillary skin may be numb or less sensitive to touch after surgery, because nerves may have been damaged during the procedure. Arm and shoulder range of motion may be affected, so be sure to ask for physical therapy to help regain your motion and strength.

Lymph Node Status Affects Treatment

Axillary lymph node dissection is an important part of your complete diagnosis and staging. Clear nodes and a small tumor will require less treatment because the chances of metastasis are low. However, it's important to know how many nodes are involved with cancer, so more tests can be done to determine if and where the cancer may have spread. This information impacts your treatment options and helps you and your doctor choose the most effective treatment plan for you.

Sources:
Detailed Guide: Breast Cancer in Men – Surgery. Last Revised: 09/24/2008. American Cancer Society.

Node retrieval in axillary lymph node dissections: recommendations for minimum numbers to be confident about node negative status. J. E. A. Somner, J. M. J. Dixon, and J. S. J. Thomas. J Clin Pathol. 2004 August; 57(8): 845–848.

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