If breast cancer spreads, it usually first passes to the lymph nodes of the armpit. Sometimes, it may also spread to the lymph nodes near the collarbone or near the sternum. To know if the cancer has spread to your lymph nodes helps your doctors figure out the best way to treat your cancer. To help determine if the cancer has spread to the lymph nodes of the armpit, are extracted one or more lymph nodes and examined in the department of pathology. If the lymph nodes contain cancer cells, there is a greater likelihood that the cancer cells have also spread to other parts of the body. In these patients, in most cases, complete the surgery with a radical dissection of the axilla (excision of all lymph nodes in the armpit). The removal of the lymph nodes can be performed in different ways, depending on whether the lymph nodes are affected, the tumor size of breast and other factors.

BIOPSY OF A LYMPH NODE SUSPICIOUS

If any of the axillary lymph looks suspicious, it will be necessary to take a biopsy of these and examine them in search of cancer. This is done either by means of a fine needle aspiration (FNA) or a core needle biopsy.

TYPES OF SURGERY OF LYMPH NODES

Even if the axillary lymph nodes are not affected, you will still need to review them to see if they have cancer. This can be done in two different ways:

• Biopsy of the sentinel lymph node, which is the most common and least invasive.
• In some cases it may be necessary a radical dissection of the axilla.

The surgery of lymph nodes is often performed as part of the major surgery to remove the breast cancer, but in some cases it can be performed as a separate operation.

SENTINAL LYMPH NODE BIOPSY

In a sentinal lymph node biopsy, the surgeon finds and removes the first lymph nodes to which it is likely to spread a tumor (so-called sentinel lymph nodes). To do this, the surgeon injects a radioactive substance, a green dye and/or a blue dye in the tumor or around the areola. The lymph vessels carry these substances by the same way that it would probably take the cancer. The first lymph nodes to which you travel the dye or radioactive substance will be the sentinel lymph nodes.

Once you have injected the substance, the sentinel lymph nodes can be found using a special machine to detect radioactivity in the lymph nodes, or looking for the lymph nodes that have become blue. The most effective and secure way is to use both methods. The surgeon cuts through the skin over the area and removed the lymph nodes that contain the dye and/or radioactivity. A pathologist then examines closely the few lymph nodes excised in search of cancer cells. This is done during the surgery. Because there is the possibility that other nodes in the same area also have cancer if cancer is found in the sentinel lymph nodes, the surgeon may proceed with a full axillary dissection (radical dissection of axilla) to remove more lymph nodes while you are still on the operating table. If there are cancer cells in the lymph nodes at the time of the surgery, it will not be necessary to perform the more extensive operation (radical dissection of axilla). If it is subsequently found cancer in the lymph node (s) sentinel, the surgeon may recommend a radical dissection of axilla complete at a later time. However, studies have shown that, in some cases, it may be safe to leave behind the rest of the lymph nodes.

If there is no cancer in the lymph node (s) sentinel, it is very unlikely that the cancer has spread to other lymph nodes, so that you do not need any more surgeries of lymph nodes. The sentinel lymph node biopsy is often considered for women with breast cancer in initial stage and, in general, is not an option for women with inflammatory breast cancer.

RADICAL DISSECTION OF AXILLA

In this procedure, it is removed between 10 and 40 (although usually less than 20) lymph nodes of the armpit and reviewed to detect the spread of cancer. Usually done at the same time as a mastectomy or conservative surgery of the breast, but can be performed in a second operation.

• It is possible that you need a radical dissection of axilla:
• If a sentinel lymph node biopsy earlier showed that 3 or more of the lymph nodes of the armpits have cancer cells.
• If you can feel the lymph nodes of the axilla prior to surgery or can be seen on imaging tests and a biopsy shows cancer.
• If the cancer has grown large enough to extend outside of the lymph nodes
• If the sentinel lymph node biopsy is positive for cancer cells after being administered chemotherapy to shrink the tumor before surgery.

SIDE EFFECTS OF THE SURGERY OF LYMPH NODES

After the surgery, the lymph nodes, it is possible to be pain, swelling, bleeding, blood clots, and infection. Lymphedema as A possible long-term effect of the surgery of the lymph nodes is the swelling in the arm or the chest called lymphedema. Because any excess of fluid in the arms normally returns to the bloodstream through the lymphatic system, the removal of the lymph nodes sometimes blocks the drainage of the arm, which causes the fluid to accumulate. Lymphedema is less common after a sentinel lymph node biopsy. It is believed that the risk is between 5% to 17% in women who have a sentinel lymph node biopsy, and about 20% to 30% in women who have a radical dissection of the axilla. It may be more common if administered radiation after surgery or in obese women. Sometimes, the swelling only lasts for a few weeks and then disappears. But in some women, it lasts for a long time. If your arm is swollen, tight or painful after the surgery of the lymph nodes, be sure to inform your doctor against immediately. Limited movement of the arms and shoulders. You can also have limited movement in the arm and shoulder after surgery. This is more common after radical dissection of axilla that of a sentinel lymph node biopsy. Your doctor may recommend physical therapy to perform exercises that will help you to avoid permanent problems (frozen shoulder). Some women notice a similar structure to a string that starts under the arm and can extend toward the elbow. This is sometimes called syndrome of the membrane, axillary cord or lymphatic. It is more common after a radical dissection of axilla that of a sentinel lymph node biopsy. It is possible that the symptoms appear after weeks or even months after the surgery. It can cause pain and limit the movement of the arm and the shoulder. This often goes away without treatment, although some women may find it useful to physiotherapy. Numbness numbness of the skin in the upper and inner arm is a common side effect because the nerve that controls sensation here travels through the area of the lymph nodes.

The treatment of the axilla in breast cancer is essential to obtain adequate control of the disease. Advances in medicine have allowed us to get increasingly better results with less invasive treatments.