Breast Lumpectomy and Sentinel Lymph Node Biopsy

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1 Breast Lumpectomy and Sentinel Lymph Node Biopsy Introduction Breast cancer is a common condition that affects millions of women every year. It usually shows up as a lump that can be felt and/or seen on mammography. Your doctor may recommend surgery to remove it and to test some of the surrounding lymph nodes. This is called a breast lumpectomy and sentinel lymph node biopsy. The decision whether or not to have this surgery is yours. This reference summary will help you better understand breast lumpectomy and sentinel lymph node biopsy. The summary explains the anatomy of the breast, lists alternative treatments, explains its benefits and risks, and what to expect after the procedure. Anatomy The breast has glands responsible for making, storing, and delivering milk. Breast milk is made and stored in the glands inside the breast tissue. From the glands, milk flows through special ducts to the outside, passing through the nipple area. A duct is a tube-like passageway through which substances move. Pectoralis Major The breast rests on a chest muscle called the pectoralis major. All the nerves going to the arm pass through the axilla, or armpit region. Important arteries and veins also pass through the axilla. Lymph Nodes Breast Glands Axillia Region Lymph, a nearly clear fluid produced by the body, drains waste from cells. It travels through the lymphatic system which is made up of channels and bean-shaped structures called lymph nodes. The lymphatic system drains excess fluids and waste. 1

2 The underarm area contains many lymph nodes. The lymph nodes in this area are specialized structures that allow lymph to drain away from the breast area and the arm back to the blood stream. Lymph nodes play an important role in fighting infection. But breast cancer could spread to other parts of the body through lymph nodes and lymph channels. Alternative Treatments If a breast lump is cancerous, the treatment includes one or more of the following: 1. Surgery 2. Radiation therapy: Radiation is a form of energy released in particles or waves. In high doses, radiation destroys cells or keeps them from multiplying. Radiation therapy is a cancer treatment. Its goal is to kill cancer cells and shrink tumors. However, it can also harm healthy cells, which causes side effects. 3. Chemotherapy: Chemotherapy is a drug therapy that can stop cancer cells from multiplying. However, it can also harm healthy cells, which causes side effects. 4. Hormonal therapy: Hormonal therapy is the use of hormones to treat cancer. Examples of breast cancer surgery include: Lumpectomy: Lumpectomy is a surgery to remove the cancerous lump and a small amount of normal tissue around it. Total mastectomy: Total mastectomy is the removal of all the breast tissue along with the nipple. Radical mastectomy: Radical mastectomy is the removal of the breast, lymph nodes, and chest muscles. This is no longer common. Modified radical mastectomy: Modified radical mastectomy is the removal of the breast, most of the lymph nodes under the arm, and often the lining over the chest muscles. Which treatment your doctor recommends depends on the type of cancer you have as well as your age and condition. Your doctor will help you figure out the best treatment for you. This program explains the benefits and risks of lumpectomy and sentinel lymph node biopsy. Surgical Treatment The operation to remove breast lumps, as well as test and remove affected lymph nodes, is known as lumpectomy and sentinel lymph node biopsy. 2

3 Its purpose is to: 1. Take out the cancerous lesion 2. See if the cancer has spread to the underarm lymph nodes. First the breast cancer is surgically taken out with some healthy breast tissue surrounding it. This is known as lumpectomy. Normally there are about a dozen lymph nodes in the armpit. Because the lymph nodes in the armpit also help drain lymph from the arm, taking out all these lymph nodes could lead to long-term swelling of the arm, known as lymphedema. In order to prevent this complication, surgeons try to remove the fewest number of lymph nodes possible and check them for cancer. Doctors use a procedure called lymph node mapping technique to decide which lymph nodes need to be taken out. Before the operation a dye is injected in the area of the tumor. The dye moves through the lymphatic system to the lymph nodes of the underarm. The first lymph node or lymph nodes to pick up the dye are known as sentinel lymph nodes. If the cancer has spread to the lymph nodes, the sentinel nodes are more likely than other lymph nodes to have cancer. Two types of dyes can be used. One is a radioactive material (not harmful), usually injected by a radiologist in the area of the tumor a few hours before the surgery. The other dye is a blue dye, usually injected by the surgeon 10 minutes or so before the operation. A radioactivity detector is used if radioactive dye was injected to identify the sentinel nodes. If your doctor used the non-radioactive blue dye, he or she will visually find the sentinel nodes. Radioactivity detector The sentinel nodes are taken out during surgery. They are sent to a pathologist who looks at them under the microscope while you are still under general anesthesia. If cancer is found in the sample, the surgeon will remove some of the remaining lymph nodes. Your doctor will probably place a drain that may stay in place for a week or more if additional lymph nodes are removed 3

4 Risks and Complications This surgery is very safe. There are, however, several possible risks and complications. These are unlikely, but possible. You need to know about them just in case they happen. By being informed you may be able to help your doctor detect complications early. The risks and complications include those related to anesthesia and those related to any type of surgery. Risks of general anesthesia include nausea, vomiting, urinary retention, cut lips, chipped teeth, sore throat, and headache. More serious risks of general anesthesia include heart attacks, strokes, and pneumonia. Your anesthesiologist will discuss these risks with you and ask if you are allergic to certain medications. Blood clots in the legs can occur due to inactivity during and after the surgery. These usually show up a few days after surgery. They cause the leg to swell and hurt. Blood clots can become dislodged from the leg and go to the lungs where they will cause shortness of breath, chest pain and possibly death. It is extremely important to let your doctors know if any of these symptoms occur. Sometimes the shortness of breath can happen without warning. Getting out of bed shortly after surgery may help decrease the risk of blood clots in the legs. Some of the risks are seen in any type of surgery. These include: 1. Infection, deep or at the skin level. Treating deep infections may require longterm antibiotics and possibly surgery. 2. Bleeding, either during or after the operation. This may require a blood transfusion or another operation. 3. Fluid may collect under the skin, which is known as seroma. This fluid may need to be taken out with a needle or another operation. A seroma could cause the incision to open up. 4. Skin scar that may be painful or unsightly. Other risks and complications are related specifically to this surgery. These again are very rare. However, it is important to know about them. The more extensive the surgery, the higher the risks. The risks are still rare. 4

5 Even the simplest operation may change the way the breast looks. Nerves running through the axilla may be injured causing shoulder or arm weakness, loss of sensation, or arm pain. This is rare. The arteries and veins running through the axilla may also be injured. More surgeries may be needed to take care of such injuries. When underarm lymph nodes are removed, the arm on the side of the operation may swell. Occasionally the use of an elastic arm stocking, or other methods, might be needed to reduce the swelling. This swelling is also known as lymphedema. After the operation, some patients feel down because of the diagnosis and because of the disfigurement. Even though this is normal, you should let your doctor know about these feelings. Counseling, support groups and breast reconstruction is available and may be helpful. After the Surgery After the operation is done, you will be moved to the recovery room and then to a regular room. You may go home the same day or in a few days, depending on how extensive the operation was and how you are doing. Depending on the pathology reports from the surgery as well as other tests, further treatment may be needed. This could include: 1. Radiation therapy 2. Chemotherapy 3. Hormonal therapy Make sure to call your doctor if you get any new symptoms, such as a fever, wound drainage, severe pain, weakness, swelling, or infection. 5

6 Summary Breast cancer is a common condition that affects about eleven percent of women. Doctors may recommend surgery to remove breast cancer. They may also recommend removing and testing the lymph nodes in the armpit area to make sure the cancer has not spread to them. An operation known as lumpectomy and sentinel lymph node biopsy may be recommended to: 1. Take out the cancerous lesion and 2. see if the cancer has spread to the underarm lymph nodes. Breast lumpectomy and sentinel lymph node biopsy is very safe. Risks and complications are very rare. Knowing about them may help you detect and get them treated early if they happen. 6