NHS Foundation Trust Breast Sentinel Lymph Node Biopsy www.mcht.nhs.uk
What is Sentinel Lymph Node Biopsy? Sentinel Lymph Node Biopsy is an operation to remove the first lymph gland or glands under the arm, that are responsible for draining the particular area of the breast involved by a tumour. This gland is then analysed by a Pathologist to determine whether there are tumour cells in it. The presence or absence of tumour cells within the sentinel lymph node is an accurate indicator of the presence or absence of tumour under the arm. Sentinel Lymph Node Biopsy is a relatively new procedure, however, many thousands of cases have been done throughout the world. Sentinel Lymph Node Biopsy is still being carefully studied by many scientists and doctors. What are Lymph Glands/Nodes? The lymphatic system is a system of lymph vessels and lymph glands throughout the body, which play an important role in your body s mechanism of fighting infections and tumours. Lymph is the name given to fluid that drains through the lymph glands. The main lymph glands responsible for the breast lie mainly within the armpit, but occasionally may be within the chest or neck. Why is it so important to know whether tumour cells are present in the gland(s) under the arm? The presence of tumour cells in the gland(s) under the arm may suggest that the breast cancer could put you at risk of spread of the disease elsewhere in your body. This is known as metastatic disease. Hence very important decisions regarding the overall treatment of your breast cancer are made, based on whether the lymph glands contain tumour cells. This treatment may involve further surgery, radiotherapy, hormone treatment, chemotherapy or a combination of these treatments.
How do you identify the sentinel lymph nodes? We use one or both of the following methods to identify the sentinel lymph nodes: 1. Radio Isotope Injection: This is usually done the day before your operation within the Nuclear Medicine Department at Royal Stoke University Hospital. A small amount of radioactive fluid is injected into the breast. This fluid is carried into the armpit by the lymph and trapped in the sentinel lymph node. During your operation a hand held gamma probe is moved over the skin and guides your surgeon to the lymph glands, which have radioactive material in them. 2. Blue Dye Injection: This is injected once you are asleep in theatre. This dye stains the sentinel lymph node or nodes blue, thereby assisting the surgeon to find the correct lymph node. The blue dye can have some side effects but these are rare. The side effects are: The blue dye may be visible around your scar following surgery but this usually disappears over the following weeks or months. The blue dye can initially make your urine and your stools appear blue in colour, but this will settle. Urticaria (skin reactions) After your operation your skin colour may appear a very pale colour sometimes with a tinge of blue. This is nothing to be alarmed about and usually settles within 24 hours. In very rare instances an anaphylaxis allergic reaction can occur. If this was to occur the doctors would prescribe medication to counteract this reaction. Patients who are known to be allergic to blue food dye and pregnant ladies should NOT have this injection, but can have the radioactive injection. Please tell your surgeon or Macmillan Breast Care Nurse if this applies to you. 3
What is the advantage of Sentinel Lymph Node Biopsy? Sentinel Lymph Node Biopsy is an accurate way of determining the stage of your disease. It is a significantly smaller operation than Axillary Lymph Node Dissection resulting usually in a small scar, less pain, more rapid recovery and fewer long-term side effects. What will happen if my Sentinel Lymph Node contains tumour? You will require further treatment to your armpit, either a second operation to remove all the lymph glands, or radiotherapy treatment. Your doctor will discuss this with you. Does Sentinel Lymph Node Biopsy affect whether I have a lumpectomy or a mastectomy? No having Sentinel Lymph Node Biopsy will not affect whether your tumour is suitable for lumpectomy (wide local excision) or mastectomy. Is the radioactive dye harmful? No the dose of radiation used in Sentinel Lymph Node Biopsy is very low, being similar to that of having a mammogram. How long will it take to get the results from my Sentinel Lymph Node Biopsy? When the sentinel lymph nodes are removed, they are analysed by the Pathologist under the microscope. Usually a result will be obtained within 2 weeks of the operation. When you are discharged from hospital you will be given an appointment to come back to the out patient clinic to discuss the results of your operation with your surgeon. Can Sentinel Lymph Node Biopsy be unsuccessful? Yes. In less than 5% (one in twenty) patients, the sentinel lymph node cannot be identified. If this should occur your surgeon will perform an axillary sample of the lymph glands. 4
What if I decide that I do not want to undergo Sentinel Lymph Node Biopsy? The decision to undergo Sentinel Lymph Node Biopsy is entirely up to you. If you decide you do not want to have this procedure let the team that are looking after you know as soon as possible. This is so that the alternatives can be explained to you and alternative arrangements can be made. Prior to your operation You will be asked to sign a consent form for Sentinel Lymph Node Biopsy and your operation. The day before your operation a hospital taxi will collect you from the Macmillan Unit at Leighton Hospital and take you to Royal Stoke University Hospital to have the Isotope injection. You will be informed by letter of the time to arrive at Leighton Hospital. Transport will be arranged to bring you back to Leighton Hospital. After the procedure you will be able to go home. If you prefer to travel in your own transport to Royal Stoke University Hospital, please inform your Macmillan Breast Care Nurse. Please arrange your own transport to take you home from Leighton Hospital. If you feel well enough you can drive yourself. General Information Seroma The most common thing to happen is that the fluid continues to collect under the wound.this can be uncomfortable but it is not dangerous. If you have a build up of fluid please contact your Macmillan Breast Care Nurse who can remove this quite easily in clinic using a needle and syringe. Numbness or pain Your armpit can sometimes be quite uncomfortable following surgery. Shooting pains, burning sensations, and other sensations may occur. This is due to the irritation of the nerves and will settle down. If you are concerned, please contact your Macmillan Breast Care Nurse. You will be given regular pain relief whilst you are on the ward and you will be given pain relief tablets to take home with you. 5
Frozen shoulder This is a painful condition and it is very difficult to move your arm. You should take your painkillers regularly and do the exercises as shown in your exercise leaflet or by the physiotherapist to avoid this happening to you. If you have any concerns about your arm movements you should contact your Macmillan Breast Care Nurse. Infection Infection is uncommon, but can happen after any operation. If your wound becomes red and inflamed, becomes increasingly painful, or you have a temperature you should see your GP that day. If this happens during out of hours, please contact your GP Out of Hours Service. Please also inform your Macmillan Breast Care Nurse as soon as possible. Lymphoedema Lymphoedema is swelling of the arm. Lymph is a colourless liquid, which forms in the tissues in the body. Under normal circumstances, it drains back into the blood stream through the lymphatic system, a network of lymph vessels and lymph nodes. If the lymph nodes are damaged, by surgery or radiation to that area, you may be at risk of developing lymphoedema. It is possible that this could occur months or even years after your initial treatment. If you notice any swelling or heaviness of your arm or swelling of the area around your breast, please contact your Macmillan Breast Care Nurse who can offer the appropriate advice. You will be invited to a lymphoedema education session, usually about 6 weeks after your surgery where further information and advice will be given to you. General Advice Wash and pat dry the affected arm. Apply cream daily to your arm. Any non-perfumed cream or lotion that suits your skin is acceptable for example E45. Apply the cream starting at the top of your arm in an upward, gentle stroking movement gradually working your way down the arm to the fingertips. Lastly, 6
stroke the arm from the shoulder to the fingertips in one movement, which will allow the hairs on your arm to return to their natural position. Be more cautious and try to prevent cuts, scratches and grazes to the arm. Apply antiseptic lotions to any cuts or scratches. Use gloves for heavy household jobs and gardening. Don t get sunburnt. You are advised to use a high factor sun cream or to wear long sleeves to cover up. Take care when cutting your nails. Avoid blood samples, injections and blood pressures on that arm. Use insect repellent when outside or when travelling to hot climates. If you feel you have an infection in your arm please see you GP as antibiotics may be required. Use a depilatory cream to remove hair from the armpit, but always do a patch test first to ensure you are not allergic to the cream. Electric razors can also be used, but wet shaving, waxing or an epilator is not advised as potential cuts can introduce infection. Don t overdo heavy arm exercises. Always increase intensity and volume of arm exercises slowly and gradually. Swimming is an excellent activity as water supports your arm and will help promote drainage of fluid. Yoga and Tai Chi are forms of gentle controlled exercise, which may help. Flying If you are flying it may be sensible to wear a light compression sleeve on your arm for the flight. You can obtain a flight sleeve by completing the referral form which will be given to you at the lymphoedema education session, or speak to your Macmillan Breast Care Nurse who will advise you. Please note that you will have to pay for this sleeve. What if I have further questions about Sentinel Lymph Node Biopsy? Please do not hesitate to contact your Macmillan Breast Care Nurse if you have any concerns or questions. 7
Useful contacts Your Consultants secretary s telephone number Direct Line: 01270 612064 Macmillan Breast Care Nurses Direct Line: 01270 612130 Breakthrough Breast Cancer Tel: 0207 025 2400 www.breakthrough.org.uk Macmillan Cancer Support Macmillan Cancerline: 0808 808 2020 www.macmillan.org.uk NHS Choices www.nhs.uk Breast Cancer Care Helpline: 0808 800 6000 www.breastcancercare.org.uk Nuclear Medicine Department - Within the X-ray Department Lower Ground One, Main Building Royal Stoke University Hospital Newcastle Road, Stoke-On-Trent, ST4 6QG Direct Line: 01782 675912 This leaflet is available in audio, large print, Braille and other languages. To request a copy, please speak to your Macmillan Breast Care Nurse. This leaflet has been reviewed by the Readers Panel July 2008 Macmillan Information and Support Manager Leighton Hospital Direct Line: 01270 273606 E-mail: macmillaninfo-support@mcht.nhs.uk Printed on paper sourced from sustainable forests. IMPRESSIONS DESIGN & PRINT 01270 767661 Revised and reprinted November 2014 Review November 2016 Ref: SC/MBCNS/0111114