Breast Cancer: Lymph Node Biopsy or Node Dissection

In addition to removing the cancer through a mastectomy or lumpectomy, doctors need to know whether the cancer has spread beyond the breast. This is done by removing one or more lymph nodes from under the patient's arm on the same side to see if cancer has spread to the lymph nodes.

Lymph node biopsy and dissection has two main purposes. It removes the cancer that may have spread into the axilla (armpit). And it allows the surgeon to stage your cancer by learning how far the cancer has spread. There are two ways to remove and test lymph nodes:

• Axillary node dissection. This involves removing at least six to 10 or more of the lymph nodes under the arm. These nodes are then sent to the lab where they are checked for cancer. Axillary node dissection is very reliable but has a longer recovery and poses complications such as lymphedema (swelling of the arm) or nerve damage.
• Sentinel node biopsy. In this surgery, a special blue dye and/or a radioactive substance is first injected into the breast to determine which lymph nodes are the first to receive drainage from the breast. These nodes would potentially be the first to be invaded by cancer cells. One to three sentinel nodes are usually removed and tested for cancer. If cancerous, then all the lymph nodes are removed. This surgery has fewer complications than axillary node dissection, but the physicians performing the procedure must have special training. Sentinel node biopsy is newer than axillary node dissection, but it appears to be as accurate. Several major studies are under way to confirm this.

If an axillary node dissection was performed, a drain is placed under the arm to remove fluids that may accumulate and cause swelling and the wound is then closed. Patients stay in the hospital one to two nights or longer if reconstruction is done. Many women go home with the drain in place, but it is removed shortly afterward. Women can soon begin simple exercises taught by a physical therapist to relieve the muscle soreness and tightness common after mastectomy. Pain medication is taken as needed and some swelling is common. Additional exercises are possible once stitches are removed. Complete healing takes about six weeks.

Before surgery, print out these Questions to Ask so you can better understand your care

Also before surgery, your doctor should provide:

• Specific instructions to follow in the days before surgery.
• An overview of the surgical procedures.
• Information about recovery and follow-up care.

After surgery, watch for complications such as infection or lymphedema, swelling in your arm or hand. Call your doctor immediately if you see signs of swelling, a build-up of fluid, redness or other symptoms of infection.

Reviewed by Sonja Eva Singletary, MD, Professor of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center.