Breast Cancer

  • Medical Author:
    Jerry R. Balentine, DO, FACEP

    Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

Table of Contents

Quick GuideBreast Cancer Diagnosis and Treatment

Breast Cancer Diagnosis and Treatment

Should breast cancer patients have their lymph nodes removed?

Lymph nodes are small glandular structures that filter tissue fluids. They filter out and ultimately try to provide an immune response to particles and proteins that appear foreign to them. There are thousands of these nodes scattered in groups throughout the body. Each cluster is more or less responsible for the drainage of a particular region of the body.

The lymph nodes under the arm (axillary nodes) are the dominant drainage recipients from the breast. When cancer cells break free from a breast cancer, they may travel through the lymph tubes (vessels) to the lymph nodes. There, the cancer cells may establish a secondary growth site. The presence of cancer cells in the lymph nodes proves that cancer cells have traveled away from the primary breast tumor. Therefore, the presence or absence of cancer cells in these regional nodes is an important indicator of the future risk of recurrence. This information is often important in making decisions about whether to use chemotherapy and what type of chemotherapy should be employed.

Unfortunately, removal of the lymph nodes also carries a potential risk of lymphedema, a condition that may cause the arm to swell. Lymphedema can occur early after surgery or many years later. It can be a difficult and disabling condition. Here again, there are tradeoffs in risk. When more lymph nodes are removed, more accurate information about tumor spread is obtained and the chance for tumor recurrence is less. But there is a greater incidence of lymphedema.

There are alternatives to standard lymph-node removal (called axillary node dissection). These alternatives should be considered in each patient's situation. They include

  1. replacing standard axillary-node removal with sentinel node biopsy (explained below);
  2. not doing lymph-node removal in patients who will receive chemotherapy anyway based on other information; and
  3. not doing lymph-node removal in patients with very small or "favorable" tumors.

Again, these alternatives must be selectively applied with the benefits and risks carefully evaluated.

Reviewed on 6/23/2016
References
REFERENCES:

Hammer, C., A. Fanning, and J. Crowe. "Overview of Breast Cancer Staging and Surgical Treatment Options." Cleve Clin J Med. 75.1 Mar. 2008: S10-6.

McGrath, K.G. "An Earlier Age of Breast Cancer Diagnosis Related to More Frequent Use of Antiperspirants/Deodorants and Underarm Shaving." European Journal of Cancer 12.6 (2003): 479-485.

Mirick, D.K., S. Davis, and D.B. Thomas. "Antiperspirant Use and the Risk of Breast Cancer." Journal of the National Cancer Institute 94.20 (2002): 1578-1580.

Shield, Kevin D., et al. "Alcohol Use and Breast Cancer: A Critical Review." Alcoholism: Clinical and Experimental Research Apr. 30, 2016. IMAGES:

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