Targeted Axillary Dissection - When to Use and Why
Q1. What are axillary lymph nodes, and how are they related to breast cancer?
Axillary lymph nodes refer to the lymphatic tissues and nodes located under the armpit. They help filter and transport lymph fluid from the upper limbs and breast area back to the center of the body. These nodes are generally divided into three groups, totaling around 20 lymph nodes.
Breast cancer is generally categorised into non-invasive (stage 0 or in situ) and invasive types. Invasive breast cancer has the potential to spread to nearby tissues, with the most common initial site being the axillary lymph nodes on the same side as the tumour. Therefore, doctors usually assess the status of the axillary nodes before surgery to determine whether cancer has reached the lymph nodes. Traditionally, if cancer is found in these nodes, an axillary lymph node dissection may be required.
Q2. What are the types of traditional axillary lymph node surgery?
There are two main types of traditional axillary lymph node procedures. The first is sentinel lymph node biopsy, which is suitable for patients whose preoperative tests show no signs of lymph node involvement. Only the sentinel nodes, the nodes most likely to be affected, are removed and tested. If no cancer is found, the remaining nodes are preserved. The second is axillary lymph node dissection, which is performed when cancer has already spread to the lymph nodes. In this case, two of the three axillary node groups are usually removed to eliminate any potentially affected lymph nodes, typically amounting to about 10 to 20 nodes.
Q3. What are the effects of axillary lymph node removal on the body?
Removing axillary lymph nodes can lead to several side effects. Mild and common issues include altered sensation or numbness in the armpit or inner arm due to nerve damage. More serious effects may involve reduced shoulder mobility. One of the most troublesome complications is lymphedema, or swelling caused by blocked lymphatic drainage. While some patients experience only mild or temporary symptoms, others may face long-term swelling that affects daily life and may lead to further health problems.
Q4. If cancer has spread to my lymph nodes, do they all need to be removed?
Traditionally, if cancer has spread to the axillary lymph nodes, axillary lymph node dissection should be performed to remove two groups of lymph nodes. However, with advancements in medical treatments, many patients now receive chemotherapy or targeted therapy before surgery. These treatments often shrink or even eliminate cancer cells. In suitable cases, doctors may recommend a new type of surgery called targeted axillary dissection, which removes only the selected lymph nodes. This approach allows accurate diagnosis while reducing the extent of surgery and the risk of complications.
Q5. What is targeted axillary dissection?
Targeted axillary dissection is a modern surgical technique involving collaboration amongst between surgeons, radiologists, and oncologists. Before neoadjuvant chemotherapy, examinations are performed to assess lymphatic spread. If the spread is not too extensive, the largest and most suspicious lymph nodes are identified and marked. After neoadjuvant chemotherapy, the area is re-evaluated to assess whether the lymphatic condition has improved. During surgery, doctors remove the marked nodes along with any sentinel nodes. If pathology shows that the cancer has been eliminated and no suspicious cells remain, no further nodes need to be removed. This approach reduces surgical complications while ensuring accurate diagnosis and effective treatment.
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