AXILLARY SURGERY
Lymph Node Biopsy
Why do we talk about lymph nodes when we are talking about breast cancer?
If breast cancer spreads, it usually goes to the lymph nodes first. So when a woman is diagnosed with breast cancer, it’s important to know if it’s already spread to the lymph nodes.
There are thousands of lymph nodes in the body. They are usually tiny, about the size of a grape seed or maybe a watermelon seed, and we ‘re usually not even aware of them. Lymph nodes have several jobs:
- Act like sponges and mop up excess fluid
- Act as filters and trap harmful things like bacteria and cancer cells
In the axilla (underarm or arm pit) there are about 30 or 40 lymph nodes on each side, everyone is a little different. If a cancer cell or clump of cellsbreaks off the main tumor it is usually (but not always) taken up by one of the lymphatic vessels in the breast.The lymphatic vessels form a network and drain (for the most part) into the lymph nodes located in the axilla on the same side as the breast (ipsilateral axillary lymph nodes) where they are trapped. Sometimes the lymph node kills the cancer cells (way to go lymph node!) but other times the cancer cells are able to resist the lymph node and multiply (tricky cancer).
Cancer cells can also spread through the blood vessel and bypass the lymphatic vessels, but this is less common.
It’s important to understand that, although it seems counter intuitive, removing malignant lymph nodes in a patient whose lymph nodes appear normal on physical examination and imaging, does not to improve survival.
The reason we remove axillary lymph nodes is to accurately stage a patient and plan treatment.
Vessels
In the body, a vessel refers to soft, flexible tube that carries some sort of fluid.
There are 2 types of vessels:
- Lymphatic vessels. Lymphatic vessels carry lymphatic fluid, which is clear. For the most part, lymphatic vessels are microscopic and pretty much impossible to see with the human eye.
- Blood vessels. Blood vessels carry…wait for it…blood!There are 2 types of blood vessels:
- Arteries. Arteries carry oxygenated blood that is bright red. Arterial vessels pulsate. They are the vessels used when taking a patient’s pulse or blood pressure.
- Veins.Veins carry deoxygenated blood that is dark red, even a little bluish. Veins are soft and can be compressed easily. They do not pulsate.
How can you tell if breast cancer has spread to the axillary lymph nodes (ALNs)?
Axillary lymph nodes can be seen on mammogram (partially), ultrasound (sonogram) and MRI (magnetic resonance imaging). So they can be evaluated preliminarily with imaging. If a lymph node looks abnormal on imaging, it can be biopsied it with a needle.
Keep in mind that just because the lymph nodes look normal on imaging, doesn’t mean they don’t contain cancer cells. That’s because ten, a few hundred, or a few thousand cancer cells will not change the appearance of a lymph node on imaging orto the human eye. Small amounts of cancer like that can only be seen with a microscope.
So if the lymph nodes look normal on imaging or if a lymph node is biopsied and cancer cells are not seen, it’s still necessary to go the extra step and remove the whole lymph node and look at it under the microscope to determine whether or not it contains cancer.