Innovative surgery attacks breast cancer

(In recognition of October as Breast Cancer Awareness Month, a Federal Way surgeon explains one of the treatment options)

By William K. Cray

A woman newly diagnosed with breast cancer has many treatment options to consider these days, especially when it comes to surgery. One of the most important goals of surgery is to detect whether or not cancer involves the lymph nodes under the arm—usually the first place for breast cancer to spread.

Until just a few years ago, the only way of evaluating these lymph nodes was by performing an operation called an axillary node dissection, in which most of the lymph nodes under the arm are removed.

The consequences of this operation can be devastating. The most feared result is lymphedema –– swelling of the arm –– which happens when the lymph fluid cannot drain back through the scarred area under the arm. This condition can occur any time throughout a woman’s life after the operation and is sometimes very disabling and difficult to treat.

An innovative technique called sentinel lymph node biopsy is one of the most remarkable advances in breast cancer surgery in years and can help women avoid the complications of lymph node removal. This is not a new idea. In fact, it has been used for patients with melanoma, a kind of skin cancer, for decades.

With a sentinel node biopsy, only the first one or two lymph nodes that drain the cancer (the sentinel nodes) are removed for laboratory testing when a patient undergoes surgery for breast cancer. Studies suggest that if no cancer cells are found, it’s likely that the cancer has not spread beyond the tumor and the patient can usually avoid removal of the remaining axillary nodes.

How can a surgeon locate the sentinel nodes? This is where team medicine is so important. To do this procedure properly, a medical team is assembled, including a radiologist, nuclear medicine technologists, a breast surgeon, an anesthesiologist, operating room personnel and a pathologist.

On the day of surgery, the patient first goes to the radiology department, where the radiologist injects a very small amount of radioactive tracer into the breast. The tracer goes into the lymph channels to the sentinel nodes, which are shown on an X-ray. This X-ray merely tells which nodes are first to drain the area of the cancer, but not which ones have cancer.

Next, when the patient is in the operating room under anesthesia, the surgeon injects a special blue dye into the breast. This dye goes into the lymph channels, straight to the sentinel node. A small incision is made under the arm and the surgeon uses a gamma probe, similar to a small geiger counter, and looks for nodes that are radioactive or colored blue from the dye. Usually, one or two sentinel nodes are sent to the pathologist for examination under the microscope to look for cancerous cells.

If no cancer is found, the remaining lymph nodes are left in place. If the cancer has spread to the sentinel nodes, however, the rest of the lymph nodes under the arm are usually removed.

This procedure has definite advantages for the patient. It has a much smaller risk of some of the complications that can occur with axillary node dissection such as lymphedema and nerve damag –– a great relief to women with breast cancer. Because the incision is smaller, and the operation less invasive, there is less pain and recovery is quicker. Most women return to their normal activities within a week.

If you or someone you know has been diagnosed with breast cancer, be sure to ask your healthcare provider about this procedure to find out if it’s right for you. Most women with breast cancer are eligible for this new technique, unless there is a strong suspicion of cancerous lymph nodes under the arm felt by examination or seen by x-ray tests.

Dr. William Cray performs sentinel node biopsies at the Virginia Mason Federal Way Outpatient Surgery Center.Additional information is

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