Breast Cancer: New Surgical Treatment
By Rick Daniels, MD, FACS, Published in Healthy Viewpoints, Fall 2003.
Each year in the United States over 180,000 women are diagnosed with breast cancer. Along with this overwhelming news, a woman must make treatment choices in a relatively short period of time. Today's treatment choices involve various modalities including surgery, chemotherapy, radiation, hormonal therapy, etc. In general, the initial treatment begins with surgery. Women must choose whether to have a lumpectomy (removal of a portion of the breast) or a mastectomy (removal of the entire breast). Both surgical procedures involve removal of the axillary (arm pit) lymph nodes. It is the current standard of care to identify whether or not the cancer has spread outside of the the axillary lymph nodes. Survival benefit and future treatment depends on whether or not the lymph nodes are involved with tumor.
Surgically removing the lymph nodes may be associated with some mild complications such as numbness (19%), pain (17%), arm swelling (11%), infection (6%), and limited motion (4%). To lower these post-operative complications a new surgical procedure has been developed to limit the surgery done in the armpit. The concept is based on the knowledge that breast cancers spread to the axillary lymph nodes in an orderly fashion i.e., tumor spreads in the breast to one initial lymph node (called the "sentinel lymph node"). Later the tumor then spreads from the sentinel node to other nodes. The key to this new technique involves finding the "sentinel lymph node." This procedure is called "Sentinel Lymph Node Biopsy" and uses either blue dye or a small amount of radioactive material injected around the tumor site. The surgeon performs a small incision in the axillary underarm area looking for the blue dye or uses a scanner to locate the radioactive material. The lymph node where the dye or radioactive material accumulates is called the "sentinel node". The node is surgically removed and examined by a pathologist. If the lymph node is positive for cancer cells, then the standard axillary lymph node dissection is done; if it is negative, the remaining lymph nodes may not have to be removed. Therefore, a limited dissection is done and most of the complications of a full axillary lymph node removal (swelling, pain, numbness, etc.) Can be avoided.
We are currently using this technique in Eau Claire, and the procedure has shown great promise not only for breast cancers but other cancers such as melanoma, etc. Although this technique is currently considered experimental, I believe that it will become the standard of care in the future.
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