What Is An Axillary Lymph Node Dissection
An axillary lymph node dissection is when doctors remove most or all of the lymph nodes in the armpit. The procedure may be done if cancer is found in the sentinel nodes. The number of lymph nodes in the armpit varies from person to person but is usually between 15 and 30. In women found to have cancer in their lymph nodes before surgery, giving chemotherapy before surgery is a way to reduce the likelihood of needing an axillary dissection.
Will Reconstruction Affect Any Possible Recurrence Of Cancer
Breast reconstruction has no known effect on the recurrence of cancer since this most often occurs in surrounding skin, not reconstructed tissue. The reconstructed breast will not interfere with chemotherapy or radiation treatment. After your breast surgeon and reconstructive plastic surgeon have evaluated your health, age, anatomy, skin tissue and clinical situation, you can discuss which reconstruction option is best for you.
Are Lymph Nodes Removed During A Lumpectomy
Women with invasive breast cancer typically have one or more lymph nodes taken from the underarm area during a lumpectomy. These nodes, called the sentinel nodes, are the first lymph nodes to which cancer cells would travel if they were to leave the breast. This is done so that your doctor can check to see if the cancer has spread.
Women with DCIS undergoing lumpectomy do not need to have lymph nodes removed.
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What Is Breast Reconstruction Surgery
You may choose to have breast reconstruction surgery after a mastectomy to rebuild the breast so that it looks similar to the way it did before the surgery. Many times this can be done at the same time as your breast cancer surgery. But it is also possible afterward, even years later. There are many options for reconstruction. After lumpectomy, doctors can enhance the appearance of the breast using fat injections to plump up any dimpled areas where tissue has been removed. They can also perform a breast lift or breast reduction or do plastic surgery on the other breast to create a closely matched pair. After mastectomy, methods of rebuilding the breast include breast implant surgery and using tissue from another part of your body to create a new breast.
Are There Risks Associated With Breast Reconstruction
All surgeries carry some degree of risk and uncertainty. Some possible surgical difficulties, such as bleeding, fluid collection, excessive scar tissue and difficulties with anesthesia can occur with operation. Smokers should also be made aware that nicotine might delay healing and possibly result in conspicuous scars and prolonged recovery.
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How Is Breast Cancer Treated
Breast cancer is treated in several ways. It depends on the kind of breast cancer and how far it has spread.
Breast cancer is treated in several ways. It depends on the kind of breast cancer and how far it has spread. People with breast cancer often get more than one kind of treatment.
- Surgery. An operation where doctors cut out cancer tissue.
- Chemotherapy. Using special medicines to shrink or kill the cancer cells. The drugs can be pills you take or medicines given in your veins, or sometimes both.
- Hormonal therapy. Blocks cancer cells from getting the hormones they need to grow.
- Biological therapy. Works with your bodys immune system to help it fight cancer cells or to control side effects from other cancer treatments.
- Radiation therapy. Using high-energy rays to kill the cancer cells.
Doctors from different specialties often work together to treat breast cancer. Surgeons are doctors who perform operations. Medical oncologists are doctors who treat cancer with medicine. Radiation oncologists are doctors who treat cancer with radiation.
For more information, visit the National Cancer Institutes Breast Cancer Treatment Option Overview.external icon This site can also help you find health care services.external icon
Signs And Symptoms Of Infection
Having drains provides bacteria an access route to your body, and the longer drains are in place, the greater the risk of infection.
Signs of a drain-related infection may include:
- A fever with a temperature of 101 degrees F or higher
- Redness of your skin surrounding the drain
- Hardness or firmness where the drain exits your body
- Thickening rather than thinning of the drained liquid
- Foul smelling drainage or pus at the entry site
- Pain or discomfort at your drain sites
- A sudden change in the smell or color of the drainage
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Surgeries That Typically Require Surgical Drains
Surgeries requiring drains are those in which fluid collects during healing. Drains are usually required following a mastectomy or reconstructive breast surgery. You may have only one drain, or you may have five or more if you have a bilateral mastectomy with immediate reconstruction.
A separate drainage tube is often placed if you have a lymph node dissection. You will not usually need a drainage tube if you are undergoing a surgical biopsy, lumpectomy, or a sentinel node biopsy.
The location of your drains will depend on the surgery you have, but often includes a drain at your mastectomy site and one in your armpit if you have lymph nodes removed.
Emptying And Tracking Drainage
Always wash your hands before and after each measurement. Early on, you’ll likely have around 100 cc drainage per day, but this will steadily decrease. You may be asked to empty your drains two to four times daily, or whenever they become about half full.
Note the color and consistency of the drainage. Early on, it will be bright red, but this should change to a straw color after a few days. After emptying your bulb into the toilet, rinse it with water and gently compress it to make sure a vacuum is recreated when you close the system. It is very helpful to have someone assist you with draining your surgical bulbs, if possible.
If you notice an increase in the amount of fluid, think about what you have been doing that may be causing that.
Increased drainage may be a sign that you’ve been too active and need to take it easy for a few more days.
Keep the insertion site clean and dry by washing with soap and water and gently patting dry.
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A Family History Of Breast Cancer And Other Factors Increase The Risk Of Breast Cancer
Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer not having risk factors doesn’t mean that you will not get cancer. Talk to your doctor if you think you may be at risk for breast cancer.
Risk factors for breast cancer include the following:
- A personal history of benign breast disease.
- A family history of breast cancer in a first-degree relative .
- Inherited changes in the BRCA1 or BRCA2 genes or in other genes that increase the risk of breast cancer.
- Breast tissue that is dense on a mammogram.
- Exposure of breast tissue to estrogen made by the body. This may be caused by:
- Menstruating at an early age.
- Older age at first birth or never having given birth.
- Starting menopause at a later age.
Older age is the main risk factor for most cancers. The chance of getting cancer increases as you get older.
NCI’sBreast Cancer Risk Assessment Tool uses a woman’s risk factors to estimate her risk for breast cancer during the next five years and up to age 90. This online tool is meant to be used by a health care provider. For more information on breast cancer risk, call 1-800-4-CANCER.
The Grading System Is Used To Describe How Quickly A Breast Tumor Is Likely To Grow And Spread
The grading system describes a tumor based on how abnormal the cancer cells and tissue look under a microscope and how quickly the cancer cells are likely to grow and spread. Low-grade cancer cells look more like normal cells and tend to grow and spread more slowly than high-grade cancer cells. To describe how abnormal the cancer cells and tissue are, the pathologist will assess the following three features:
- How much of the tumor tissue has normal breast ducts.
- The size and shape of the nuclei in the tumor cells.
- How many dividing cells are present, which is a measure of how fast the tumor cells are growing and dividing.
For each feature, the pathologist assigns a score of 1 to 3 a score of 1 means the cells and tumor tissue look the most like normal cells and tissue, and a score of 3 means the cells and tissue look the most abnormal. The scores for each feature are added together to get a total score between 3 and 9.
Three grades are possible:
- Total score of 3 to 5: G1 .
- Total score of 6 to 7: G2 .
- Total score of 8 to 9: G3 .
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What Is Breast Conservation Surgery For Breast Cancer Doctor Explains
With technological advancement, several options are available to treat breast cancer, one of which is breast conservation surgery
In 2020 alone, 2.3 million women were diagnosed with breast cancer globally. 685,000 breast cancer patients died last year. Over the past five years, a whopping 7.8 million women were diagnosed, making it the most prevalent cancer in the world, according to the World Health Organisation . In fact, it accounts for 14% of the cancers diagnosed among women. In India, breast cancer is the most common kind of cancer.
Although breast cancer can develop in any woman after puberty, it is more common among those in their 50s and 60s, which means the cancer risk increases with age. Timely diagnosis and treatment are crucial to increase the chances of survival. With the advancement of technology, several treatment options are now available that can cure breast cancer. One of the options is breast conservation surgery. To know about the surgery, Onlymyhealth spoke to Dr Mahesh Bandemegal, Surgical Oncology, HCG Cancer Hospital, Bengaluru. But before that, let us understand breast cancer a little better.
There Are Three Ways That Cancer Spreads In The Body
- TX: Primary tumor cannot be assessed.
- T0: No sign of a primary tumor in the breast.
- Tis: Carcinoma in situ. There are 2 types of breast carcinoma in situ:
- Tis : DCIS is a condition in which abnormal cells are found in the lining of a breast duct. The abnormal cells have not spread outside the duct to other tissues in the breast. In some cases, DCIS may become invasive breast cancer that is able to spread to other tissues. At this time, there is no way to know which lesions can become invasive.
- Tis : Paget disease of the nipple is a condition in which abnormal cells are found in the skin cells of the nipple and may spread to the areola. It is not staged according to the TNM system. If Paget disease AND an invasive breast cancer are present, the TNM system is used to stage the invasive breast cancer.
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Who Can Have Breast
Breast-conserving surgery is a good option for many women with early-stage cancers. The main advantage is that a woman keeps most of her breast. However, she will in most cases also need radiation therapy, given by a radiation oncologist . Women who have their entire breast removed for early-stage cancers are less likely to need radiation, but they may be referred to a radiation oncologistfor evaluation because each patients cancer is unique.
- Are very concerned about losing a breast
- Are willing to have radiation therapy and are able to get to the appointments
- Have not already had their breast treated with radiation therapy or BCS
- Have only one area of cancer in the breast, or multiple areas that are close enough to be removed together without changing the look of the breast too much
- Have a tumor smaller than 5 cm , and that is also small relative to the size of the breast
- Are not pregnant or, if pregnant, will not need radiation therapy immediately
- Do not have a genetic factor such as a BRCA or ATM mutation, which might increase your chance of a second breast cancer
- Do not have certain serious connective tissue diseases such as scleroderma or lupus, which may make you especially sensitive to the side effects of radiation therapy
- Do not have inflammatory breast cancer
- Do not have positive margins
Checking Lymph Nodes Before Surgery
If you have invasive breast cancer, your treatment team will want to check if any of the lymph nodes under the arm contain cancer cells. This helps them decide whether youll benefit from any additional treatment after surgery.
Usually an ultrasound scan of the underarm is done before surgery to assess the lymph nodes.
If this appears abnormal, youll have a fine needle aspiration or a core biopsy to see if the cancer has spread to the lymph nodes. An FNA uses a fine needle and syringe to take a sample of cells to be looked at under a microscope. A core biopsy uses a hollow needle to take a sample of tissue for analysis under a microscope.
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What To Expect On The Day
You will usually be admitted to the hospital on the morning of your operation or occasionally the day before. Theres a brief explanation below of what will happen on the day of your surgery for more detailed information, see our booklet Your operation and recovery.
A doctor from the surgical team will talk to you about your operation and discuss what has been planned. If youve not already signed a consent form, youll be asked for your written consent. This confirms that you understand the benefits and risks of your surgery, and what you are agreeing to. If youre unsure, dont be afraid to ask the doctor to explain further.
Your anaesthetist will also usually visit you on the ward before your surgery. If youre feeling anxious and would like some medication to relax you before the operation, you can ask the anaesthetist.
Once all the pre-surgery checks have been done, youll be taken to the anaesthetic room where the theatre staff will confirm your name, any allergies and when you last ate and drank. Youll be given a combination of drugs into a vein .
Youll usually be asked to take deep breaths and as the anaesthetic takes effect you will fall into a deep sleep. Once you are fully anaesthetised you will be taken into the theatre.
For more information about going into hospital, see our booklet Your operation and recovery.
Staying On Track With Radiation Treatments
The benefits of radiation therapy strongly depend on getting the full recommended dose without significant breaks, because:
- The full dose of radiation is needed to get rid of any cancer cells remaining after surgery.
- Radiation therapy is most effective when given continuously on schedule. In the past, it was given every day, 5 days a week, for 5 to 7 weeks. Accelerated, also called hypofractionated, radiation therapy schedules deliver about the same total dose of radiation over a shorter schedule usually 3 to 4 weeks, which can be more convenient. Partial breast radiation can be completed in 1 to 3 weeks. Also, by seeing your doctor regularly during and after treatment, you can best deal with any side effects.
Why you might have problems sticking to your radiation therapy plan:
- The treatment schedule may conflict with job demands, family needs, or the distance you live from the treatment facility. This may cause you to miss or postpone appointments, even if youre on an accelerated schedule.
- Skin irritation from radiation can cause soreness, peeling, and sometimes blisters. If you’ve also had lymph-node surgery, radiation treatment may worsen breast or underarm pain or discomfort. If you have these side effects, you might feel like stopping radiation.
Ways to overcome problems and stay on track with radiation treatment:
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Preparing For Breast Cancer Surgery
No matter what type of breast cancer surgery you have, youâll need to take steps to get ready.
One of the first things youâll need to do is to give your medical history. Your doctor will ask you about any medications youâre taking, including vitamins and supplements. Theyâll also want to know if youâve had any reactions to medications or surgical procedures in the past. If you have any conditions that could affect how your body responds to surgery, such as heart disease, diabetes, or high blood pressure, you should let your doctor know at this time.
Your doctor may suggest that you donate a pint or two of blood in case you need it during surgery. If you do this, youâll need to allow extra time in your pre-op schedule to donate and recover.
As your surgery date gets closer, your doctor may order tests for you. These can include a chest X-ray, EKG, and blood and urine tests. These tests let your doctor know if your body is ready for the operation. They may also request a CT scan to check the size and location of your tumor.