Understanding Your Cancer And Treatment
Not all breast cancers are alike. Someone elses experience with their treatment may be completely different from yours. Understanding your type and stage can help make sense of your doctors recommendations. This may help you feel better about your treatment choices.
A big part of cancer treatment is the relationship between you and your oncology team. Here are some things youll want to know about early on so youre well informed about your specific type of breast cancer:
Oncologists meet with cancer patients every day and its their job to see you as a whole person. Express your wants and needs. Rest assured that no question is too insignificant to ask.
What Happens After A Sentinel Node Biopsy
If the lymph nodes do not contain cancer cells, you wont need to have any more nodes taken out.
If cancer cells are in the sentinel nodes, you have another operation to remove most or all of the lymph nodes under your arm. This is an axillary lymph node dissection or clearance. You generally have it about 2 weeks after you get the results.
Some people have radiotherapy to the armpit to destroy any remaining cancer cells instead of surgery.
Axillary Lymph Node Dissection
In this procedure, anywhere from about 10 to 40 lymph nodes are removed from the area under the arm and checked for cancer spread. ALND is usually done at the same time as a mastectomy or breast-conserving surgery , but it can be done in a second operation. ALND may be needed:
- If a previous SLNB has shown 3 or more of the underarm lymph nodes have cancer cells
- If swollen underarm or collarbone lymph nodes can be felt before surgery or seen on imaging tests and a FNA or core needle biopsy shows cancer
- If the cancer has grown large enough to extend outside the lymph node
- If the SLNB is positive for cancer cells after chemotherapy was given to shrink the tumor before surgery
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Days Before Your Surgery
Follow your healthcare providers instructions for taking aspirin
If you take aspirin or a medication that contains aspirin, you may need to change your dose or stop taking it 7 days before your surgery. Aspirin can cause bleeding.
Follow your healthcare providers instructions. Dont stop taking aspirin unless they tell you to. For more information, read the resource Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs , or Vitamin E.
Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements
Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements 7 days before your surgery. These things can cause bleeding. For more information, read the resource Herbal Remedies and Cancer Treatment.
Types Of Lymph Node Surgery
Even if the nearby lymph nodes are not enlarged, they will still need to be checked for cancer. This can be done in two different ways. Sentinel lymph node biopsy is the most common way and only a few lymph nodes are removed. But in some cases, an axillary lymph node dissection , which removes more lymph nodes, might be needed.
Lymph node surgery is often done as part of the main surgery to remove the breast cancer, but sometimes it might be done as a separate operation.
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Why Are Lymph Nodes Important
One main lymph node area and two secondary lymph node areas filter the lymph fluid draining away from the breast area.
Since the job of the lymph nodes is to filter out “bad guys” like cancer cells, this is a logical place to look for breast cancer cells that have escaped the original tumor and are trying to go elsewhere in the body. Cancer cells may also leave the breast through the bloodstream and bypass the lymph nodes. However, the presence or absence of cancer in the lymph nodes is one of the most important signposts your doctor will use to determine the best treatment for you.
Another purpose of lymph node dissection is to remove cancer that might be in the nodes. This is done, so that the cancer can’t grow further in the lymph node area or shed cells that could go elsewhere.
Doctors once believed that removing as many lymph nodes as possible would reduce the risk of cancer ever spreading to the rest of the body. The hope was that if you caught every last possible cell that could be in those lymph nodes and “cured” the armpit and breast of any cancer, you could “cure” the rest of the body. But lymph node removal does nothing to fight cancer cells that may have already spread elsewhere. That’s where systemic, or whole-body, treatment comes in to kill any cells that escaped the original breast cancer or the adjacent lymph nodes.
What Does It Mean If Cancer Cells Are Found In The Lymph Nodes
If cancer cells are found in the lymph nodes removed from the armpit, it means theres a higher chance that cancer has spread into the bloodstream as well. In this case, treatment with systemic therapies such as chemotherapy or hormonal therapy will probably be recommended.
If a large number of lymph nodes contain cancer cells, radiotherapy to the armpit may be recommended to destroy any cancer cells that may be left in the armpit but cannot be removed by surgery.
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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.
Lymph Node Surgery For Breast Cancer
If breast cancer spreads, it typically goes first to nearby lymph nodes under the arm. It can also sometimes spread to lymph nodes near the collarbone or near the breastbone . Knowing if the cancer has spread to your lymph nodes helps doctors find the best way to treat your cancer.
If you have been diagnosed with breast cancer, its important to find out how far the cancer has spread. To help find out if the cancer has spread outside the breast, one or more of the lymph nodes under the arm are removed and checked in the lab. This is an important part of staging. If the lymph nodes have cancer cells, there is a higher chance that cancer cells have also spread to other parts of the body. More imaging tests might be done if this is the case.
Lymph node removal can be done in different ways, depending on whether any lymph nodes are enlarged, how big the breast tumor is, and other factors.
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Locally Advanced Breast Cancer
If breast cancer has spread to the chest wall or skin of the breast, or the lymph nodes around the chest, neck and under the breast bone, but has not spread to other areas of the body, its called locally advanced breast cancer. Sometimes breast cancer is locally advanced when it is first diagnosed.
People who have locally advanced breast cancer are thought to have an increased risk of cancer cells spreading to other areas of the body, compared to those with stage 1 or 2 breast cancers.
What Are The Benefits Of Slnb
SNLB helps doctors stage cancers and estimate the risk that tumor cells have developed the ability to spread to other parts of the body. If the sentinel node is negative for cancer, a patient may be able to avoid more extensive lymph node surgery, reducing the potential complications associated with having many lymph nodes removed.
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How Is A Local Recurrence After Lumpectomy Diagnosed
After a diagnosis of early stage breast cancer, any remaining breast tissue should be evaluated annually with scans .
Most local recurrences within the breast after lumpectomy are detected on routine annual breast imaging, which usually takes the form of mammography and ultrasound, and on occasions MRI.
If you have a local recurrence or new primary breast cancer, you may find symptoms similar to an initial breast cancer. This includes:
- A new lump in the breast, armpit area or around the collarbone
- A change in breast size or shape
- Changes to the nipple, such as sores or crusting, an ulcer or inverted nipple
- Clear or bloody nipple discharge
- Changes to the skin including redness, puckering or dimpling
- Breast tenderness or pain
Once a local recurrence has been diagnosed, we do tests to see whether there are signs of cancer elsewhere in the body. These may include a chest X-ray, CT scan, bone scan or PET scan, and blood tests , then we have to figure out how best to treat the tumour in the breast. Usually in these cases we do a mastectomy, as the prior less drastic surgery and radiation didnt take care of it.
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Removing Most Or All Of The Lymph Nodes
An operation to remove most or all of the lymph nodes under the arm is called an axillary lymph node dissection or axillary clearance.
You have a general anaesthetic for this operation. You will be asleep the whole time.
The surgeon makes a small cut in your armpit to remove the lymph nodes. Generally, they remove between 10 and 15 lymph nodes. But the number of nodes in the armpit varies from person to person.
The surgeon sends the lymph nodes to the laboratory. A pathologist checks them for cancer cells. You get the results at your follow up appointment, about 2 weeks after surgery.
Some people will have radiotherapy to the lymph nodes instead of surgery.
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Surgical Removal Of Underarm Lymph Nodes In Breast Cancer
This review aimed to compare the benefits of surgical removal of underarm lymph nodes with the potential harms associated with this surgical procedure. The review also aimed to learn whether complete removal of all underarm nodes could be replaced by procedures that remove only a small number of lymph nodes.
Surgical removal of underarm lymph nodes is often part of the initial surgical treatment for patients with operable breast cancer. If cancer has spread to these lymph nodes, patients are advised to undergo additional treatments, such as chemotherapy or radiotherapy, to help treat their disease. If cancer has not spread to these lymph nodes, patients are spared extra treatments . Surgical removal of lymph nodes can lead to short-term surgical complications and long-term problems ) when fluid accumulation causes restricted function and discomfort.
Moderate-quality evidence suggests that patients treated with approaches involving lesser axillary surgery do not have a reduced chance of survival compared with those treated with ALND. Moderate-quality evidence indicates that overall survival is slightly reduced in patients who receive radiotherapy when compared with ALND. If survival is assumed to be 81% five years after surgery with ALND, then the evidence suggests it would be between 77% and 81% after treatment with radiotherapy alone.
No studies reported on disease control in the axilla.
Exercise And Secondary Breast Cancer In The Lung
Some people with secondary breast cancer in the lung have no symptoms while others have a combination of pain, sickness, loss of appetite, hiccups, tiredness and fatigue. While physical activity may help reduce some symptoms its important to listen to your body and not push yourself too hard. Gentle, regular activity, such as walking, is often most effective.
If youre currently having treatment you may need to exercise at a slightly lower level. Stop if it hurts or feels like youre working too hard.
When choosing your exercise, try to focus on aerobic activities such as walking, swimming or cycling. Activities such as dancing and gardening can also be beneficial. You could also include some light toning or conditioning exercises such as stretching or low-impact yoga. The most important thing is to choose something you can safely enjoy.
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The Morning Of Your Surgery
Instructions for drinking before your surgery
You can drink a total of 12 ounces of water between midnight and 2 hours before your scheduled arrival time. Do not drink anything else.Do not drink anything starting 2 hours before your scheduled arrival time. This includes water.
Take your medications as instructed
If your healthcare provider told you to take certain medications the morning of your surgery, take only those medications with a sip of water. Depending on what medications you take, this may be all, some, or none of your usual morning medications.
Shower with a 4% CHG solution antiseptic skin cleanser
Shower with a 4% CHG solution antiseptic skin cleanser before you leave for the hospital. Use it the same way you did the night before.
Dont put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.
Things to remember
- If you wear contact lenses, wear your glasses instead. Wearing contact lenses during surgery can damage your eyes.
- Dont wear any metal objects. Remove all jewelry, including body piercings. The tools used during your surgery can cause burns if they touch metal.
- Leave valuable items at home.
- If youre menstruating , use a sanitary pad, not a tampon. Youll get disposable underwear, as well as a pad if needed.
What to bring
Once youve arrived for your surgery
When its time to change for surgery, youll get a hospital gown, robe, and nonskid socks to wear.
Meet with a nurse
Meet with an anesthesiologist
Getting The Results During Surgery
In some hospitals, the surgeon gets the results of the sentinel lymph node biopsy during the operation. This is called an intra operative assessment. They can remove the rest of the nodes if necessary. You then avoid having a second operation.
Your surgeon will explain this to you before your operation, so you know what to expect.
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Diagnosing Symptoms Related To Lymph Nodes
When touching an affected area, swollen lymph nodes may feel soft and round, like lumps the size of a pea, peanut or grape. If theyre painful when touched, that may be a sign of inflammation. Since lymph nodes appear in parallelas, for instance, on both sides of the neckyou can feel lymph glands on both sides to see whether they are a normal size on one side and enlarged on the other, which may be a sign of infection.
In determining a diagnosis, its important for doctors to look at other symptoms or factors. Swollen lymph nodes near the ear may indicate an ear infection, for instance. Swollen glands in the neck area near the collarbone, combined with a sore throat and cough, may be a sign of an upper respiratory infection. When multiple regions of lymph nodes are swollen, it may indicate a body-wide disease that needs immediate attention.
Besides reviewing your medical history, doctors may use some of the following methods to diagnose the cause of swollen lymph nodes:
- Physical examination, feeling with fingers the nodes in the affected area to check their size and whether they feel hard, tender or warm
- Lab tests, including blood tests to check for suspected underlying conditions
Less Lymph Node Surgery Equivalent Survival
The trial, called ACOSOG Z0011, was designed to compare whether sentinel lymph node biopsy alone provided equivalent survival benefits to ALND after breast-conserving surgery among a subset of women who also received radiation and systemic therapy. The research team enrolled 891 participants into the study from 1999 to 2004.
Women who had stage I or II cancer and metastases in only one or two sentinel nodes were eligible to join the study. All women had undergone SLNB at the time of breast-conserving surgery.
Half of the trial participants received no further surgery, and the other half underwent ALND. Almost 90% of women in both groups had radiation therapy after surgery, and almost all received some type of systemic therapy.
In the initial results from the trial, published in 2010 and 2011, women who had only SLNB did not have worse overall survival than women who underwent full ALND. The two groups also had similar rates of disease-free survival and cancer recurrence in the lymph nodes.
These early results were absolutely practice changing, and at this point the overwhelming majority of surgeons are not doing a full axillary lymph node dissection in patients with one or two positive nodes, said Larissa Korde, M.D., head of Breast Cancer Therapeutics in NCIs Division of Cancer Treatment and Diagnosis.
However, the cancer research community had lingering concerns about the trial, the authors of the new paper explained.
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Diagnosing Cancer Of The Lymph Nodes
In addition to a biopsy, the TNM system is commonly used to issue a diagnosis and determine which type of treatment is best. The T refers to the size of the tumor or cancerous growth. The N refers to the number of lymph nodes that contain cancerous cells. And, the M is for metastasis, which refers to cancer thats spread to areas far from the originating tumor.5
This categorization is used in addition to other diagnostic tests and tools to determine the cancer stage such as:
- Imaging tests X-rays, CT scans, MRIs, and other types of imaging tests can provide a clearer picture and more information about where the cancer is located and how much is present.
- Endoscopy exams An endoscope is a thin, lighted tube with a video camera attached that looks around on the inside of the body for cancerous areas.
In general, cancers assigned as Stage I are less advanced and have a better prognosis and response to treatment. Whereas, a higher stage indicates that the cancer has spread further and requires a more intense or multiple types of treatment. Other factors that affect treatment are: