It's normal to have questions, fears, and confusion after being diagnosed with breast cancer. At this point, your doctor will talk to you about the tests and treatments. One of them may be that you "need to have some lumps removed from your armpit." Hearing this may have given you a little shock. What exactly is this operation? Why is it so important? Let's talk about it in a friendly way that you can understand.
First, let's see, what are these armpit lumps?
Simply put, our body has a lymphatic system. This is like a cleaning system in our body. A liquid called lymph flows throughout this system. Along the paths of this lymph, there are little checkpoints. That's what we call lymph nodes , or "nodules" in colloquial terms.
There are about 20 to 40 lymph nodes in your armpit. We call these ``axillary lymph nodes''. Their main job is to filter and clean the lymph fluid that comes from your arms, breasts, and chest wall. In this filtering, they catch germs, unwanted things, and cancer cells in that fluid. That's why, if breast cancer spreads, it usually spreads first to the lymph nodes in your armpit.
Why do you need to have this operation?
There are several reasons why your surgeon (surgical oncologist) may recommend this surgery. It is usually done at the same time as a lumpectomy or mastectomy.
| Main reasons for resorting to surgery | This means... |
|---|---|
| Getting a swollen ankle | If you have a lump in your armpit or near your collarbone that feels tender when you touch it, this can be caused by a buildup of cancer cells. |
| Appearance on scans | If your ultrasound scan , CT scan , or PET scan reports that your armpit lumps are swollen or look abnormal. |
| Sentinel Node Biopsy Result | This involves taking the first few cells that are most likely to spread the cancer and testing them. If the test confirms that more than three cells contain cancer cells, |
| After chemotherapy treatments | Sometimes chemotherapy is given before surgery to shrink the breast tumor. If the cancer in the armpits doesn't go away after that treatment, |
How is the operation performed?
There's nothing to be too worried about. This is a planned surgery.
Before surgery
You will be given general anesthesia . This means that you will not feel anything during the surgery, and you will be completely asleep. Your doctor will give you clear instructions about when to stop eating and drinking before the surgery.
During surgery
1. Making an incision: The surgeon will make a small incision in the skin of your armpit. This will allow you to easily access the areas where the lumps that are suspected to contain cancer cells are located.
2. Tissue Removal: The tissue containing the pus is then carefully removed. This is sent to a ``Pathologist``, a doctor who specializes in tissue.
3. Surgical Drain: A small tube is placed at the surgical site to drain any excess fluid (such as blood or pus) that collects there. This is removed in a few days.
4. Stitching the incision: Finally, the incision is sewn with a fusible thread or regular thread.
What are the benefits and risks of this?
The biggest advantage of this surgery is that it can tell exactly if the cancer has spread to the armpits and how far it has spread. This information is essential for deciding what treatment you should give yourself going forward.
As with any surgery, there are some minor risks, and it's important to be aware of them.
| Possible risk | Description |
|---|---|
| Lymphedema | This is the main risk. When lymph nodes are removed, there may be a slight obstruction to the flow of lymph fluid. This can cause swelling in the arm on the side of the operation. There are special exercises and instructions to prevent this. |
| Axillary Web Syndrome (AWS) | There may be pain under the armpit, with a string-like sensation under the skin. This can also be treated with physiotherapy. |
| Other risks | As with any surgery, there is a small chance of bleeding, infection, and minor nerve damage. |
Don't worry, your doctor will do everything they can to minimize these risks. He or she may also refer you to a lymphedema specialist to help you prevent lymphedema.
What does the report say?
After surgery, the tissue removed is examined and a report is given. It tells how many of the tissue samples contain cancer cells. This is very important in determining the stage of the cancer.
| Node Category | Simple meaning |
|---|---|
| N1 | There are cancer cells in 1 to 3 lymph nodes in the armpit. |
| N2 | There are cancer cells in 4 to 9 lymph nodes in the armpit. |
| N3 | There are cancer cells in 10 or more lymph nodes in the armpit, or the cancer has spread to the lymph nodes under the collarbone. |
But keep this in mind: The number of cells in the tumor is not the only factor that determines the severity of the cancer.
Your doctor will take several other factors into account when determining the exact stage of the cancer.
- The size and location of the breast tumor.
- Whether the cancer has spread to surrounding tissues (metastasized).
- The hormone receptor status of cancer cells. That is, whether they have estrogen receptors or progesterone receptors.
If you find this difficult to understand, don't worry. Don't be afraid to ask your doctor what this report means and how it affects your condition.
When should you call the doctor immediately?
When you get home after surgery, watch out for these symptoms. If you have any of these, let your doctor know right away.
- If the surgical wound becomes red, swollen, or oozing fluid , this could be a sign of infection.
- If you have more severe pain than expected, or if the pain does not subside even after taking painkillers.
- If the arm or fingers on the side of the surgery are swollen , this could be the beginning of a condition called `(Lymphedema)`.
Dealing with cancer is not an easy journey. But remember, every step is a step towards healing. This surgery is an important step in that journey. The information you gain from it will be a great strength in your journey to recovery.
Take-Home Message
- Axillary Lymph Node Dissection is an important step in the treatment of breast cancer.
- This is mainly done to confirm whether the cancer has spread to other parts of the body.
- Be aware of the risks of arm swelling (lymphedema) after surgery. Follow your doctor's instructions and exercises exactly to prevent it.
- If you have any questions about the test reports you receive, don't hold anything back and don't be afraid to ask your doctor for clarification.
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