Understanding Lymph Nodes

These tiny organs, roughly the size and shape of beans, produce germ-killing white blood cells. Part of a massive network of vessels that carry a fluid called lymph throughout your body, they also act as filters, trapping harmful substances. When breast cancer starts to spread, it often passes through the lymph nodes in the armpit before it goes anywhere else. The presence of little clusters of cancer cells (called micrometastases) in those nodes can indicate the best course of treatment. And that's why your surgeon may…

  • Do a sentinel node biopsy. Unless your nodes are already known to contain cancer cells within them, a sentinel node biopsy will be performed. The first node in line as fluid drains from your breast, the sentinel node is the one most likely to contain escaped cancer cells. Using a dye and/or a radioactive tracer injected into the breast, a surgeon can identify the sentinel node or nodes, which can be removed at the time of surgery and then examined under a microscope. If your sentinel node is cancer-free, then doctors can skip the more extensive underarm surgery. Read more about lymph-node surgery and its link to cancer treatments.
  • Perform an axillary dissection. If sentinel node biopsy reveals the presence of cancer, your doctor may suggest traditional lymph node removal surgery, called axillary (underarm) dissection. Because it is more extensive and invasive than sentinel node biopsy, it increases the risk of postsurgical arm swelling, known as lymphedema.

However, it's important to remember that many factors—not just the presence or absence of micrometastases in lymph nodes—are taken into account when determining the best course of surgical treatment.

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