Dr. MJ Bazos MD,
Cancer – Lymph Node Dissection
Removal of lymph nodes during breast
What are lymph
Lymph nodes (sometimes called
“glands”) are part of the system that conducts a fluid called
“lymph” around the body, just as arteries and veins conduct blood.
The lymph nodes that are connected to the breast area are located in the armpit
and near the collarbone. When breast cancer spreads, cancer cells will usually
collect in the nearby lymph nodes. Lymph nodes are frequently removed during
breast cancer surgery. Since the medical term for the armpit is
“axilla,” this procedure is called “axillary
Why are the lymph nodes
Removal of the lymph nodes for microscopic
examination can give important information about how far the cancer has
progressed. The recommended therapy after your surgery is different depending on
whether the nodes are “positive” (contain cancer cells) or
“negative” (do not contain cancer cells). Removal of lymph nodes
also reduces the
risk that the cancer will
come back in the armpit area.
How does the doctor know if cancer has spread
to the lymph nodes?
Before your surgery, your doctor will examine
your armpit and collarbone areas for any suspicious swelling. However, since
cancer in the lymph nodes often cannot be felt, surgical removal and microscopic
examination are needed to know for sure whether they contain cancer or
Is it always necessary to remove lymph
Removal of lymph nodes is recommended as the
standard procedure for women with most forms of early breast cancer. However,
some types of cancer, such as ductal carcinoma in situ (DCIS), have a very low
risk of spreading to the lymph nodes. Also, in certain cases the recommended
treatment is the same whether or not cancer cells are found in the nodes. In
such instances it may sometimes be acceptable not to remove any
How many lymph nodes are
The lymph nodes in the armpit region are found
in 3 layers, or “levels”. When breast cancer spreads, it usually
goes to the level 1 nodes first, then to levels 2 and 3. It is recommended that
the surgeon remove all lymph nodes found at levels 1 and 2. In general, this
will result in the removal of approximately 10 lymph nodes — enough to
tell for sure whether the cancer has spread to the nodes or not. Removing 10 or
more nodes also reduces the chance of the cancer returning to the nodes.
However, complications become more frequent and more severe as more nodes are
removed. For this reason, removal of level 3 nodes is not usually
What kinds of complications can occur after
the lymph nodes are removed?
Removal of nodes often affects nearby nerves,
leading to the most common complication — numbness in the arm. In a few
instances (less than 6%) there is also significant pain with this condition.
Another common problem is “lymphedema.” This is a pooling of lymph
fluid in the arm, causing swelling, stiffness in the arm and shoulder, and
sometimes infection and pain. The chance of lymphedema developing after surgery
increases with the number of nodes removed. After a typical operation, between
2% and 7% of patients experience significant lymphedema. Mild lymphedema is more
common and is experienced by about 1 out of every 5 patients. Radiation
treatment to the armpit area also increases the risk of lymphedema. For this
reason, it should be avoided unless there is an especially high risk of the
cancer coming back in this area.
What can I do if I have persistent pain after
You do not have to live
with pain, nor should you try.