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Removal of the signal nodes in breast cancer
What should I know about removing the signal nodes
Mammology - Breast surgery
One of the "innovations" in the method of removal of lymph nodes in cancer surgery is the removal of so-called signaling nodes. This operation is an excellent alternative to standard axillary lymphadenectomy. Many patients believe that this operation will allow them to avoid more aggressive surgery and serious side effects inherent in the traditional technique of removing the lymph nodes.
Unfortunately, it is important to understand that this type of intervention is not indicated for all patients suffering from breast cancer. In addition, recent studies have shown that sometimes the signal after removing the lymph nodes may require additional surgery. This has both advantages and disadvantages and limitations.
The name of the signaling nodes were on the grounds that they were the first to react to the penetration of cancer cells and are the first barrier to the outflow of lymph from the mammary tissue. When you remove the lymph nodes the surgeon looks for the signal most of the affected lymph nodes near the breast cancer. If a woman has invasive breast cancer, that is when the cancer goes to the healthy tissue and into the lymph nodes are the most signal first barrier to tumor cells.
The idea of removing the lymph nodes of signal is this: instead of excise ten or more nodes, and then examine them to determine the presence of cancer cells, removes only one lymph node, which can be struck. If the histological examination of lymph node signal turns out that he was "clean", then there is a huge chance that the other lymph nodes were not affected. Usually, the surgeon removes a small complex of two - three lymph nodes - a signal node and the node that is closest to it.
This procedure allows to evaluate the status of all regional lymph nodes for patients with cancer of relatively small size (less than 2 cm) before surgery if they had no increase in lymph nodes. Studies show that the efficiency of this operation is comparable to the efficiency of conventional lymphadenectomy.
What should I know about removing the signal nodes
Removal of lymph nodes signal - a relatively new technique of surgical intervention, so long as she has not done everywhere. Even if technically correct implementation of all phases of the operation may be such that the signal does not stain lymph node contrast agent. This occurs in 5% of cases. When applied to detect the radioactive signal nodes of the drug and dye, the efficiency of operations increased by 10 - 15%. If contrast dye is injected under the skin, not only, but also in the tumor, staining of lymphatic vessels and lymph nodes is much better. In addition, your doctor may massage the area of injection of contrast, that he quickly absorbed into the lymph. Removing only the signaling nodes can not guarantee that the transactions will not occur after the typical side effects include pain, numbness, and lymphedema. A blue dye may remain in the body for a long time - from several months to a year. At the same time at the injection site can be seen as a spot under the skin. Sometimes, after the introduction of dye staining of urine may be blue.
How is the removal of the signal nodes
In order to identify the lymph nodes, the doctor before surgery puts into the tumor under the skin of the contrast agent: the radioactive drug or a dye (usually methylene blue) or both drugs at once. Contrast enters the lymph vessels, which, by him - in the lymph nodes. The latter in turn stained blue or detected by radionuclide scintigraphy.
Thus, the surgeon can see the progress of lymphatic vessels and lymph nodes: signaling and regional. Once they are removed, the surgeon examines them, and gropes for the defeat of cancer. However, this study provides only approximate information. Therefore, lymph node dissection must study pathologist.
Indications for removal of the signal nodes
Removal of the signal nodes - this is an excellent choice for women with early stage invasive breast cancer who have a low risk of lymph node involvement.
In such patients is extremely important to find out whether the cancer has not moved beyond the breast. But it is equally important to remove only a small number of lymph nodes, which will help assess the condition and the remaining lymph nodes than indiscriminately remove all lymph nodes, including normal and who quietly do their work.
Sometimes, on the basis of physical data (inspection, palpation), these x-rays or the size of the tumor the doctor may suspect lymph node involvement. In this case the main question would no longer be "amazed if lymph nodes with cancer?" But "how many lymph nodes affected?" In this case, the method of choice is a standard axillary lymph node dissection, since it is very important to make sure that you do not have a single lymph node, where they could stay cancer cells. In addition, this operation will allow to estimate the number of lymph nodes.
When there is no removal of lymph nodes signal
Lymph node removal operation signal is not shown in the following cases:
If there is a probability of the cancer, lymph nodes,
If a woman underwent any surgical interventions that violate the normal lymph flow.
In addition, this procedure is not suitable for the following situations:
Age older than 50 years as a result of age-related changes in normal lymph flow is disturbed. In this case, a single lymph node removal of the signal can not assess the condition of the remaining lymph nodes.
When the patient was chemotherapy before surgery to reduce the size of the tumor or as a treatment for a variety of affected lymph nodes. This is due to the fact that as a result of chemotherapy may be violated in the lymphatic tissues.
ADVANTAGES removal of signal nodes
Removal of lymph nodes is the signal that the surgeon removes only one lymph node or a small group of two - three lymph nodes, in order to determine the cancer went to the axillary lymph nodes or not. When this procedure is not affected by normal functioning lymph nodes unaffected. There are many reasons why women are more inclined to this operation.
The fact that surgery on the lymph nodes can lead to undesirable side effects, such as the accumulation of lymph in the armpit area (called seroma).
Among other effects can be noted discomfort and numbness in the armpit and shoulder, as well as soft tissue swelling throughout the upper extremity - lymphedema. This so-called lymph edema. It can be observed not only in his hands, he is also in the chest and armpits. Thus, the greater the volume of surgical intervention, the higher the risk of discomfort, numbness, and sensitivity.
Therefore, if there is evidence, then the delete operation signaling nodes - this is an important step in the right direction. It is a reasonable way to assess the lymph nodes at high risk of cancer lesions. This operation is ideal for patients who have early stage cancer with a relatively low risk of lymph node involvement.
Removal of one or more lymph node signal can fairly accurately assess the condition of the remaining lymph nodes in the axilla in women with relatively small tumor size (less than 2 cm), unless prior to surgery with no enlarged lymph nodes.
Studies over the next five years have shown that the efficiency of this operation is the same as in the traditional removal of axillary lymph nodes.
The main disadvantage of removing the lymph nodes is a signal that the detection of cancer cells in them had to resort to additional methods of treatment (surgery, radiotherapy or both). Therefore, many doctors are more inclined to traditional lymphadenectomy in order to avoid further intervention. This requires a more careful selection of indications for removal of signaling nodes in each case. In case you had a high risk of lymph node involvement, which is defined inspection and survey data, it is recommended to conduct a traditional axillary lymphadenectomy.
When lymph nodes are found in signaling tumor cells
If the histological examination confirmed that the signal is not affected lymph nodes with cancer, it is most likely that the remaining lymph nodes in the armpit do not contain tumor cells. In this case, there is a good prognosis because the cancer has not spread beyond the breast tissue.
In the case when the signal detected lymph node tumor cells may require other treatments.
In this situation, you can choose several methods:
If the surgeon suspects that the signaling nodes affected by cancer, then immediately performed removal of more lymph nodes (axillary lymph node dissection), and their research.
If the histological examination revealed a significant loss of signal lymph node cancer cells, it is recommended that another intervention - axillary lymph node dissection to remove more lymph nodes and examine them.
Instead of surgery, postoperative radiotherapy is carried out in the field of remote nodes in order to kill any remaining cancer cells.
