This page is devoted to educational topics for our patients
and is updated periodically. |
1.) What is Cancer?
Cancer is a group of more than 100 different diseases which develop when our body's cells become abnormal, continuing to divide forming new cells without the usual control mechanisms. All of our body's tissues are made up of cells. Normally, cells divide to produce new cells only when our body needs them, such as to replace old dead cells or to repair damage from injury. If cells keep dividing, forming new cells when not needed, a mass of tissue forms called a tumor. This may be either benign or malignant. Benign tumors are not cancerous. They may be removed and in most cases do not grow back. They do not invade adjacent tissues, nor do they spread to other parts of our bodies. Malignant tumors are cancerous. Cancer cells invade adjacent tissues causing local damage. Cancer cells may break away from a malignant tumor and spread to other parts of our bodies by way of the lymphatic system or blood stream. The spread of cancer cells to a distant site is called metastasis. Metastases, in turn, form new tumors which invade local tissues at distant sites.
Most cancers are named for the type of cell or organ in which they arise. When a cancer spreads, the new tumor has the same type of abnormal cells which were present in the original tumor and carries the same name. For example, if lung cancer spreads to the liver, the cancer cells in the liver are still lung cancer cells (not liver cancer). This disease is called metastatic lung cancer.
Cancer cells develop as a result of injury to individual cells from a complex mix of factors related to the environment, lifestyle, and genetics (inherited traits). We estimate about 80 percent of all cancers are related to cellular damage from the use of tobacco products, to what we eat and drink, and, to a lesser extent, to exposure to radiation and cancer-causing chemicals in the environment and workplace. Some people are much more sensitive than others to various factors.
2.) Sentinel Lymph Node Biopsy For Breast Cancer
Sentinel lymph node biopsy is a new surgical technique for evaluating the axillary (armpit) lymph nodes in a patient with breast cancer. This is a less invasive alternative to the conventional surgical evaluation of axillary lymph nodes in a patient with early breast cancer.
(click on the question below to find the answer)
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a) What is a sentinel node?
A sentinel node is the first lymph node to which a cancer is likely to spread. In breast cancer, the sentinel node is usually located among the axillary nodes, the group of lymph nodes under the arm. In a small percentage of cases, however, the sentinel node is found elsewhere in the lymphatic system of the breast. In some cases, there can be more than one sentinel lymph node. If a doctor can feel lymph nodes during a physical exam of the underarm area that are enlarged or firm then there is a suspicion that there has been spread of cancer to the lymph nodes, and the patient is diagnosed as clinically node-positive. If a patient is clinically node-negative, surgery and pathologic analysis must be performed to determine whether there is microscopic evidence of cancer in the lymph nodes.
b) What is the conventional surgical treatment for breast cancer?
Standard treatment usually involves removing a breast tumor by either lumpectomy or mastectomy, and also removing most of the axillary nodes (axillary node dissection). Several complications can arise from removing the axillary nodes; some reports indicate that more than 80 percent of women who undergo a complete axillary dissection have at least one complication after surgery. These complications are of varying severity, but can include lymphedema (swelling in the arm caused by excess fluid buildup), numbness, a persistent burning sensation, infection, and limited movement of the shoulder.
c) Why is sentinel lymph node biopsy advantageous?
The sentinel node can provide valuable information about the status of a woman’s cancer without risk of the potential complications associated with standard axillary dissection.
d) Is sentinel lymph node biopsy a new procedure?
The concept of mapping a sentinel node was first reported in 1977 by a researcher studying cancer of the penis. The technique was later used to study drainage patterns in patients with melanoma, as well as many other types of cancer, and was first reported for breast cancer in 1993. Since that time, it has become standard in the treatment of patients with melanoma and has become available to patients with breast cancer in most areas of the United States. There are two large national multi-institutional studies currently underway designed to evaluate many aspects of the sentinel lymph node biopsy technique. While this procedure has been proven by multiple studies to provide valid information, it is important that the surgeon involved be experienced in performing the technique so that the results are accurate and useful.
e) What are the potential side effects and complications of sentinel lymph node biopsy?
The side effects of sentinel node biopsy can include minor pain, bruising, scarring, or the formation of a small fluid collection at the site of the biopsy. There is also a very low possibility of an allergic reaction to the blue dye used in finding the sentinel node.
f) How is the sentinel lymph node found?
There are two methods for finding the sentinel node. One is to inject a blue dye near the breast tumor and track its path through the lymph channels to the axillary lymph nodes. The dye accumulates in the sentinel lymph node and becomes visible. A small skin incision under the arm is used to locate and remove the sentinel node or nodes. In a similar technique, a small amount of radioactive solution is injected near the tumor that accumulates in the sentinel node. A radioactivity detector is then used to locate the sentinel node or nodes for removal. These two techniques are complementary and may be used together.
g) What information is provided by the sentinel node biopsy?
The best information for determining the stage (extent of spread) of a breast cancer comes from the axillary lymph nodes. Previous research has shown that the sentinel node can be used to determine if cancer cells have spread to the lymph nodes. In the sentinel node biopsy, only one or a few lymph nodes are removed for pathologic (laboratory) analysis when a patient has a lumpectomy or mastectomy. The pathologic analysis of this limited set of lymph nodes is potentially more accurate because specialized techniques can be focused on a smaller amount of material. Studies have shown that if pathologic analysis finds no cancer cells in the sentinel node, the patient is unlikely to have tumor cells in the remaining axillary nodes.
h) What surgical procedures are involved?
Patients will either undergo breast-conserving surgery with sentinel lymph node biopsy, or mastectomy and sentinel lymph node biopsy. If cancer cells are detected within the sentinel node, then there is a 30%-40% chance that other axillary lymph nodes will also contain cancer cells. When the sentinel lymph node is found to contain cancer cells, a standard axillary dissection is required to remove the remaining lymph nodes.
i) What other treatments will patients receive?
In accordance with standard guidelines for cancer treatment, patients may receive chemotherapy and/or hormonal therapy following mastectomy or lumpectomy with sentinel lymph node biopsy. Patients undergoing lumpectomy will also receive breast radiation treatments. Patients undergoing mastectomy who have positive sentinel lymph nodes may also require radiation treatments to the chest wall or to the lymph node area under the arm.
j) Who is eligible for the sentinel lymph node biopsy procedure?
Breast cancer patients may be eligible if:
1. They have been diagnosed with breast cancer removable by lumpectomy or mastectomy.
2. The breast cancer size is not greater than five centimeters.
3. Their axillary lymph nodes cannot be felt during a physical examination.
4. They have not had any treatment for their current breast cancer.
The best way to determine which patients with breast cancer should be offered this procedure is by consultation with an experienced cancer surgeon.
If there are any specific topics you would like to learn more about send us an e-mail to: info@cascadesurgicaloncology.com
