Minimal surgery for breast cancer
 
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Breast cancer, towards mini-surgery.

Date: 08/10/2015
Last edited: 08/10/2015

Breast cancer can spread to other organs (liver, lung metastases, etc.) via the lymph. Obligatory passage of this liquid, a number of axillary lymph nodes can be removed simultaneously with the operation of the tumor. This axillary dissection may nevertheless lead to painful consequences. A new less traumatic method could remedy: the technique of the sentinel node.

The invasion of the lymph nodes in the armpits is the first step towards the development of metastases in breast cancer. It largely determines the prognosis of this cancer and its treatment.

If an operated tumor measures less than a millimeter in diameter and has not yet invaded the lymph nodes, it has nine in ten chance of healing. But if there is already a node negative at treatment, the chances of recovery are only 50%.

To maintain maximum survivability, affected lymph nodes should be removed and the treatment shoud be completed by chemotherapy that will destroy disseminated tumor cells in the body.

Until very recently, removal of invasive breast tumor (that is to say having started to infiltrate the mammary gland) was therefore systematically associated with axillary dissection on the affected side. This involves removal of a portion of the node string in the armpit of the treated breast side. Formerly, all nodes were removed. Today, a dozen nodes are removed and examined.

Among the consequences of axillary dissection, the lymphatic drainage of the breast and arm suffers, and there is an increased susceptibility to infections in the arm. In addition, this dissection can cause pain and a certain impotence of the arm in the weeks following the procedure. A physical therapist will help the patient to gradually regain full mobility.

After three to eight days of operation, a Redon (small tube for draining lymph) is retained below the arm. Despite this, the lymph drainage is less effective, and a third of women needs a puncture after the operation.

Finally, 5% of women face after several years with a problem of “thugs” or lymphedema of the arm. This swelling of the hand and the arm is a very discomfortable problem for the patient. Currently, there is no real effective treatment for this issue.

Developed since the early 1990s, the technique of the sentinel lymph node is much less traumatic. The specialist first identifies the axillary lymph node chain, and the nodes who are the first to be invaded by the malignant cells, and removes them for examination. A real dissection will be made only if they are affected.

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