Breast Sentinel Lymph Node Biopsy
A sentinel lymph node biopsy involves removing the lymph node(s) that specifically drain cancer in the breast. A sentinel lymph node biopsy involves injecting a small amount of radioactive tracer (or occasionally a blue dye) around the tumor. This involves less radiation than getting a chest x-ray.
The sentinel lymph node (think of it as a gatekeeper lymph node at the entrance to the other lymph nodes under the arm) is then identified under the arm using a small hand-held Geiger counter and removed, leaving the remaining lymph nodes intact. The sentinel lymph node is then extensively examined by the pathologist and, if no cancer is found, there is no need to remove the rest of the lymph nodes under the arm.
If cancer is found in the sentinel lymph node, cancer may be in others as well, and sometimes the remaining lymph nodes are removed at a second operation. The sentinel lymph node biopsy will allow most women with breast cancer to avoid removal of all their lymph nodes and avoid its potential problems (swelling of the arm, numbness/pain of the upper arm, decreased the mobility of the shoulder, etc.). This technique combined with lumpectomy allows for the least amount of pain and deformity for the patient and can easily be performed as an outpatient.
The patient with breast cancer is often treated with all modalities of therapy available today – surgery, chemotherapy, and radiation. We will make an individualized plan for you while providing emotional support for you and your family throughout the entire process.
Systemic Therapy
Sometimes the patient needs the whole body or ‘systemic’ treatment in case a few breast cancer cells have escaped the breast and lymph nodes. This therapy may involve chemotherapy, hormonal therapy, or both. The chemotherapy usually involves several drugs used in combination and is given in ‘cycles’ – that is one day of chemotherapy followed by 2-3 weeks off. This is considered one ‘cycle’. Most patients get 4-8 cycles of chemotherapy depending on the extent of the tumor and whether it is in the lymph nodes or not.
Most people tolerate chemotherapy very well with only the rare patient experiencing nausea or vomiting. The biggest side effects are fatigue and hair loss. Chemotherapy is given to increase the chances of a cure.
Hormonal therapy is also considered systemic therapy. There are many hormonal agents, but the most commonly prescribed are Tamoxifen, and a group of drugs called aromatase inhibitors (Arimidex, Femara, and Aromasin). Tamoxifen is very well tolerated, with some patients experiencing hot flashes. Rare complications include blood clots in the legs, cancer of the uterus, and stroke. Tamoxifen has an additional beneficial effect of decreasing osteoporosis. The aromatase inhibitors may also cause hot flashes but do not raise your chances of uterine cancer, blood clots or stroke. However, they can increase bone loss leading to bone fractures.
Studies have shown that hormonal therapy only works in patients whose tumors were estrogen receptor positive.