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Breast Cancer — Surgical Management of Lymph Nodes

On-Topic Video Transcript

Gretchen Ahrendt, MD

A woman who has an early stage invasive breast cancer, who we plan to perform a lumpectomy, we also need to see if the lymph nodes have cancer, and the surgical procedure we do is called sentinel lymph node biopsy. And the sentinel lymph node is a very specialized lymph node. It is the first lymph node that cancer would spread to if it was going to travel out of the breast. And so what the surgery does is identify that lymph node, and we test it for evidence of cancer. And traditionally, if we found cancer in that lymph node, the next step would be to remove all of the lymph nodes under the arm. So what we’ve learned is that even if we find cancer in the first one or two sentinel lymph nodes, it may not be necessary to surgically remove the rest of the lymph nodes. If we’re doing the surgery in a woman who is having a lumpectomy, our plan is to administer follow up radiation. And radiation not only helps prevent the cancer from coming back in the breast but also in the lymph node area.

Lower Risk of Lymphedema

The benefits to not removing all of the lymph nodes is that it leaves the patient with a lower risk of lymphedema. So lymphedema is a chronic condition that develops when you perform extensive lymph node surgery, that can lead to a back-up of lymph fluid in the arm, and that can cause progressive swelling and discomfort, and ultimately disability with that arm.

Suitable Patients

This approach is suited for women who have an early breast cancer — so a small tumor in a woman who’s planning to have a lumpectomy and follow-up radiation treatment to her breast to help prevent the cancer from coming back. We wouldn’t employ this approach for someone with a more advanced breast cancer.

Personalized Treatment

The philosophy at UPMC CancerCenter is to personalize the approach to cancer care. So every woman’s breast cancer is different. We apply the latest knowledge and the most advanced technology to personalize the treatment plan for each woman to give her the best possible outcome.

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