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2797 Finding out whether your breast cancer has spread to your lymph nodes

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A key part of your surgery involves identifying whether the cancer has affected the lymph nodes near your breast. The lymph nodes are part of the body's drainage system and there are a number of them around your breast and in your armpit. The Sentinel Lymph Node or nodes, are the first lymph nodes in your armpit (which we also call your axilla) and are the first place to which breast cancer usually spreads. Occasionally there is more than one Sentinel Node. By removing the Sentinel Node and testing it, we gain information about the behaviour of your breast cancer in your armpit. The procedure we use to find this out is call Sentinel Lymph Node Biopsy. There are three results that are possible from the test: You can be clear of cancer in the nodes, which we call a negative result. You will not need further nodes removed. You can have a ‘low volume’ result, called a micro-metastasis. Or you can have a ‘high volume’ result, called a macro-metastasis. This important information helps us to advise you and to recommend the best type of treatment for you. To do this we need to find your Sentinel Node and remove it for testing. So, on the day before, or the morning of your surgery to remove the lump in your breast, you will come in to hospital to have a radioactive fluid injected into your breast. Afterwards, you may have images taken of the fluid's path so that your surgeon can see the lymph nodes connected to your breast cancer. Once you have been taken to theatre and are asleep, the surgeon may inject a blue dye into your breast. This works in the same way as the radioactive fluid, and gives us another way to show us where the lymph nodes are. The surgeon will use a special type of wand to detect signals from the radioactive fluid injection, and will look for the blue nodes stained by the blue dye in order to identify the sentinel nodes that will be removed for testing. Usually, between one and four nodes absorb the injected materials. Occasionally, it is not possible to find the sentinel node and if this happens the surgeon will remove more nodes to make sure the node which is likely to be the Sentinel node is removed. Our aim is always to remove as few nodes as possible to minimise the side effects. Some hospitals offer intra-operative testing, which means that sentinel nodes that have been removed are tested whilst your surgeon continues with your operation and removes the lump in your breast. In most cases the Sentinel node is clear of cancer cells and you will not need any more nodes removed. If this is the case for you, the surgeon will finish the operation at this point and your oncologist may advise further treatment. However, if the Sentinel node contains high-volume of cancer cells the surgeon needs to remove all the lymph nodes in your lower armpit. This may be done immediately whilst you are in theatre, or in a second operation. Your surgeon will discuss your options with you in advance. The procedure of removing all the lymph nodes in your lower armpit is called an Axillary Node (Gland) Clearance There are some pros and cons to this testing procedure. Using the radioactive fluid and blue dye does have some side effects. The blue dye will discolour your urine, stools, tears and contact lenses for a few days, and your breast skin will be discoloured for a few months and very occasionally for a year or so. Some people have an allergic reaction to the blue dye, and the injection of radioactivity into the breast may give you some discomfort. There is also a small risk that the procedure doesn't identify the right lymph node. In this instance it is possible that the lymph node containing cancer cells could be left behind undetected. The surgeon will let you know about the risks of this happening to you. Because of these issues, we will ask you to sign a consent form agreeing to have the Sentinel lymph node biopsy using the radioactive fluid and blue dye, and also whether you are in agreement to the surgeon removing all of your lymph nodes if a high volume of cancer cells are detected or if the Sentinel node cannot be detected.

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Duration: 4 minutes and 19 seconds
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Language: English
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Posted by: richardwh on Nov 16, 2015

2797 Finding out whether your breast cancer has spread to your lymph nodes

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