Lymph Removal
The guards standing between your breast and the rest of you.
Lymph nodes remove cell waste and fluids from lymph and help fight infections. Sometimes they also catch cancer cells. These nodes are located in the armpit, collarbone, and the outer edge of the breast. Sometimes when these areas are swollen, it can be an indication of the need for further investigation.
To determine if cancer cells have spread to the rest of the body, lymph nodes in your armpit, under your arm, collarbone and neck may be felt by hand to check for signs of enlarged nodes. Often lymph nodes are removed during a mastectomy. The more invasive a cancer is, the more likely more nodes will be taken.
Breast cancer spreads in a very predictable fashion. As the tumor becomes larger, it tends to invade lymphatic vessels and tumor cells break free. They flow along with the lymph away from the breast, typically first to the axilla (armpit), then to the supraclavicular region (under the collarbone). Rarely, the internal mammary lymph nodes may collect cancer cells. These internal mammary nodes are located along the sternum (breastbone). Given enough time, tumors can invade blood vessels and send tumor cells throughout the body to distant sites. This is called metastasis. The most common sites of metastatic disease in breast cancer include bones, the brain, the liver and the lungs.
There are also lymph nodes called “sentinels” which are the nodes closest to the tumor, that stand as “sentinels” or “guards” to the rest of the body. These guards are investigated during a lumpectomy when a cancer is: not invasive, enlarged lymph nodes can’t be felt in the axilla (armpit), and a biopsy has proved the presence of cancer. Investigating these lymph “guards” to see if they carry cancer is done by injecting a small amount of radioactive dye into the breast and is taken up by the lymphatic system. The surgeon can measure the highest site of radioactivity which represents the first, closest lymph node (or SLN) to which the tumor drains. This is removed and immediately examined by a pathologist. If no tumor is seen, the surgeon does not need to perform an axillary lymph node dissection. If it does have significant tumor, a dissection is done.
