When early-stage breast cancer is removed, the lymph node or nodes closest to the cancer -- the sentinel node(s) -- often is removed and sent to a pathologist for evaluation. Removing just these nodes is called sentinel lymph node biopsy or sentinel lymph node dissection.
If cancer cells are in the sentinel node, it means the cancer has spread beyond the breast. So more treatment may be needed to reduce the risk of the cancer coming back (recurrence). If cancer is in the sentinel node, there are several treatment choices to reduce recurrence risk:
- removing other lymph nodes near the cancer, called axillary lymph node dissection
- axillary radiation therapy (radiation therapy to the lymph nodes near the cancer)
- targeted therapy
- hormonal therapy (if the cancer is hormone-receptor-positive)
Lymphedema is one risk of breast cancer surgery, no matter which type of lymph node surgery is done. Lymphedema is swelling of the arm, hand, chest wall, and/or back caused by lymph fluid collecting in tissue after lymph nodes are removed. Edema is the medical term for swelling, so swelling caused by lymph fluid is "lymphedema." Experts estimate that from 5% to 40% of women will experience some level of lymphedema after breast cancer surgery. Having sentinel lymph node dissection instead of axillary lymph node dissection can lower the risk of lymphedema, but there is still some risk. Research shows that between 4% and 13% of women will experience lymphedema after sentinel lymph node dissection.
Other risks of breast cancer surgery include decreased range of arm motion and arm pain.
Still, because younger women who’ve been diagnosed with breast cancer are less likely to be in a clinical trial, doctors don’t know much about rates of arm problems in younger women after breast cancer surgery.
A study suggests that up to 40% of younger women say they have arm problems 1 year after being diagnosed with breast cancer.
The research was presented on Dec. 8, 2017 at the 2017 San Antonio Breast Cancer Symposium. Read the abstract of “Risk of arm morbidity after local therapy in young breast cancer survivors.”
The study included 1,037 women who are part of the Young Women’s Breast Cancer Study, a study created to look at biological, medical, and psychosocial issues in young women diagnosed with breast cancer.
All the women in the study were 40 or younger; half were younger than 37 and half were older. The women had been diagnosed with stage I to stage III breast cancer. Other characteristics of the women:
- about 50% said they felt financially comfortable
- about 40% were overweight or obese
- 79% were diagnosed with breast cancers that were T1 or T2 in size; this means they were smaller cancers
- 90% had no cancer in the lymph nodes or cancer in only a few lymph nodes
- 72% were diagnosed with hormone-receptor-positive breast cancer
- 65% were diagnosed with HER2-negative breast cancer
- about 30% had lumpectomy; the rest had either single or double mastectomy
- 55% had sentinel lymph node dissection only
- 21% had both sentinel lymph node and axillary lymph node dissection
- 20% had axillary lymph node dissection only
(some of the women had missing data, which is why the lymph node surgery percentages don’t add up to 100%)
Overall, 13% of the women said they had some type of arm swelling and 40% said they had decreased range of arm motion 1 year after being diagnosed with breast cancer:
- The type of lymph node surgery didn’t seem to affect the number of women who had decreased range of arm motion.
- Arm swelling was much more common among women who had axillary lymph node dissection with either lumpectomy or mastectomy without radiation.
- Women who were overweight were 70% more likely to say they had arm swelling than women who weren’t overweight.
- Women who were overweight were 40% more likely to say they had decreased range of arm motion than women who weren’t overweight.
- Women who felt financially comfortable were 40% less likely to report arm swelling.
Factors linked to a higher risk of arm swelling were:
- being overweight
- feeling financially uncomfortable
- being diagnosed with a large breast cancer
- having axillary lymph node dissection
- having radiation
Factors linked to a higher risk of decreased range of arm motion were:
- being overweight
- having mastectomy
- having radiation therapy
"These issues are of particular importance in these patients given their long survivorship period, frequently active lifestyle, and the importance of body image," said Anne Kuijer, a postdoctoral research fellow at Dana-Farber Cancer Institute/Brigham and Women's Hospital and a surgical resident at Diakonessen Hospital Utrecht, in the Netherlands, who presented the research. "The study highlights the importance of de-escalating axillary treatment when appropriate in young breast cancer patients, and illustrates that even conservative surgery has long-lasting effects. Women should be encouraged to talk to their doctors about all of their options for surgery and the expected outcomes."
If you’re a younger woman who’s been diagnosed with early-stage breast cancer, sentinel node biopsy may be done as part of your surgery. If cancer cells are found in the sentinel node, your doctor will consider all the details of your situation, including your age and the characteristics of the cancer (size, stage, etc.) before recommending treatments to reduce the risk of recurrence.
If you develop lymphedema or have decreased range of motion in your am, talk to your doctor immediately about ways to treat either condition. Because early swelling in your arm can be hard to notice, you may want to ask your doctor or a lymphedema therapist to have the circumference of your arms measured before breast cancer surgery. That way you can judge any changes in your arm over time.
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