Axillary Lymph Node Dissection

What is axillary lymph node dissection?

Axillary lymph node dissection (ALND) is surgery to remove the lymph nodes in your armpit (axillary lymph nodes). Surgical oncologists perform this surgery to see if cancer from your breast is in your axillary lymph nodes. You may have this procedure as part of breast cancer surgery like a lumpectomy or mastectomy.

What are axillary lymph nodes?

Your axillary lymph nodes act like a checkpoint for lymph draining from your arms, breast and chest wall. Lymph is a watery colorless fluid that, among other things, sweeps up cancer cells. You have between 20 and 40 axillary lymph nodes spread among groups of nodes in your armpit. In breast cancer, your axillary lymph nodes are generally the first place that cancer spreads.

Why would I need an axillary lymph node dissection?

Your surgical oncologist may recommend you have this procedure as part of your breast cancer surgery if:

• Your provider can feel swollen lymph nodes in your underarm or collarbone area. Cancer in lymph nodes can make them swell.
• Imaging tests show signs of swollen lymph nodes in your underarm. Imaging tests may be breast ultrasound, computed tomography (CT) scan or positron emission tomography (PET) scan.
• A sentinel node biopsy shows that three or more of your lymph nodes contain cancer cells. This test involves removing the first few nodes in a group of lymph nodes where a particular cancer is most likely to spread (metastasize).
• A course of pre-surgical chemotherapy to shrink a breast cancer tumor doesn’t eliminate cancer in target axillary lymph nodes.

What happens before axillary lymph node dissection?

This procedure typically happens if you’re having a lumpectomy or mastectomy. But in some situations, your surgical oncologist will do an axillary lymph node dissection after your breast cancer surgery.

You’ll typically receive general anesthesia so you’re asleep during surgery. Your surgical oncologist will explain specific steps you should take before surgery, like whether you should stop eating and drinking before surgery.

What happens in axillary lymph node dissection?

The specific steps in an axillary lymph node dissection are:

• Your surgical oncologist will make an incision (cut) in your armpit so they can get to the lymph nodes that tests show may contain cancer cells.
• They’ll remove the tissue containing the lymph nodes from a particular area in the armpit for a medical pathologist to examine.
• They’ll place a surgical drain in the surgery site.
• They’ll close the incision.

What are the benefits of axillary lymph node dissection?

This procedure is how your surgical oncologist finds out if there’s cancer in your axillary lymph nodes. Cancer in these lymph nodes can carry cancer to other areas of your body.

What are the risks of axillary lymph node dissection?

Axillary lymph node dissection may affect your lymphatic system so it doesn’t move lymph through your body like it should. That can cause lymphedema (swelling in your arm). That swelling can lead to skin issues like wounds and infections. Other potential complications include:

• Axillary web syndrome (AWS), which is scar tissue in your lymph vessels that causes pain and may make it hard for you to move your shoulder.
• Bleeding.
• Infection.
• Nerve damage.

Your surgical oncologist may have you see a lymphedema specialist as part of your treatment team to monitor for signs or symptoms of lymphedema. These specialists can recommend ways to prevent lymphedema.

What do the results of an axillary lymph node dissection mean?

This procedure is how your surgical oncologist finds out how many cancerous lymph nodes are in your armpit. In general, a high number of cancerous axillary lymph nodes leads to a higher overall. Node categories are:

• N1: A sentinel node biopsy shows there’s cancer in one to three axillary lymph nodes or abnormal internal lymph nodes in your chest.
• N2: An axillary lymph node dissection detects cancer in four to nine underarm lymph nodes or there are abnormal internal lymph nodes in your chest.
• N3: Cancer affects 10 or more axillary lymph nodes or is spreading to lymph nodes under your collarbone.

But it’s important to remember the lymph node number is just one factor in staging breast cancer. Your surgical oncologist will also consider:

• Tumor size and location.
• Whether the tumor is spreading (metastasizing) to nearby tissues.
• The tumor receptor status, like whether the tumor contains the estrogen receptor protein or the progesterone receptor protein.

It’s not always easy to make sense of cancer staging. Don’t hesitate to ask your surgical oncologist to explain how the results may affect your situation.

When should I call my oncologist?

Call your oncologist if you experience:

• Redness or discharge at the surgery site. This may be a sign of infection.
• You have more pain than you expected, or your prescription pain medication doesn’t reduce your pain.
• Your arms and hands swell. This may be a symptom of lymphedema.