What is Axillary Lymph Node Dissection?
Axillary lymph node dissection (ALND) is a surgical procedure involving the removal of lymph nodes from the axilla, or armpit region. This procedure is primarily performed in patients with breast cancer to determine whether the cancer has spread to the lymphatic system. The information gathered from this surgery can significantly influence the course of treatment, including the need for additional surgery, chemotherapy, or radiation therapy.
Why is ALND Performed?
ALND is often performed to assess the extent of cancer spread. In breast cancer, for instance, the axillary lymph nodes are typically the first location where cancer cells metastasize. By examining the removed lymph nodes, doctors can determine the stage of cancer, which directly impacts prognosis and the choice of treatment.
How is the Procedure Conducted?
During an ALND, the patient is placed under general anesthesia. The surgeon makes an incision in the armpit area and carefully removes a group of lymph nodes. The number of nodes removed can vary but generally ranges from 10 to 40. The excised lymph nodes are then sent to a pathology lab for microscopic examination to detect the presence of cancer cells.
1. Lymphedema: Swelling in the arm due to the accumulation of lymphatic fluid.
2. Infection: Although rare, infections can occur at the surgical site.
3. Nerve Damage: Temporary or permanent nerve damage can cause numbness, tingling, or pain.
4. Limited Range of Motion: Some patients may experience a reduced range of motion in the shoulder and arm.
What are Alternatives to ALND?
In some cases, less invasive alternatives to ALND may be considered. One such alternative is the
sentinel lymph node biopsy (SLNB). This procedure involves removing only the first few lymph nodes into which a tumor drains (sentinel nodes). If the sentinel nodes are free of cancer, further lymph node removal may not be necessary. SLNB is associated with fewer complications and a quicker recovery time compared to ALND.
What is the Recovery Process Like?
Recovery from ALND typically involves a hospital stay of one to two days, although some patients may be discharged on the same day. Post-operative care includes managing pain, caring for the surgical wound, and performing exercises to maintain arm mobility. Patients are often advised to avoid heavy lifting and strenuous activity for several weeks following the surgery.
Impact on Cancer Treatment and Prognosis
The results from an ALND provide crucial information that helps tailor the patient's treatment plan. For example, if cancer cells are found in the lymph nodes, additional treatments such as chemotherapy or radiation therapy may be recommended. Conversely, if the lymph nodes are free of cancer, the treatment plan may be less aggressive. The number of affected lymph nodes also provides valuable prognostic information, as a higher number of involved nodes generally indicates a more advanced stage of cancer.Conclusion
Axillary lymph node dissection remains a critical procedure in the management of certain cancers, particularly breast cancer. While it offers valuable diagnostic and prognostic information, it is not without risks. Advances in less invasive techniques, such as sentinel lymph node biopsy, offer promising alternatives for some patients. Discussing the potential benefits and risks with a healthcare provider is essential for making informed decisions about cancer treatment.
