Research Advances
Recent Development in
Axillary Lymph Node Management in Breast Cancer By Winkle Kwan
I
n North America, cancer treatment is the most important contributor to the lymphedema problem. The axillary dissection used for breast cancer therapy has historically been responsible for most of the chronic upper limb lymphedema cases. Fortunately, there have been several key publications from large clinical trials in the last five to six years, resulting in significant decline in the use of full or partial axillary dissection. This article will review these key publications, discuss controversies on the impact of these publications and explore potential development in the axillary nodal management of breast cancer. Surgeons have been aware of the long-term morbidities of axillary dissection for years. These include lymphedema, nerve injuries (brachial plexopathy and upper arm numbness), upper arm weakness and limited shoulder mobility. While axillary dissection is arguably responsible for most of the long-term physical morbidity of breast cancer surgery, it also plays an important role in breast cancer treatment. It provides prognostic information, guides further management and, until recently, was believed to have therapeutic benefits—after all,
cancer involved lymph nodes should theoretically The late 1990s saw the launch of several large be surgically removed. cooperative group randomised trials comparing In the last 10 years, however, the importance of sentinel node biopsy and axillary nodal dissection. axillary dissection has been questioned. Advances Early results of these trials became available in systemic adjuvant treatment with from 2003 onwards and have transformed hormones and chemotherapy the strategy of lymph node have cast doubt on whether management in breast cancer. Sentinel node minimally involved lymph biopsy is a new nodes need to be Key published removed. In addition, randomized technique based on the the use of adjuvant trials theory that malignant cells systemic therapy European Institute from certain cancers first (hormones and of Oncology study1 involve one or a few chemotherapy) has Published in the New “sentinel nodes” before become wide spread England Journal of involving others in the enough that lymph Medicine in 2003, this lymph node group. node status may not be single institutional study crucial in guiding the use of from the institute of the well adjuvant therapy. Sentinel node known Italian breast oncologist biopsy is a new technique based Umberto Veronesi, provided the earliest on the theory that malignant cells from certain evidence that sentinel node biopsy results in less cancers first involve one or a few “sentinel nodes” arm problems. The study randomized low risk before involving others in the lymph node group. breast cancer patients (≤ 2 cm primary) to Sentinel Node Biopsy (SNB) and Axillary Nodal Dissection (AND) versus SNB followed by AND only if the Dr. Winkle Kwan, MBBS FRCPC Dip ABR, is a Radiation Oncologist in Surrey SNB was positive. As reported in the New England working with the BC Cancer Agency at the Fraser Valley Center. Breast cancer treatment has Journal, the follow-up was short, but there been his area of expertise for 15 years. He is an avid supporter of the provincial and national was less pain and better arm mobility in patients efforts in raising the awareness of lymphedema, particularly as a result of cancer treatment.
who underwent SNB only, without AND.
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