Significance of evaluating the arm pit during breast cancer surgery

In his quarterly column, Dr P Raghu Ram discusses the options to assess whether the cancer has spread to the lymph nodes in the axilla (arm pit) or not. Knowing this will help in the further treatment of the patient

Along with surgery to the breast, i.e., wide local excision (lumpectomy)/mastectomy (removal of the breast), evaluating the axilla (arm pit) is a vitally important component of breast cancer surgery. Knowledge regarding the spread of cancer to lymph nodes in the axilla has a bearing on further treatment.

The options for assessing whether the cancer has spread to the lymph nodes in the axilla are:

Axillary node clearance: This is a time-tested standard procedure where most of the lymph nodes in the axilla (arm pit) are removed. However, it can cause significant morbidity and the common side effects include shoulder stiffness, numbness and pins and needles sensation in the inner part of the arm. This usually happens during the first few months after the operation. There is also a small possibility that a permanent swelling of the arm (lymphoedema) may affect about 10-20 in 100 women (10-20 per cent).

Sentinel Node Biopsy (SNB): Sentinel Node Biopsy is a minimally invasive procedure that has evolved to become the standard of care for women, who are unlikely to have spread of cancer to lymph nodes in the arm pit (axilla). The risk of side effects such as arm swelling, and altered sensation in the inner aspect of the arm are significantly reduced with SNB, when compared to Axillary node clearance.

Sentinel nodes are the first lymph nodes in the axilla, which drain from the area where the breast cancer has been found.

Sentinel Node Biopsy is a minimally invasive procedure that has evolved to become the standard of care for women, who are unlikely to have spread of cancer to lymph nodes in the arm pit (axilla).

Traditionally, SNB is performed using both the blue dye and radioactive fluid. More recently, Indocyanine green (ICG) Fluorescence Navigation System is being increasingly used in some centres to undertake SNB, with equivalent accuracy and relative ease. In this technique, SNB can be identified and resected more rapidly and easily, and equally, this technique has the major advantages of lower cost and fewer adverse effects.

The theory in doing SNB is that if the sentinel node/s are clear of cancer cells, all other nodes in the axilla should be clear. If cancer cells are found in the sentinel

Axillary node clearance is a time-tested standard procedure where most of the lymph nodes in the axilla (arm pit) are removed node/s, the patient may need to have the remaining lymph nodes removed (axillary node clearance) at the same time as surgery to the breast.

It is also possible to have radiotherapy instead of additional surgery. A multi-disciplinary team will decide the best option.

World’s first mobile app on Breast Health in 12 languages

Breast cancer is the commonest cancer affecting women in India. Due to lack of awareness, absence of a robust nationwide population-based breast cancer screening programme and inequitable cancer care, the vast majority present in advanced stages with poor survival.

Inspired by Prime Minister of India Narendra Modi’s dream of Digital India, in 2017, Ushalakshmi Breast Cancer Foundation developed the world’s first mobile app on breast health in English and 11 commonly spoken Indian languages – Hindi, Gujarati, Telugu, Tamil, Kannada, Malayalam, Punjabi, Bengali, Marathi, Oriya and Assamese.

The mobile application, “ABCs of Breast Health”, which is freely downloadable in both Apple and Google play store, provides information about every aspect of breast cancer and benign noncancer breast health issues. The aim of this landmark initiative launched in 2017 is to counsel, guide and educate people across the nation, about various aspects of breast health. The app will help people to be well informed and better prepared, thus filling a huge void in breast healthcare in south Asia.

Links for free download https://apps.apple.com/de/app/abcs-of-breast-health/id1482487468 https://play.google.com/store/apps/details?id=devatech.kims.avantari