Breast Cancer Surgery: Less Is Better? Review of the Study From JAMA

Traditionally, early stage breast cancer patients who have decided to undergo breast conservation procedures. This includes at least three steps:

Step 1: The surgeon removes the breast lump

Step 2: The color of the surgeon performing the lumpectomy injection area of ​​the original cancer that follows along the lymph channels in the lymph glands in the arm pit. This color gets trapped in the lymph glands that drains this area and called lumpectomy sentinel lymph nodes. Examination of these nodes can show cancer cells indicate that breast cancer has spread. If you are negative then the surgeon believes that breast cancer has not spread to these glands, and further surgery in the hands of the pit must be performed.

3 step. If the sentinel node showed cancer cells, the belief is that the cancer has spread to other nodes in the arm pit and should be removed. This procedure is called a dissection of lymph nodes removed several nodes and sent to pathology for a full assessment as to the exact number of lymph nodes involved with cancer.

Step 4:. The patient will receive external beam radiation therapy, also called Tele-therapy involving the breast for six to seven weeks

Step 5:. Some patients will require chemotherapy in a variety of factors to make sure that the cancer has not returned elsewhere in the body

So what is wrong in this picture?

As shown in step 3, the belief that all patients with sentinel nodes that contained cancer should continue to complete lymph node dissection is a question that is asked in this study. The results showed that as long as these patients had minimal involvement of these nodes were treated with external radiation therapy, that there really was no need to go through a complete node dissection disekcije.Problem to lymph nodes caused a significant risk of lymph edema of the hands that side which can be disabling and debilitating. The authors found no difference in results between groups of patients with cancer sentinel nodes underwent a lymph node dissection or not. Those who did not undergo full axillary node dissection had none of the complications such as lymph edema, and not jeopardize their ability to survive their cancer.

Which patients with early stage breast cancer have cancer that has spread to lymph nodes and sentinel absolutely have to go through the entire node dissection?

These patients undergo a mastectomy, they undergo lumpectomy without radiation therapy, those treated with partial breast irradiation, those receiving chemotherapy prior to surgery and those who receive whole breast irradiation in prone position, in which the low axilla is not treated.

In summary: axillary lymph node dissection can not be justified for women with early stage breast cancer with minimal spread to the sentinel lymph nodes and who were treated with breast conservation surgery, whole breast radiation and some chemotherapy.