Lymphedema, also known as lymphoedema and lymphatic edema, is a condition of localized swelling caused by a compromised lymphatic system. The lymphatic system functions as a critical portion of the body's immune system and returns interstitial fluid to the bloodstream.
A lymph node, or lymph gland, is a kidney-shaped organ of the lymphatic system and the adaptive immune system. A large number of lymph nodes are linked throughout the body by the lymphatic vessels. They are major sites of lymphocytes that include B and T cells. Lymph nodes are important for the proper functioning of the immune system, acting as filters for foreign particles including cancer cells, but have no detoxification function.
The femoral triangle is an anatomical region of the upper third of the thigh. It is a subfascial space which appears as a triangular depression below the inguinal ligament when the thigh is flexed, abducted and laterally rotated.
The axilla is the area on the human body directly under the shoulder joint. It includes the axillary space, an anatomical space within the shoulder girdle between the arm and the thoracic cage, bounded superiorly by the imaginary plane between the superior borders of the first rib, clavicle and scapula, medially by the serratus anterior muscle and thoracolumbar fascia, anteriorly by the pectoral muscles and posteriorly by the subscapularis, teres major and latissimus dorsi muscle.
Lymphadenectomy, or lymph node dissection, is the surgical removal of one or more groups of lymph nodes. It is almost always performed as part of the surgical management of cancer. In a regional lymph node dissection, some of the lymph nodes in the tumor area are removed; in a radical lymph node dissection, most or all of the lymph nodes in the tumor area are removed.
Inguinal lymph nodes are lymph nodes in the groin. They are situated in the femoral triangle of the inguinal region. They are subdivided into two groups: the superficial inguinal lymph nodes and deep inguinal lymph nodes.
The periaortic lymph nodes are a group of lymph nodes that lie in front of the lumbar vertebrae near the aorta. These lymph nodes receive drainage from the gastrointestinal tract and the abdominal organs.
Lumpectomy is a surgical removal of a discrete portion or "lump" of breast tissue, usually in the treatment of a malignant tumor or breast cancer. It is considered a viable breast conservation therapy, as the amount of tissue removed is limited compared to a full-breast mastectomy, and thus may have physical and emotional advantages over more disfiguring treatment. Sometimes a lumpectomy may be used to either confirm or rule out that cancer has actually been detected. A lumpectomy is usually recommended to patients whose cancer has been detected early and who do not have enlarged tumors. Although a lumpectomy is used to allow for most of the breast to remain intact, the procedure may result in adverse affects that can include sensitivity and result in scar tissue, pain, and possible disfiguration of the breast if the lump taken out is significant. According to National Comprehensive Cancer Network guidelines, lumpectomy may be performed for ductal carcinoma in situ (DCIS), invasive ductal carcinoma, or other conditions.
In human anatomy, the axillary artery is a large blood vessel that conveys oxygenated blood to the lateral aspect of the thorax, the axilla (armpit) and the upper limb. Its origin is at the lateral margin of the first rib, before which it is called the subclavian artery.
In human anatomy, the axillary vein is a large blood vessel that conveys blood from the lateral aspect of the thorax, axilla (armpit) and upper limb toward the heart. There is one axillary vein on each side of the body.
The subclavius is a small triangular muscle, placed between the clavicle and the first rib. Along with the pectoralis major and pectoralis minor muscles, the subclavius muscle makes up the anterior axioappendicular muscles, also known as anterior wall of the axilla.
The sentinel lymph node is the hypothetical first lymph node or group of nodes draining a cancer. In case of established cancerous dissemination it is postulated that the sentinel lymph nodes are the target organs primarily reached by metastasizing cancer cells from the tumor.
Radical mastectomy is a surgical procedure that treats breast cancer by removing the breast and its underlying chest muscle, and lymph nodes of the axilla (armpit). Breast cancer is the most common cancer among women. During the early twentieth century it was primarily treated by surgery, when the mastectomy was developed. However, with the advancement of technology and surgical skills in recent years, mastectomies have become less invasive. As of 2016, a combination of radiotherapy and breast conserving mastectomy are considered optimal treatment.
A micrometastasis is a small collection of cancer cells that has been shed from the original tumor and spread to another part of the body through the lymphovascular system. Micrometastases are too few in size and quantity to be picked up in a screening or diagnostic test, and therefore cannot be seen with imaging tests such as a mammogram, MRI, ultrasound, PET, or CT scans. These migrant cancer cells may group together to form a second tumor, which is so small that it can only be seen under a microscope. Approximately 90 per cent of people who die from cancer die from metastatic disease, since these cells are so challenging to detect. It is important for these cancer cells to be treated immediately after discovery, in order to prevent the relapse and the likely death of the patient.
Breast cancer management takes different approaches depending on physical and biological characteristics of the disease, as well as the age, over-all health and personal preferences of the patient. Treatment types can be classified into local therapy and systemic treatment. Local therapy is most efficacious in early stage breast cancer, while systemic therapy is generally justified in advanced and metastatic disease, or in diseases with specific phenotypes.
The superficial lateral cervical lymph nodes are found along the course of the external jugular vein, between the inferior aspect of the parotid gland and the supraclavicular nodes. The nodes are intercalated along the course of the vessels draining the parotid nodes and the infraauricular nodes. These nodes drain into the supraclavicular nodes, and on to the jugular trunk, followed by the thoracic duct on the left or the right lymphatic duct.
Brachial plexus block is a regional anesthesia technique that is sometimes employed as an alternative or as an adjunct to general anesthesia for surgery of the upper extremity. This technique involves the injection of local anesthetic agents in close proximity to the brachial plexus, temporarily blocking the sensation and ability to move the upper extremity. The subject can remain awake during the ensuing surgical procedure, or they can be sedated or even fully anesthetized if necessary.
Axillary dissection is a surgical procedure that incises the axilla, usually in order to identify, examine, or take out lymph nodes. The term "axilla" refers to the armpit or underarm section of the body. The axillary dissection procedure is commonly used in treating the underarm portion of women who are dealing with breast cancer. The lymph nodes located in the axilla area that are affected by breast cancer are called the guardian or sentinel lymph nodes. Lymph nodes are essential to the lymphatic/immune system due to their main function of filtering unrecognized particles and molecules. The idea of treating breast cancer with the axillary dissection procedure was introduced in the 18th century and was backed by German physician Lorenz Heister. There are certain criteria that make patients eligible candidates for this procedure. Patients tend to have three different levels of axillary lymph nodes; the level helps to determine whether or not the patient should undergo axillary dissection.
Armando Elario Giuliano is a surgical oncologist, surgeon scientist and medical professor in Los Angeles, California, United States of America. He is the Linda and Jim Lippman Chair in Surgical Oncology and co-director of Saul and Joyce Brandman Breast Center at Cedars-Sinai Medical Center, Los Angeles.
