| Lymphadenectomy | |
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| Other names | Lymph node dissection |
| ICD-9-CM | 40.2-40.5 |
Lymphadenectomy, or lymph node dissection, is the surgical removal of one or more groups of lymph nodes. [1] 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. [2] [3] [4]
It is usually done because many types of cancer have a marked tendency to produce lymph node metastasis early in their natural histories. This is particularly true of melanoma, head and neck cancer, differentiated thyroid cancer, breast cancer, lung cancer, gastric cancer, and colorectal cancer. Famed British surgeon Berkeley Moynihan once remarked that "the surgery of cancer is not the surgery of organs; it is the surgery of the lymphatic system."[ citation needed ]
The better-known examples of lymphadenectomy are axillary lymph node dissection for breast cancer; radical neck dissection for head and neck cancer and thyroid cancer; D2 lymphadenectomy for gastric cancer; and total mesorectal excision for rectal cancer.[ citation needed ]
For clinical stages I and II breast cancer, axillary lymph node dissection should only be performed after first attempting a sentinel node biopsy. [5] A sentinel node biopsy can establish cancer staging of the axilla if there are positive lymph nodes present. [5] It is also less risky than performing a lymphadenectomy, having fewer side effects and a much lower chance of causing lymphedema. [5] If cancer is not present in the sentinel lymph nodes, then the axillary lymph node dissection should not be performed. [5]
If one or two sentinel nodes have cancer that is not extensive, then no axillary dissection should be performed, but the person with cancer should have breast-conserving surgery and chemotherapy appropriate for their stage of cancer. [5]
Lymphedema may result from lymphadenectomy. Extensive resection of lymphatic tissue can lead to the formation of a lymphocele.[ citation needed ]
It is uncertain whether inserting wound drainage after groin lymph nodes dissection can reduce complications such as seroma, haematoma, wound dehiscence, and wound infection. [6]
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.
Mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. A mastectomy is usually carried out to treat breast cancer. In some cases, women believed to be at high risk of breast cancer have the operation as a preventive measure. Alternatively, some women can choose to have a wide local excision, also known as a lumpectomy, an operation in which a small volume of breast tissue containing the tumor and a surrounding margin of healthy tissue is removed to conserve the breast. Both mastectomy and lumpectomy are referred to as "local therapies" for breast cancer, targeting the area of the tumor, as opposed to systemic therapies, such as chemotherapy, hormonal therapy, or immunotherapy.
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.
This is a list of terms related to oncology. The original source for this list was the US National Cancer Institute's public domain Dictionary of Cancer Terms.
The neck dissection is a surgical procedure for control of neck lymph node metastasis from squamous cell carcinoma (SCC) of the head and neck. The aim of the procedure is to remove lymph nodes from one side of the neck into which cancer cells may have migrated. Metastasis of squamous cell carcinoma into the lymph nodes of the neck reduce survival and is the most important factor in the spread of the disease. The metastases may originate from SCC of the upper aerodigestive tract, including the oral cavity, tongue, nasopharynx, oropharynx, hypopharynx, and larynx, as well as the thyroid, parotid and posterior scalp.
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.
Lymph node biopsy is a test in which a lymph node or a piece of a lymph node is removed for examination under a microscope.
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.
Papillary thyroid cancer is the most common type of thyroid cancer, representing 75 percent to 85 percent of all thyroid cancer cases. It occurs more frequently in women and presents in the 20–55 year age group. It is also the predominant cancer type in children with thyroid cancer, and in patients with thyroid cancer who have had previous radiation to the head and neck. It is often well-differentiated, slow-growing, and localized, although it can metastasize.
The axillary lymph nodes or armpit lymph nodes are lymph nodes in the human armpit. Between 20 and 49 in number, they drain lymph vessels from the lateral quadrants of the breast, the superficial lymph vessels from thin walls of the chest and the abdomen above the level of the navel, and the vessels from the upper limb. They are divided in several groups according to their location in the armpit. These lymph nodes are clinically significant in breast cancer, and metastases from the breast to the axillary lymph nodes are considered in the staging of the disease.
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.
Breast-conserving surgery refers to an operation that aims to remove breast cancer while avoiding a mastectomy. Different forms of this operation include: lumpectomy (tylectomy), wide local excision, segmental resection, and quadrantectomy. Breast-conserving surgery has been increasingly accepted as an alternative to mastectomy in specific patients, as it provides tumor removal while maintaining an acceptable cosmetic outcome. This page reviews the history of this operation, important considerations in decision making and patient selection, and the emerging field of oncoplastic breast conservation surgery.
Breast surgery is a form of surgery performed on the breast.
Axillary lymphadenopathy is distinguished by an increase in volume or changes in the morphology of the axillary lymph nodes. It can be detected through palpation during a physical examination or through changes in imaging tests. On a mammogram (MMG), normal lymph nodes typically appear oval or reniform with a radiolucent center representing hilar fat. The cortex is usually hypoechoic or even imperceptible on ultrasound imaging, whereas the medulla is hyperechoic. When a lymph node is damaged, whether by benign or malignant disease, it changes shape and structure, resulting in different patterns in imaging tests.
Elisa Rush Port FACS is Associate Professor of Surgery at the Icahn School of Medicine at Mount Sinai Hospital, as well as cofounder and director of the Dubin Breast Center at the Tisch Cancer Institute at Mount Sinai Health System, since 2010. She has received four research grants, has served as an investigator or co-investigator on 15 clinical trials, published 44 peer-reviewed articles, and published a total of 12 book chapters and books. She has specialized in sentinel-node biopsy, a diagnostic method that determines cancer stages based on spread to regional lymph nodes, nipple sparing mastectomy, and the use of MRI for breast cancer.
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.
Post-mastectomy pain syndrome (PMPS) is used to describe persistent neuropathic pain that follows breast surgery, such as mastectomy and lumpectomy. PMPS manifests as pain in the arm, axilla, chest wall, and breast region.
This article incorporates public domain material from Dictionary of Cancer Terms. U.S. National Cancer Institute.
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