Axillary dissection

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Axillary dissection is a surgical procedure that incises the axilla, usually in order to identify, examine, or take out lymph nodes. [1] The term "axilla" refers to the armpit or underarm section of the body. [2] The axillary dissection procedure is commonly used in treating the underarm portion of women who are dealing with breast cancer. [3] 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. [4] 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. [3] 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.[ citation needed ]

Contents

Appropriate Candidates for Treatment

This treatment is only appropriate for women who are node positive or who have tested positive for disease in the armpit area. Conducting the axillary dissection procedure on patients who are node negative can result in over-treatment and unnecessary procedures for patients to endure. [3] To determine if a patient is permitted to receive treatment, the number of affected axillary nodes will have to be counted for. If there are only one or two affected guardian lymph nodes, then it may not be necessary for the patient to undergo the axillary dissection procedure. However, if a patient contains at least three or more affected guardian lymph nodes, then a physician will recommend that the patient undergo axillary dissection. [4]

The Three Levels of Axillary Lymph Nodes

This image shows the surgical procedure of axillary dissection. 6 Start of axillary dissection.jpg
This image shows the surgical procedure of axillary dissection.

There are three different levels of axillary lymph nodes. Level I refers to lymph nodes located below the axillary vein or towards the very bottom end of the pectoralis minor muscle. Level II refers to lymph nodes located directly under the pectoralis minor muscle. Level III refers to lymph nodes that are located over the pectoralis minor muscle and would require an intense procedure. Typically lymph nodes located in Levels I and II are removed with the axillary dissection. A mastectomy may also have to accompany this procedure in some cases depending on the patient. [2]

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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. Lymphedema is most frequently a complication of cancer treatment or parasitic infections, but it can also be seen in a number of genetic disorders. Though incurable and progressive, a number of treatments may improve symptoms. Tissues with lymphedema are at high risk of infection because the lymphatic system has been compromised.

<span class="mw-page-title-main">Mastectomy</span> Surgical removal of one or both breasts

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.

<span class="mw-page-title-main">Paget's disease of the breast</span> Medical condition

Paget's disease of the breast is a rare skin change at the nipple nearly always associated with underlying breast cancer. Paget's disease of the breast was first described by Sir James Paget in 1874. The condition is an uncommon disease accounting for 1 to 4% of all breast cancers cases. 92% to 100% of patients with Paget's disease of the breast have an underlying breast cancer.

<span class="mw-page-title-main">Axilla</span> Area of the human body beneath the joint between arm and torso

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.

<span class="mw-page-title-main">Lymphadenectomy</span> Medical procedure

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.

<span class="mw-page-title-main">Lumpectomy</span> Limited surgical removal of breast tissue

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.

<span class="mw-page-title-main">Axillary artery</span> Large blood vessel bringing oxygenated blood to the thorax

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.

<span class="mw-page-title-main">Lateral thoracic artery</span> Large blood vessel

In human anatomy, the lateral thoracic artery is a blood vessel that supplies oxygenated blood to the lateral structures of the thorax and breast.

<span class="mw-page-title-main">Sentinel lymph node</span> First lymph node to receive drainage from a primary tumor

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.

<span class="mw-page-title-main">Radical mastectomy</span>

Radical mastectomy is a surgical procedure involving the removal of breast, underlying chest muscle, and lymph nodes of the axilla as a treatment for breast cancer. Breast cancer is the most common cancer among women today, and used to be primarily treated by surgery, particularly during the early twentieth century when the mastectomy was developed with success. However, with the advancement of technology and surgical skills, the extent of mastectomies has been reduced. Less invasive mastectomies are employed today in comparison to those in the past. Nowadays, a combination of radiotherapy and breast conserving mastectomy are employed to optimize treatment.

<span class="mw-page-title-main">Axillary lymph nodes</span> Lymph nodes in the human armpit

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 ninety percent 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.

Rotter's lymph nodes are small interpectoral lymph nodes located between the pectoralis major and pectoralis minor muscles. They receive lymphatic fluid from the muscles and the mammary gland, and deliver lymphatic fluid to the axillary lymphatic plexus. These lymph nodes are susceptible to breast cancer, as the cancer sometimes spreads (metastasizes) to the interpectoral lymph nodes. It signifies retrograde spread of tumour. Rotter's lymph nodes are named after German surgeon Josef Rotter (1857-1924), who described them in the late 19th century.

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.

<span class="mw-page-title-main">Axillary space</span>

The axillary spaces are anatomic spaces. through which axillary contents leave the axilla. They consist of the quadrangular space, triangular space, and triangular interval. It is bounded by teres major, teres minor, medial border of the humerus, and long head of triceps brachii.

<span class="mw-page-title-main">Breast-conserving surgery</span> Surgical operation

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.

Cancer of unknown primary origin (CUP) is a cancer that is determined to be at the metastatic stage at the time of diagnosis, but a primary tumor cannot be identified. A diagnosis of CUP requires a clinical picture consistent with metastatic disease and one or more biopsy results inconsistent with a tumor cancer

Breast cancer classification divides breast cancer into categories according to different schemes criteria and serving a different purpose. The major categories are the histopathological type, the grade of the tumor, the stage of the tumor, and the expression of proteins and genes. As knowledge of cancer cell biology develops these classifications are updated.

Ling Yuan "Thomas" Dao was a Chinese American physician and specialist in breast cancer, its causes and treatment, who was one of the earliest proponents of minimalist alternatives to radical mastectomy as a treatment option for breast cancer, in addition to advocacy of breast self-examination and mammography as means to detect breast cancer as early as possible.

Anne Louise Rosenberg is an American surgical oncologist retired from practice in Cherry Hill, New Jersey.

References

  1. The Dorling Kindersley illustrated family encyclopedia . Dorling Kindersley. 2002. ISBN   9780789488657.
  2. 1 2 "Axillary Lymph Node Dissection". Breastcancer.org. 2018-09-19. Retrieved 2020-04-07.
  3. 1 2 3 "Axillary Dissection: Overview, Periprocedural Care, Technique". 2020-01-17.{{cite journal}}: Cite journal requires |journal= (help)
  4. 1 2 Brown, Ken. "Axillary Node Dissection: Johns Hopkins Breast Center". www.hopkinsmedicine.org. Retrieved 2020-04-07.