Breast Cancer (cont.)
Jerry R. Balentine, DO, FACEP
Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- Breast cancer facts
- What is breast cancer?
- What are the different types of breast cancer?
- What causes breast cancer?
- What are breast cancer risk factors?
- What are breast cancer symptoms and signs?
- How is breast cancer diagnosed?
- How is breast cancer staging determined?
- What is the treatment for breast cancer?
- What is the prognosis of breast cancer?
- Can breast cancer be prevented?
- What research is being done on breast cancer? Should I participate in a clinical trial?
- I may have breast cancer. What questions should I ask my doctor?
- Is the doctor sure I have breast cancer?
- What type of breast cancer do I have?
- What difference does a precise diagnosis make?
- What has been done to exclude cancer in other areas of the same breast or in my other breast?
- What type of medical team do I need for the most accurate diagnosis?
- Is my family history relevant to my breast cancer diagnosis?
- What other studies should be done on my tissue biopsy?
- How urgent is it that I make decisions and begin treatment?
- Should I stop taking hormone therapy (HT)?
- Even though my breast tumor does not have hormone receptors, should I take tamoxifen to reduce the risk of a new tumor?
- I have a ductal carcinoma in situ (DCIS), a type of localized cancer. Why have I been advised to have a mastectomy when other women with invasive cancer have lumpectomies?
- Should I start chemotherapy before surgery?
- If I am advised to have a mastectomy, what are the risks and benefits of immediate breast reconstruction?
- Should my lymph nodes be removed?
- What is a sentinel lymph node biopsy and what are its benefits and risks?
- Are there any other questions I should ask my doctor?
- Breast Cancer FAQs
- Find a local Oncologist in your town
Should my lymph nodes be removed?
Lymph nodes are small glandular structures that filter tissue fluids. They filter out and ultimately try to provide an immune response to particles and proteins which appear foreign to them. There are thousands of these nodes scattered in groups throughout the body. Each cluster is more or less responsible for the drainage of a particular region of the body.
The lymph nodes under the arm (axillary nodes) are the dominant drainage recipients from the breast. When cancer cells break free from a breast cancer, they may travel through the lymph tubes (vessels) to the lymph nodes. There, the cancer cells may establish a secondary growth site. The presence of cancer cells in the lymph nodes proves that cancer cells have traveled away from the primary breast tumor. Therefore, the presence or absence of cancer cells in these regional nodes is an important indicator of the future risk of recurrence. This information is often important in making decisions about whether to use chemotherapy and what type of chemotherapy should be employed.
Unfortunately, removal of the lymph nodes also carries a potential risk of lymphedema, a condition that may cause the arm to swell. Lymphedema can occur early after surgery or many years later. It can be a difficult and disabling condition. Here again, there are trade-offs in risk. When more lymph nodes are removed, more accurate the information about tumor spread is obtained and the chance for tumor recurrence is less. But there is a greater incidence of lymphedema.
There are alternatives to standard lymph node removal (called axillary node dissection). These alternatives should be considered in each patient's situation. They include
- replacing standard axillary node removal with sentinel node biopsy (explained below);
- not doing lymph node removal in patients who will receive chemotherapy anyway based on other information; and
- not doing lymph node removal in patients with very small or "favorable" tumors.
Again, these alternatives must be selectively applied with the benefits and risks carefully evaluated.
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