The second aim of axillary (underarm) surgery is to provide effective local treatment in those patients where tumour cells have spread, or metastasised, to these lymph nodes. This would usually take the form of an axillary node clearance where the majority of lymph nodes in the underarm area are removed. This is a very effective treatment that will reduce to chance of the tumour coming back in the same area (local recurrence) to a very small amount. It is increasing being used only for those patients with biopsy proven spread to the lymph nodes.
Approximately 40% of all patients with breast cancer have tumour spread to the axillary lymph nodes and it is usually detected following either sentinel node biopsy or axillary sampling. It may also be detected prior to surgery by ultrasound-guided needle biopsy of axillary lymph nodes that are suspicious on ultrasound scanning. This allows these patients to proceed straight to axillary clearance, thus avoiding two axillary operations.
There are three levels of axillary clearance: level I, level II and level III and different surgeons may have different preferences that will be discussed with individual patients.
Although axillary node clearance is an extremely effective treatment, in terms of reducing the chances of local recurrence, it does however have several recognised potential complications as follows:
- Lymphoedema: slight swelling of the arm, part of the arm, or the breast. This can affect part of the arm, or the whole arm, and usually occurs within the first 3-5 years. It only becomes a significant problem in less than 5% of patients although up to 25% may have minor symptoms. It often becomes evident following infection in the arm so care must be taken to avoid unnecessary cuts or scratches that may allow infection to enter. Lymphoedema is much more treatable when picked up early so check with your doctor if you have any concerns.
The following precautions may help reduce the chance of lymphoedema happening:
- Take particular care of your skin to avoid developing infection in your arm – use moisturising cream to prevent dryness.
- Try to avoid scratches or cuts but if they do happen wash them thoroughly and apply a simple antiseptic. If the cut becomes sore, red or inflamed contact your family doctor as soon as possible.
- Whenever possible avoid injections, blood samples or drips in the operated arm. 5f there is no alternative however a blood sample or a drip for a short time is unlikely to cause any major problem.
- Wear gloves for manual jobs like gardening, washing up or taking hot food out of the oven. Use a thimble for sewing.
- Avoid razor blades for underarm shaving – use an electric razor or depilatory cream.
- Take care when cutting fingernails – always use nail clippers.
- Use insect repellent to prevent bites. If an insect bite becomes infected contact your family doctor immediately.
- Take care in the sun – always use skin protection and try not to burn
- Use your arm normally but avoid very heavy lifting for extended periods of time
Lymphoedema of the breast seems to present much earlier than with the arm and the breast can be heavy, swollen and red, especially later in the day.
- Numbness of the inner aspect of the upper arm. This is due to division of a nerve that supplies feeling in the skin of this part of the arm during the lymph node surgery. The extent of the numbness usually get much less with time and is not usually a significant problem.
- Shoulder stiffness often occurs following axillary clearance but will usually recover completely with a course of exercises that will be recommended by your nurse specialist.