Patient information sheet-NEW START Programme Sentinel Lymph Node Surgery

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Patient information sheet

NEW START Programme
Sentinel Lymph Node Surgery


Breast cancer can spread along fine lymph channels to the lymph nodes (glands) in the
armpit. At present there is no simple test that can tell us whether the nodes in the armpit
contain cancer or are cancer free. This means that during breast cancer surgery the surgeon
also needs to remove some lymph glands from the armpit. These glands can be examined
under a microscope to find out if the cancer has started to shed cells to the nodes. This
information can then help you and your doctors decide on what further treatment you may
require to treat your breast cancer. Currently removal of 4 or more lymph nodes is regarded
as the standard of care.

Unfortunately, removal of the lymph nodes can sometimes have side effects:

• seroma (a temporary collection of fluid in the armpit, which can last a matter of weeks,
sometimes longer),
• neuralgia (pain in the armpit region, usually temporary),
• lymphoedema (permanent swelling of the arm),
• numbness, soreness or a stiffness of the shoulder.

In view of this surgeons have been looking for other accurate ways to find out what is
happening in the lymph nodes but that have less side affects. A new technique of assessing
the armpit glands is called Sentinel Lymph Node Biopsy (SLNB).

Sentinel Lymph Node Biopsy

The sentinel node (the main node) is the first lymph node to which breast cancer can spread.
Recent studies have shown that if the sentinel node is free of cancer cells it is very unlikely
there is further cancer in the armpit glands. So following removal of the sentinel lymph node,
if it is cancer free, a woman would not need to undergo any further armpit surgery. In 6-8 out
of 10 women the armpit nodes are cancer free. Those 2-4 out of 10 women who have cancer
in the sentinel lymph node (SLN) will require further treatment to their armpit. This may
involve further armpit surgery.

SLNB was developed in the USA and Europe and is being used successfully around the
world. In the UK, clinical trials (the ALMANAC trial) have confirmed that accurate
identification of the sentinel lymph node is possible and that women who had SLNB had
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fewer side effects from their surgery. Many breast teams now want to offer their patients
SLNB as it has been proven to be safe and reliable. However, before any Breast unit can
offer SLNB they need to be confident they can accurately find the sentinel lymph node. This
is where your help is needed.

What is involved in SLNB?

Before surgery a tiny amount of radioactive fluid is injected into the skin of your breast
following which the breast and armpit is scanned and the position of the SLN marked. The
radioactivity use is less than required for a mammogram. During surgery a teaspoons’ worth
of blue dye is injected into the breast near the nipple. The radioactive fluid and the dye will
travel along the lymph vessels to the sentinel lymph node. The surgeon can then remove the
blue and radioactive node as this is the node most likely to be the SLN.
At least 4 or more of the remaining armpit lymph nodes will then be removed as this is
the current “standard” treatment in the UK. The SLN will be sent to the laboratory with the
rest of the glands, where the pathologists can confirm whether the SLN has been located.

Once a surgeon has demonstrated they can successfully find the SLN in 30 patients they can
then perform just a SLNB i.e. just removing one or two glands. This will save 6-8 women out
of 10 having further armpit surgery.

To summarise:

1. Currently the standard way of assessing lymph nodes in the UK is removal of 4 or
more armpit nodes. This can result in a life-long risk of developing lymphoedema and
other minor but irritating side-effects.

2. Sentinel node biopsy, a new technique in the UK, identifies the lymph node to which
breast cancer is most likely to spread. If the sentinel node is free of cancer no further
armpit surgery would be required. If the sentinel node contained cancer, further
treatment for the armpit would be required.

3. We need your help before we can offer this new technique.

What are the possible risks to me volunteering to help this programme?

There should be no additional risks to you associated with having lymph nodes removed.
The amount of radioactive fluid is tiny and quite safe. Allergic reactions to the dye are very
rare (less than 0.1%). Allergic reactions can be treated if they occur.

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What are the disadvantages?

The radioactive injection may be slightly uncomfortable.
The operation may take 10-30 mins longer.
The dye may temporarily stain your skin, your urine and stools.

What are the possible benefits?

You will not receive any direct benefit
. Your surgeon will still be carrying out the standard
removal of further lymph nodes once the sentinel node has been removed. However, if we
can show, over the next year or two, that we can accurately and reliably identify the sentinel
lymph node, we can then reduce the amount of armpit surgery required for the majority of
women. Therefore, your participation may greatly benefit women in the future.

What if I say ‘no’?

There will be no change to your care and you will receive the current standard treatment.

Many thanks for taking the time to read this information sheet. If you have any further
questions please do not hesitate to speak to your breast care nurse:

Caroline Buchanan
tel: 445 3738
bleep no. 2046

Carol Parry

tel: 445 3737
bleep no. 2098

Pauline Connelly

tel: 445 3735
bleep no. 2660

Val Goodall

tel: 445 2537
bleep no. 2632

Lynn Pounder

tel: 445 2537
bleep no. 2632

Information Leaflet: No 58




New Start Programme – Sentinel Lymph Node Surgery

First Published:
February 07

Review Date:
February 08
Produced by:
NEW START Programme

Adapted by:
Caroline Buchanan – Breast Care Nurse

This leaflet can be made available in other languages
and formats upon request
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