Lymph Node Removal for Breast Cancer Treatment in Singapore

What Are Lymph Nodes and Why Do They Matter for Breast Cancer Treatment?

Lymph nodes are small, oval-shaped structures distributed throughout the body as part of the lymphatic system. They act as filters, trapping bacteria, viruses and other harmful substances, while also producing immune cells to fight infection and disease.

The lymph nodes in the armpit, known as axillary lymph nodes, are closely connected to the breast through lymphatic vessels. If breast cancer begins to spread, cancer cells can travel through these vessels and reach the axillary lymph nodes. Checking these nodes can therefore help determine whether the cancer has spread beyond the breast and guide treatment decisions.

When May Lymph Node Removal Be Recommended?

Lymph node removal is not performed in every breast cancer case. There are two main reasons your surgeon may recommend lymph node surgery:

1. Staging: To Determine Whether the Cancer Has Spread

Lymph node findings play a key role in understanding the overall picture of the disease. By examining these nodes, doctors can determine whether cancer cells have moved beyond the breast and how far they may have travelled.

This information helps establish the stage of the cancer and guide decisions about further treatment, such as chemotherapy, radiotherapy or targeted therapy.

2. Treatment: To Remove Affected Nodes

When cancer is found in the lymph nodes, surgery may be recommended to remove affected nodes and help control the disease in the axilla. Depending on the extent of lymph node involvement, this may involve an axillary lymph node dissection (ALND).

Types of Lymph Node Surgery

There are two main approaches to lymph node surgery in breast cancer treatment, each serving a different purpose and involving a different extent of node removal.

Sentinel Lymph Node Biopsy (SLNB)

A sentinel lymph node biopsy involves removing the first lymph node or small number of nodes that breast cancer cells are most likely to reach if they spread beyond the breast. These nodes are then examined for cancer cells.

If no cancer cells are found, further lymph node removal is often unnecessary. This allows the lymph nodes to be assessed while limiting the extent of surgery.

Axillary Lymph Node Dissection (ALND)

An axillary lymph node dissection involves removing a larger number of lymph nodes from the armpit. It may be recommended when cancer has been confirmed in the axillary lymph nodes or when more extensive lymph node involvement is suspected.

As ALND is a more extensive procedure, it is generally performed only when clinically indicated. The decision is based on the extent of the cancer, lymph node findings and the overall treatment plan.

How Is the Extent of Lymph Node Removal Determined?

The extent of lymph node surgery depends on whether cancer has spread to the lymph nodes and how extensive that involvement is. Your surgeon will consider several factors when deciding between a more limited procedure and further lymph node removal:

• Cancer stage and characteristics: The size, stage and features of the breast cancer help determine the appropriate approach to lymph node surgery.
• Lymph node involvement: Imaging, physical examination and biopsy results can indicate whether cancer has reached the axillary lymph nodes and how many nodes may be affected.
• Previous and planned treatment: Treatments such as chemotherapy given before surgery can affect the type and extent of lymph node surgery required.
• Sentinel lymph node biopsy results: If a sentinel lymph node biopsy is performed, whether cancer cells are found and the extent of involvement can help determine whether further lymph node surgery is necessary.

How Lymph Node Removal Fits into Overall Treatment

Lymph node surgery is usually planned alongside other breast cancer treatments. The results can also help guide treatment after surgery.

Breast Surgery

Lymph node removal is often performed at the same time as breast cancer surgery, such as a lumpectomy or a mastectomy.

Chemotherapy

Whether cancer is found in the lymph nodes can help determine whether chemotherapy is recommended. If chemotherapy is given before surgery, the response of affected lymph nodes may also influence the extent of lymph node surgery required.

Radiotherapy

Lymph node findings can help determine whether radiotherapy is needed and which areas should be treated.

Hormonal and Targeted Therapy

Lymph node involvement is considered alongside factors such as hormone receptor and HER2 status when planning hormonal or targeted therapies.

Are There Risks or Side Effects from Lymph Node Surgery?

Lymph node surgery is generally well tolerated, and careful surgical planning and technique help minimise the risk of complications. However, as with any surgery, some side effects can occur.

• Lymphoedema: Swelling of the arm can occur when lymphatic drainage is affected.
• Numbness or altered sensation: Temporary numbness, tingling or changes in sensation may occur around the armpit or upper arm.
• Reduced arm movement: Some patients experience temporary shoulder stiffness or reduced range of motion during recovery.
• Fluid build-up: A collection of fluid, known as a seroma, can develop around the surgical area and may occasionally require drainage.
• Nerve injury: Nerves in the armpit can be affected, although surgeons take care to identify and preserve important nerves during the procedure.

Careful surgical planning and technique help minimise these risks. Your surgeon will aim to remove only the lymph nodes necessary while minimising disruption to surrounding tissues. After surgery, appropriate wound care, exercises and follow-up can also help support recovery and manage any side effects that arise.

Recovery After Lymph Node Removal Surgery

Recovery depends on the type and extent of lymph node surgery performed. After a sentinel lymph node biopsy, recovery is generally quicker, while an axillary lymph node dissection may require a longer recovery period.

• Wound care: Keep the surgical area clean and dry according to your surgeon’s instructions. A temporary drain may be needed after more extensive lymph node removal.
• Pain and discomfort: Mild soreness, swelling or tightness around the armpit is common and can usually be managed with prescribed pain relief.
• Arm movement: Gentle arm and shoulder exercises are usually encouraged to prevent stiffness and gradually restore movement.
• Daily activities: Most activities can be resumed gradually, although strenuous exercise and heavy lifting should be avoided until your surgeon advises otherwise.
• Follow-up: Your surgeon will review your wound and recovery, discuss the lymph node results and advise on any further treatment or rehabilitation required.

Lymph Node Removal Surgery at Maven Surgery

Lymph node surgery for breast cancer requires careful assessment to determine the appropriate extent of removal while minimising unnecessary disruption to surrounding tissues.

At Maven Surgery, lymph node procedures are performed carefully to strive towards an accurate diagnosis while minimising unnecessary intervention whenever appropriate. Care is led by Dr Chong Chee Keong, our breast, colorectal and general surgeon, who has experience in breast cancer surgery and lymph node procedures. Dr Chong provides individualised surgical care based on the patient’s diagnosis, lymph node involvement and overall treatment plan.

If lymph node removal has been recommended as part of your treatment plan, arrange a consultation with Dr Chong Chee Keong to better understand the procedure and how it fits into your overall care strategy.

Frequently Asked Questions About Lymph Node Removal