Do the lymph nodes always need to be removed?
Not always, especially when there is no evidence of any cancer in the lymph system. A mastectomy or lumpectomy operation will most often include either a sentinel node biopsy or an axillary node dissection. Both procedures involve a separate incision for lumpectomy patients. Following surgery, the pathologist will test the lymph nodes to determine whether the cancer has spread past the breast. When some evidence of cancer is found in the lymph system, recents standards are as follows:
For patients who are having a lumpectomy and the sentinel node is positive for cancer:
Effective in mid 2012, the standard of care was changed to no longer require women with early stage breast cancers to have a full dissection and removal of the lymph nodes under the arm. Instead radiation to the underarm can be planned.
For patients who are having a mastectomy surgery and have a positive sentinel node:
For these women, the standard of care remains the same, calling for the node removal and dissection of the axillary (or underarm) nodes. The additional nodes removed at the time of the breast cancer surgery will be examined by the pathologist in the following days to determine if others beyond the sentinel node contained cancer or not. If cancer cells are found in those lymph nodes, other cancer treatments will be considered.