While making surgery plans for invasive ductal carcinoma (IDC), your doctor may discuss the need to move one or more of your lymph nodes to determine if cancer has spread there, as that is usually the first place it will spread. If cancer has spread to the lymph nodes, the chance that it has spread to other areas of the body is greater. This is because your lymph nodes act as part of the natural “filtration system” of the body. They act by removing foreign substances, such as bacteria, from the body. Breast cancer cells can easily spread to the axillary lymph nodes under the arm, which creates an open floodgate to travel to other areas in the body. Knowing the status of the lymph nodes is key in planning the best treatment.
In some cases, the tumor is very small and has other characteristics that make your doctor feel certain that an invasion of the lymph nodes is greatly unlikely; a different procedure may be suggested. One procedure is a sentinel lymph node biopsy, addresses the very first lymph node, known as the sentinel node and that filters the fluid as it drains from the area of the breast that is affected by cancer. If there are cancer cells breaking away from the main tumor, and moving away from the breast by way of the lymph system. The sentinel node is the most likely to contain cancerous cells first. In a sentinel lymph node biopsy, a dye or special radioactive substance is used to identify the first node and the first few nodes where it drains. This series of nodes are removed and sent to be examined by a pathologist. If the examination comes back that the nodes are cancer-free, no additional surgery will be required; however, if cancer is found, additional lymph nodes located in the armpit one need to be removed. This removal can occur at the same time or at a later date. It is important that this procedure is done by the surgical team has experience with this technique a sentinel lymph node biopsies are a relatively new approach. This may be the best procedure for you if your surgeon has cause to believe that either no lymph nodes are just a few of them have a chance of being affected.
The second procedure used to address lymph nodes is the axillary lymph node dissection, in which a group of lymph nodes under the arm is removed by a surgeon for the examination of signs of cancer. The risk with auxiliary node dissection is the arm lymphedema can be developed, which is a swelling that is caused by lymph fluid backing up into the arm. Having a sentinel node biopsy instead will reduce the risk of lymphedema, and for those that must have an axillary node dissection, there are steps that can be taken to reduce the risk of lymphedema or manage it in situations where does develop.
The other method of local treatment is radiation therapy. In radiation therapy, high-energy rays are directed at the breast, under the arm, chest area, and/or the collarbone area so that any invasive ductal carcinoma cells that remain can be destroyed. This method of treatment also reduces the recurrence risk, which is the risk of cancer coming back. Radiation is usually recommended following surgeries that conserve healthy breast tissue, such as partial mastectomies and lumpectomies. For large tumors, such as those that exceed 5 cm, or cases were lymph nodes were involved, radiation may still be recommended after total mastectomies.
There are different ways for radiation to be administered. These include external beam radiation, internal partial-breast irradiation, and external partial-breast irradiation.
An external beam radiation, a machine known as the linear accelerator is used to deliver the radiation therapy. These treatments are directed to the remaining area of skin and muscle following a mastectomy, the entire breast following a lumpectomy, in any areas where affected lymph nodes are located. Radiation therapy is usually administered for 5 to 7 weeks.
Internal partial-breast irradiation, which is also known as brachytherapy, is a method of treatment during which radioactive materials, such as pellets are seeds, are temporarily placed near or in the area where the tumor was removed.
External partial-breast irradiation is a treatment method of external beam radiation that focuses on the area surrounding the cancer’s location. This is the area that has the highest risk of recurrence. Partial-breast radiation only requires 5 to 10 days of treatment, as opposed to 5 to 7 weeks for whole breast radiation.
Partial-breast radiation is still being studied by researchers for its use following lumpectomy to compare the benefits of it versus the current standard for radiation treatment to the whole breast. As this technique is still being investigated, it is still not yet widely available.