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The sentinel lymph node technique – the newest conduct in the field of breast cancer treatment

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“At Royal Hospital Bucharest we practice the sentinel lymph node technique, which allows us to give the old one which involves the complete removal of the axillary lymph nodes. The new procedure is very simple: before surgery, the peritumoral radioactive isotope (lymphoscintigraphy) is injected, and during the surgery, a gamma chamber is used to detect the radioactive substance, thus identifying the sentinel ganglion” – Stoian Ioan, MD OB/GYN, Gynecologic Oncology.

 

What is the sentinel lymph node?

The sentinel lymph node is the first lymph node in which the lymph at the tumour level drains. Once extracted during the surgical intervention, it is immediately sent for anatomopathological examination. If the histopathological analysis shows that the lymph node has not been invaded by cancer cells, then a full regional lymphadenectomy (axillary lymphadenectomy) will not be required. Only otherwise will it be necessary to surgically remove lymph nodes. We emphasize here the fantastic importance of avoiding axillary lymphadenectomy: after lymphadenectomy, some women develop a lymphedema in the upper limb (their arm swallows a lot, special treatment being needed to get rid of this oedema), sometimes the patients remaining post-op with a certain difficulty in moving the arm.

The sentinel lymph node technique is one of the newest behaviours in the field of breast cancer treatment: the surgeon will no longer have to perform an extended axillary lymphadenectomy surgery, but can complete the excision of the sentinel lymph node with only the excision of the tumour with safety limits for conservative treatment or mastectomy), improving post-operative healing time and reducing complications (oedema, long recovery time).

What is most important to remember is that patients should see a doctor in the most incipient stages, when cancer cells have not migrated to the axilla yet, in which case the healing prognosis is most favourable as well. Monthly self-breast exams, annual ultrasound or routine mammogram every two years can detect a breast cancer that is in an early, treatable stage.

 

How can you detect breast cancer in time, so you can still enjoy your life?

  1. Self-examination / self-breast exams is the only thing the woman can do alone at home, preferably within the first 7-10 days after the menstruation starts. Throughout the whole month, however, a woman must be aware of the shape and size of her breasts, so that any small change in their appearance is an urge to see a specialist.

Warning! Changes such as: an unusually high positioned breast in relation to the other, changes in the skin covering the breast (“orange peel” appearance, dimples, redness of the skin), abnormal nipple retractions or abnormal nipple secretion, and especially the detection of a nodule, may all be signs of a possible breast cancer.

  1. Breast ultrasound (the newer technique is enhanced with elastography) is a non-invasive ultrasound breast examination, recommended annually for women with ages between 20 and 30 years old, which can detect breast conditions early. It is not painful, it does not radiate, or it poses no risks. After the age of 40, breast ultrasound is required to be complemented by a mammography.
  2. Mammography is the only method that highlights breast microcalcifications, which detect breast cancer presence from its debut, in situ (locally), at which point it can still be treated (90% of early diagnosed breast cancers can be cured in time).
  3. Breast MRI is recommended only in cases where other methods do not give sufficient information.


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