Sentinal Lymph Node Biopsy In Breast Cancer Biology Essay

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Breast cancer is the most common cancer among the women all over the world. It is caused by the uncontrolled growth of cells. The risk of having breast cancer mostly increases due to two major factors ; age and family history. According to statistics, a woman's risk of breast cancer approximately doubles if she has a first-degree relative (mother, sister, daughter) who has been diagnosed with breast cancer. About 20-30% of women diagnosed with breast cancer have a family history of breast cancer1. The most significant symptoms are new lumps or mass around the breast, nipple turns inwards, and nipple discharge other than breast milk. Although breast cancer is most popular among the women, less than 1% of all new breast cancer cases occur in men at 20081. Since, breast cancer is among the top 10 ranked killer cancer, what are the current available treatments that can help to reduce the rate of mortality due to this disease ?cancer-survival-stats-2005.gif

The most effective treatment to alleviate the cases of breast cancer is surgery. This ensures the margin of safety by removing the cancerous cell and some healthy cells around it before it spreads to other sites of body . There may be two types of surgery, i.e. radical surgery or palliative surgery. Radical surgery involves the complete surgical removal of the tumour meanwhile palliative surgery conducted when the complete removal of the tumour may not be possible, only limited surgery is done to relieve symptoms.2 The surgery is conducted by the surgeon and the type of surgery is chose based on the length of tumour.

Tumors under 2 cm: Women can generally choose lumpectomy followed by radiation.

Tumors between 2 cm and 5 cm. Even if tumors are up to 5 cm, a 2000 international study suggested that lumpectomy and mastectomy offer equivalent survival rates (about 66%) and time to metastasis at 10 years. In the study, however, local recurrence occurred in 20% of lumpectomy and 12% of mastectomy patients.

Tumors over 5 cm: Women generally choose mastectomy.3

Figure 2

Image source :

Based on the graph shown above, it can be seen that the rate of mortality due to breast cancer decreases for almost all the ethnic since surgery is introduced.



Lumpectomy is normally known as "breast-conserving" surgery. During lumpectomy, the surgeon removes the tumor and a small margin of surrounding healthy tissue. Lumpectomy is typically reserved for smaller tumors that are easily separated from the surrounding tissue4. This treatment aims to maintain a normal breast appearance when the surgery is over. After the lumpectomy, a five- to eight-week course of radiation therapy is often used to treat the remaining breast tissue. The majority of women who have small, early-stage breast cancers are excellent candidates for this treatment approach. Women who are not usually eligible for a lumpectomy include those who have already had radiation therapy to the affected breast, have two or more areas of cancer in the same breast that are too far apart to be removed through one incision, or have cancer that was not completely removed during the lumpectomy surgery.4




This type of surgery is also known as partial or segmented mastectomy. It involves the same process as in the lumpectomy. However, it is differ slightly in terms of the amount of mass of tissue removed during the surgery. Quadrantectomy removes more breast tissue compared to lumpectomy.




Mastectomy involves the process of removing entire breast including the nipples. In this process, surgeon removes all of the breast tissue - the lobules, ducts, fatty tissue and skin, including the nipple and areola. However, in mastectomy no lymph nodes is removed. Normally after the operation, immediately breast reconstruction is done. In the process of radical mastectomy, the surgeon removes all the breast tissue along with the nipple.Lymph nodes in the armpit also removed to check whether the cancerous cell has divide and attacked the lymph nodes as well. The chest muscles are left intact.




Sentinel lymph is known as removing one lymph node. Breast cancer that spreads to the lymph nodes may spread to other areas of the body. The surgeon determines which lymph node near your breast tumor receives the lymph drainage from your cancer. This lymph node is removed and tested for breast cancer cells. If no cancer is found, the chance of finding cancer in any of the remaining nodes is small and no other nodes need to be removed.5


Axilliary dissection is known as removing several lymph node. It is done to remove the glands under the arm which is called axiallary nodes. If cancerous cell is found in the gland, then the surgeon removes additional lymph nodes in the armpit.

Eventhough many type of surgery is available, but many patients prefer lumpectomy over mastectomy. This can be proved by the graph below :-




The benefit of undergoing this aggressive surgery is that the inflicted area can be completely removed, thus reducing the risk of the cancer spreading to other parts of body. It also takes away the chance of the cancer spreading to lymph nodes, which could then, in turn, spread to the lungs or brain. Furthermore, radical mastectomy removes everything in that area of body that could potentially be a new host for cancerous cells.6 There is no need of being worried of not having a breast as breast construction can be done immediately or few days after the surgery. Some women choose to have breast implants, which are filled with saline or silicone gel. Breast reconstruction also can be done with tissue removed from another part of your body such as skin, muscle, and fat from lower abdomen, back, or buttocks. The surgeon uses this tissue to create a breast shape.7



However, just like all the other surgery, mastectomy and lumpectomy also have some side effects. Seroma formation is the most frequent postoperative complication after breast cancer surgery. Seroma is defined as a serius fluid collection that develops under the skin flaps during mastectomy or in the axillary dead space after axillary dissection. Incidence of seroma formation after breast surgery varies between 2.5% and 51%. Although seroma is not life threatening, it can lead to significant morbidity (e.g.recovering period) and may delay adjuvant therapy. Fluid collection is ideally managed by repeated needle aspiration to seal the skin flaps against the chest wall.8 There is also a risk of developing lymphedema (swelling of the arm) after axillary lymph node dissection. This swelling can range from mild to very severe. It can be treated with elastic bandages and specialized physical therapy, but it is a chronic condition, requiring continuing care. Lymphedema can arise at any time, even years after surgery.9 Other possible side effects are hematoma (build up of blood in the surgical site) , lost of sensation in the breast area, and also hard scar tissue formation.10


Economically, the cost for the surgery is expensive for most of the patients.



The pie chart above shows the components being paid by the patients in the hospital. The charges include all the services and in most cases the cost is paid by the HCF, medicare, and the patients.The quote below proves my statement

Canadian women diagnosed with early breast cancer lose, on average, more than a quarter of their typical income during the first 12 months after their diagnosis, according to a study published online February 26 in the Journal of the National Cancer Institute.

I believe that this surgery had cause an adverse effect on the financial status of the patients.

In my opinion, ethical issue is also implicated here ; breast reconstruction is considered as a cosmetic surgery. However, from my point of view, breast implants and reconstruction is not considered as cosmetic surgery as it is done not for the purpose of getting a perfect body structure. It is done to complete the organs in the body. Hence, breast reconstruction should not be considered as a cosmetic surgery and the public should understand about this matter. They also should not discriminate the patients that are diagnosed of having breast cancer.

Alternative Treatments


Chemotherapy is a systemic drug treatment that is intended to kill cancer cells in the body11. Chemotherapy traverses the whole body, killing rapidly dividing cells. Besides cancer cells, other rapidly dividing cells include the lining of the gastrointestinal tract, blood cells, and hair12. Damage to these cells results in the troublesome side effects associated with chemotherapy. Research has shown that adjuvant chemotherapy for early-stage breast cancer helps to prevent the cancer from returning . Usually, more than one drug is given during adjuvant chemotherapy (called combination chemotherapy).the drug is given orally (by mouth) or by injection into a blood vessel13. The more common side effects from chemotherapy are hair loss, nausea and vomiting, fatigue, low blood counts which may results in an increased susceptibility to infection or increased risk of bleeding and premature menopause.11


Breast cancer is treated with external radiation therapy. Radiation is a highly targeted, highly effective way to destroy cancer cells in the breast that may stick around after surgery. Individual cancer cells are too small to be felt or seen during surgery or detected by testing. Radiation can reduce the risk of breast cancer recurrence by about 70%. Radiation therapy uses a special kind of high-energy beam to damage cancer cells DNA, the material that cells use to divide. Cancer cells are very busy growing and multiplying and because cancer cells are less organized than healthy cells, it's harder for them to repair the damage done by radiation. So cancer cells are more easily destroyed by radiation.14



First, simulation is started. This is when the radiation therapist uses a special x-ray machine to determine the exact place on your body where the radiation will be aimed. This is called a treatment port or field. Body molds or other devices may be made at this time. These molds are designed keep you from moving during your treatment. The simulation process may take up to two hours. The radiation therapist will mark the treatment port with permanent ink so that the exact location is targeted each time15.

Hormonal therapy

Hormonal therapy can block body's natural hormones from reaching any remaining cancer cells.16 If lab tests show that your tumor depended on your natural hormones to grow it will be described as estrogen-positive or progesterone-positive in the lab report. This means that any remaining cancer cells may continue to grow when these hormones are present in your body.17 A commonly used hormonal treatment is the drug tamoxifen, which blocks estrogen's activity in the body. Studies have shown that tamoxifen helps prevent the original cancer from returning and also helps to prevent the development of new cancers in the other breast; however, many women develop resistance to the drug over time. Tamoxifen can be given to both premenopausal and postmenopausal women.18

In very severe cases, all the treatment is used in as shown below :-




Surgery has been found to be the most effective treatment for the breast cancer as stated by . This is very reliable and factual as very the information in the website are written by the Professional Advisory Board which are experts including more than 70 medical experts in breast cancer-related fields. Besides, this website contains a lot of review articles and researchers of breast cancer. I retrieved the information on the accuracy of information on the surgery and the same information appear in There is another source that came up with the same information which is