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MANAGEMENT OF AXILLA Please choose an option from the menu below to see the information you require: Anatomy
of the lymph drainage of the breast
Rationale behind the need for the treatment of the axilla in breast cancer Halsted and then Duke identified the need for removal of the regional lymph nodes while attempting to achieve a curative excision in the case of most cancers. It would therefore be sound oncological practice, in the case of breast cancer, to treat the axilla while excising the primary tumour. Furthermore the histological assessment of the axillary nodes gives a good idea of the prognosis - where the nodes are involved by tumour the prognosis is less favourable and the greater the number of nodes involved the poorer the prognosis. The risk of systemic spread is very high when the highest group of nodes is involved (level III or apical). The risk of systemic metastasis is very low ( < 5% ) when the nodes are histologically uninvolved. One application of this valuable information is the identification of those patients who would benefit from systemic treatment, be it chemotherapy (pre-menopausal patients) or hormonal therapy (post-menopausal patients) as there is good evidence to suggest that overall survival is improved by 30% in patients who receive adjuvant chemotherapy and there is also a significant benefit in terms of disease recurrence. The current consensus
is that the axilla should be treated when the diagnosis of invasive carcinoma
is made. The debate still rages on whether the axilla should be cleared
of all the nodes or whether the axilla should be dissected to retrieve
a few nodes for histological assessment prior to a formal clearance or
radiotherapy. If
you require further advice or information please contact the |
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