|
|
|
|
|
|
|
|
|
|
|
|
||||||||
|
|
|
|
||||||
|
|
|
|
|
|
|
|
||
|
|
||||||||
|
|
|
|
||||||
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
Axillary clearance versus axillary node sampling The protagonists of axillary sampling argue that axillary clearance represents an over treatment in a significant proportion ( 60% ) of patients who will be found to be free of nodal disease on histological examination. The sampling of the axilla allows to define the group with nodal disease who would benefit from further treatment to the axilla mainly in the form of a formal clearance or radiotherapy. They argue that there is little evidence to suggest that axillary control imparts better overall survival in these patients. Against the policy of axillary sampling is the reportedly high rate of failure to retrieve nodes by the dissection ( 18-30% ). Furthermore, skip metastasis occurs in no more than 5% of the cases (that is, involvement of higher levels in absence of disease at level l) but the presence of metastasis in the nodes at level l means that there is a 45% risk of involvement of the higher groups which will then need to be treated. Treatment would then involve a formal clearance or radiotherapy. The latter raises the risk of lymphoedema from 2-6% with surgery alone to 40% with the addition of radiotherapy. Axillary clearance
offers the most effective chance of achieving local control of the disease
and although this has not shown to confer a survival advantage, it does
mean a lot to the patient in terms of psychological well-being. It is
therefore our policy to advocate axillary clearance in patients under
the age of 65 with invasive cancer. In the older patient good disease
control can be obtained with hormonal manipulation with anti-oestrogens
and therefore axillary clearance is not undertaken routinely. If
you require further advice or information please contact the |
|
|
|
|
|
|
|
 |
 |
 |
 |
 |
 |
|