The main treatment option at an early stage of breast cancer is lumpectomy (organ-preserving surgery). A biopsy of the lymph nodes is additionally performed in order to detect if they contain metastases. In modern hospitals abroad, breast cancer surgery and lymph node biopsy are performed by experienced specialists, using state-of-the-art equipment, with the possibility of breast reconstruction. Breast irradiation is always performed after surgery. According to the results of a node biopsy, a decision can be made on the need for chemotherapy.
What is lumpectomy with lymphadenectomy?
Lumpectomy is the least invasive technique of breast cancer surgery. It is most often used for tumors up to 2-2.5 cm in diameter, sometimes a tumor may be up to 4 cm in the largest dimension.
Lumpectomy for early-stage breast cancer is as effective as radical mastectomy (total breast removal), but only on one condition. The surgery must be complemented by radiation therapy.
A well-performed lumpectomy and follow-up radiation therapy demonstrate high efficacy. Local recurrences of stage 1 breast cancer almost never occur, and at the 2nd stage the risk does not exceed 3-5%. However lymph nodes can also be sources of the disease recurrence. Therefore, during the lumpectomy, the doctor must either remove them or make sure that they do not contain cancer cells.
When performing a mastectomy, the doctor usually carries out resection of the lymph nodes via the same incision through which he removes the breast. This is called en bloc surgery. If breast-conserving surgery is used for the treatment of breast cancer, then lymphadenectomy or lymph node biopsy requires an additional skin incision.
Why do doctors remove lymph nodes?
At first, the lymph node dissection in breast cancer is performed more for diagnostic purposes than for therapeutic ones. A lymph node biopsy allows the doctor to understand if they contain metastases, and if so, how many metastatic foci are expected to have spread with the lymph.
Unfortunately, non-invasive examinations are less informative than the lymph node biopsy. Sometimes metastatic foci can be detected using MRI. If the lymph nodes are swollen, then even without a biopsy of the node, it is clear that they contain metastases. Nevertheless some metastatic foci have a diameter of tenths of a millimeter. In this case, they cannot be detected with the help of non-invasive diagnostic procedures. Only a biopsy of the node will allow the doctors to find metastases.
During the treatment of early-stage breast cancer, at least 10 lymph nodes are removed. According to the results of a node biopsy, the stage of the tumor process is determined, and a decision is made on the need for chemotherapy.
In some clinics, only the sentinel lymph node is examined in women with breast cancer. Such an approach reduces the risk of complications caused by impaired lymph circulation.
What is lymphedema?
Lymphedema is a complication, which develops as a result of impaired lymph circulation after the removal of lymph nodes. Lymph accumulates in soft tissues and causes edema.
Lymphedema develops in 3 consecutive stages:
- Stage 1 – swelling of the hand occurs on the side of the removed lymph nodes due to the accumulation of lymph
- Stage 2 – fossae on the skin appear, skin induration occurs
- Stage 3 – skin is dense, no fossa are present, the shape of the limb is changed, the volume is increased significantly, lymph can flow out through skin defects
Lymphedema has 4 degrees of severity. First degree is when the circumference of the arm with impaired lymph flow is larger than the opposite limb, but the difference does not exceed 10%. At the second degree the circumference of the arm on the side of the removed lymph nodes is 10-30% larger than the opposite one. In the case of third grade lymphedema, the difference exceeds 30%, lymph can flow to the surface of the skin through its defects. The most severe degree of lymphedema is fourth. It is characterized by a complete loss of hand function. The accumulation of lymph can lead to the formation of a malignant tumor – lymphosarcoma.
According to the ISL classification, there are three degrees of severity of lymph circulation disorders. The difference in arm circumference is determined in centimeters, not percentages. The gradation is as follows: 1st degree – the difference of up to 3 cm, 2nd degree – up to 5 cm, 3rd degree – more than 5 cm.
Special exercises are used to improve lymph circulation. They reduce clinical symptoms, but in general, this complication responds bad to treatment.
How to avoid lymph circulation disorders?
In some cases, the normal circulation of lymph in the tissues can be maintained. For this purpose, it is necessary to avoid lymphadenectomy, if possible. The patient can avoid node dissection only if there are no metastases in them. If metastases are present, then the removal of lymph nodes is obligatory, despite the risk of impaired lymph circulation.
In developing countries, lymphadenectomy is performed in all women undergoing lumpectomy or other breast-conserving surgery. However, in modern hospitals abroad, the procedure called sentinel lymph node biopsy is performed. It allows the doctor to understand whether cancer cells have reached the axillary lymph nodes with lymph flow or not.
What is a sentinel lymph node?
A sentinel lymph node is a lymph node that first collects lymph on its way from the tumor. As a rule, the number of such nodes is two or three. The doctors can carry out sentinel lymph node biopsy and see if they contain metastases.
The sentinel lymph node is the first to pass the lymph through, and only after it the lymph flows to other lymph nodes. Therefore, if it is "clean" (does not contain cancer cells), it means that all other axillary lymph nodes are not affected by metastases.
Depending on the location of the breast cancer, sentinel lymph nodes are different. Therefore, the relevant sentinel lymph node still needs to be identified before performing biopsy. For this purpose, the radionuclide method is used. A radiopharmaceutical is injected along the perimeter of the tumor, in 4-8 points. A radiopharmaceutical enters the lymph, reaches the sentinel lymph nodes and accumulates in them. After that, a scintigraphy is carried out – the tomographic gamma scanner registers the radiation and determines the target lymph nodes for biopsy. The doctor removes target lymph nodes and sends them to the laboratory for histological examination.
If none of the sentinel lymph nodes contains cancer cells, this means that the malignant tumor has not spread through the lymph yet. It is not obligatory to carry out node dissection in such women. This means that there will be no complications due to impaired lymph circulation and lymph accumulation in the tissues.
If sentinel lymph nodes contain breast cancer metastases, then lymph node dissection is necessary. Although complications caused by impaired lymph circulation can develop after this procedure, it is still necessary to prevent recurrence. The doctors do not only remove lymph nodes, but also irradiate the area of possible regional metastasizing.
Why is it better to undergo breast cancer treatment abroad?
More and more often women prefer undergoing the treatment of cancer abroad, if the treatment in their native country is outdated, too expensive or takes a very long time to wait. If you want to take advantage of the very latest advances in medicine, you can go to Germany or Israel. Some patients go to Turkey, India or Thailand to cure the early-stage breast cancer with a lower cost of treatment.
Surgery abroad has the following benefits:
- Lumpectomy is performed by experienced surgeons – the best specialists work in the largest hospitals in the world, which admit many foreign patients.
- The preference is always given to organ-preserving surgery with follow-up radiation therapy. In developed countries, mastectomy in the early-stage breast cancer is performed extremely rarely.
- A sentinel lymph node biopsy is performed. Sometimes the removal and examination of sentinel lymph nodes avoids lymph node dissection and the complications (in some women, lymph circulation in the thorax and upper limb may be impaired) caused by this operation.
- Minimal health risks. Innovative sparing surgical techniques are used abroad, as well as supportive therapy and prevention of complications are carried out.
- The chance of curing early-stage breast cancer is close to 100%.
- Restoration of attractive appearance. After a lumpectomy with a lymph node biopsy, a doctor from a foreign clinic can perform an intervention on the other breast in order to achieve symmetry. Another option is restoration of the operated breast using the patient's own tissues.
Some hospitals perform intraoperative radiation therapy. It is safer for health than the external beam radiation therapy after surgery and ensures comparable clinical results.
When choosing a clinic, it is worth considering the cost of treatment. In developed countries, it is usually higher, but even in Germany or Israel, it is possible to find medical programs at affordable prices.
Treatment abroad with Booking Health
If you want to undergo breast cancer treatment abroad with minimal invasiveness, low risk of lymph circulation disorders after surgery, you can use the Booking Health services. On the Booking Health website you can find the information about hospitals, doctors and prices. You can compare the cost of treatment in different clinics and book the proper medical program at the best price.
Booking Health will arrange a trip abroad for you, providing the following services and benefits:
- Selection of a hospital for breast cancer surgery in which you can get rid of cancer with minimal health risks
- Direct communication with the doctor
- Reduced waiting period for breast cancer surgery and making appointment on a convenient date
- Reduced cost of treatment – prices for breast cancer surgery are lower due to the exclusion of additional coefficients for foreign patients
- Reliable information about your expenses, the cost of individual medical procedures, funds in the account
- Preparation of a medical program without repeating previously performed examinations
- Communication with the hospital after the breast cancer treatment completion
- Buying and forwarding of medicines
- Organization of additional diagnostics or breast cancer treatment abroad
The specialists of Booking Health provide high-quality services. We will book a hotel and airline tickets for you, organize a transfer from the airport to the hospital and back.