Breast cancer surgery updates

Holly Mason, MD

Section Chief, Breast Surgery, Baystate Health

We continue to follow the evolving recommendations concerning management of the axilla. As mentioned in a previous Rays of Hope newsletter, many patients over the age of 70 with small and non-aggressive breast cancer can safely and appropriately avoid any lymph node removal. We are also successfully using medical therapy, usually in the form of chemotherapy, to covert lymph nodes with cancer to negative (non-cancer-containing) lymph nodes which allows patients to avoid extensive lymph node removal. We have a close collaboration with our colleagues in radiation oncology to identify appropriate patients to undergo radiation treatments to the lymph nodes underneath the arm rather than remove more lymph nodes surgically. All these efforts are performed in order to minimize the risk of lymphedema, which is a chronic swelling of the arm which occurs when the lymph channels that drain the arm are disrupted by treatment to the lymph nodes in the armpit area (otherwise known as the axilla).

Unfortunately, these efforts have not eliminated the occurrence of lymphedema. Lymphedema treatment is highly effective and early intervention is ideal to minimize the long-term impact. Early symptoms include a sense of “heaviness” in the arm, which often is noticed prior to any visible or measurable swelling of the arm. When lymphedema is identified, a referral to a lymphedema therapist is imperative. Baystate Health has an established lymphedema program with Occupational therapists certified in lymphedema treatment that utilizes light massage techniques as well as compression through bandaging or garments to reduce swelling. In addition, a new focus of lymphedema care known as “pre-habilitation” begins the evaluation and education process prior to any treatment for individuals who are at high risk for lymphedema post-treatment: individuals with known cancer spread to their lymph nodes who will need extensive surgery to the lymph nodes, radiation to the lymph nodes, or both.

Any member of your oncology team can refer you to the Baystate Health lymphedema program.