Research continues to answer questions about sentinel lymph node biopsy

16 October 2019

Whether or not breast cancer has spread to the axillary or armpit lymph nodes, remains an important indicator of outcome for women/wāhine with breast cancer, and may help predict the need for further treatment (e.g. chemotherapy or radiotherapy). Historically axillary node status has been determined by removal of most of the nodes (axillary clearance).  This operation may lead to arm swelling (lymphoedema), pain, some abnormal skin sensation or shoulder stiffness.

Waikato Hospital surgeons and researchers introduced “sentinel node biopsy” to breast cancer surgery in 2002. Sentinel node biopsy involves the removal of only a small number of lymph nodes most closely related to the breast cancer.

The Waikato is now a centre for a fourth international sentinel node biopsy trial. It is important we carefully evaluate the benefits and risks of introducing this lesser surgery to the axilla for women/wāhine with different types of breast cancer. Helen is a participant on the “Sentinel Node biopsy versus Axillary Clearance Part 2 (SNAC 2) trial, she recently shared with us her journey.

As the daughter of a pharmacist and a nurse, being an occupational therapist myself and married to a medical man, particpating in a clinical trial seemed sensible

“It has been difficult to remember many details about this story as it began 10 years ago, and my mind has proven to have the ability to forget the actual pain and discomfort.

I had had a history of cysts over the years so when a routine mammogram indicated I should have an ultrasound; I assumed more cysts. I was surprised to be told I had breast cancer and disbelief was my initial reaction as I felt remarkably fit and healthy and well! My next reaction was “Tell me the plan to get rid of it”. The label for my breast cancer was multifocal grade 2 invasive lobular carcinoma and the advised plan was to have a total mastectomy with reconstruction. ‘In for a dime, in for a dollar’ – get it all over and done with in one hit was my reasoning.

With this plan timetabled, my surgeon, Ian Campbell, asked if I would participate in a clinical trial. As the daughter of a pharmacist and a nurse, being an occupational therapist myself and married to a medical man, this seemed sensible. I reasoned that it may help with future treatments and improve life expectancy for others. It was SNAC 2 trial, Sentinel Node biopsy versus Axillary Clearance.

Needless to say, I ascertained there was no additional risk to myself, only a couple of extra appointments and another ultrasound with dye injected to trace which lymph nodes were feeding / draining the three tumours.

My surgery proceeded as expected but then came the news that one lymph node had cancer cells and with that news, another date with the surgeon was organised. Following this I was discharged with a drain in place which the district nurse encouraged me to keep until there was no more fluid to drain. I have been lucky enough to escape any issue with lymphoedema.

For some weird reason I had thought that the surgeries would suffice to beat this cancer but no … chemotherapy, followed by radiation, gave me better survival stats so again – ‘in for a dime in for a dollar’. I took all the drugs to combat the side effects of chemo, wore my wig and managed.  The radiation was a chore and I remember feeling weary towards the end. Now, 10 years later, the whole experience is a bit of a blur, but I know it irrevocably changed my life and furnished me with the resilience and understanding to dual with further life events.

I know that I would not have come to this place without the comfort and kindness of friends and family.”