Sentinel Lymph Node Biopsy—Answers to Your Questions

Here is some information about sentinel lymph node biopsy that many patients have questions about.

Q. What is the sentinel lymph node?

A.  The sentinel lymph node is the first node(s) in the body to come in contact with cancer cells as they leave the primary tumor in the breast and start to spread into the rest of the body’s tissues.

Q. What are the benefits of sentinel lymph node biopsy?

A. By removing only the sentinel node(s), the pathologist who reviews the tissue sample to detect cancer will have a more targeted approach and spend more time looking at the areas most likely having the cancer. Also, if the sentinel node is found to be negative for cancer cells, patients can potentially avoid getting more invasive treatment like an axillary lymph node dissection (ALND), which leads to a higher risk of developing lymphedema. Sentinel lymph node biopsies (SLNB) typically lead to shorter recovery times and less post-operative pain than an ALND.

Q. Who is a candidate for sentinel lymph node biopsy?

A. Women who have undergone a breast biopsy and have been diagnosed with breast cancer should ask their doctor if sentinel lymph node biopsy is an appropriate alternative to axillary lymph node dissection for them.

Q. Who is not a candidate for sentinel lymph node biopsy?

A. Patients with non-invasive cancers may not require sentinel lymph node biopsy. Also, patients with known positive nodes may not need SLNB unless other areas are suspected.

  

Understanding the Extent of the Cancer

When a woman is diagnosed with breast cancer, one of the first questions she and her doctor want to answer is, “Has the cancer spread?” Advances in procedural techniques have helped answer this question and improve the physician’s ability to develop a more effective treatment plan for breast cancer. One of these techniques is the sentinel lymph node biopsy, which helps the physician better understand the extent of the cancer, potentially sparing patients from more invasive surgery and/or side effects.

Lymph nodes are small structures located throughout the body that filter out and destroy bacteria and toxic substances. The sentinel lymph node is the first lymph node of the breast. If cancer cells have broken away from the tumor and traveled away from the breast, the sentinel node is more likely than other nodes to contain these cells. By examining the sentinel node, the physician may better determine the status of the entire axilla (underarm area). For example, if the sentinel node is negative for cancer cells, then the remainder of the lymph nodes are more likely to also be cancer free.

Learning About Sentinel Lymph Node Biopsy

Sentinel lymph node biopsy (SLNB) is a minimally invasive technique. For the procedure, the tumor site is injected with a radio-isotope, blue dye, or both. The radio-isotope or blue dye is tracked into the sentinel lymph node. If a radio-isotope is used, a gamma detection device helps the surgeon identify the sentinel lymph node. Once the sentinel node is identified, the surgeon removes the node (or sometimes the first few nodes).

The node(s) are then examined under a microscope. If no cancer is found in the sentinel node, it may not be necessary to remove additional nodes. If cancer is found, more lymph nodes are removed to check for additional areas of cancer.

Studies have shown that SLNB is an accurate way to detect whether or not cancer cells have spread outside of the breast.  These studies have found that sentinel lymph node biopsies have accuracy rates greater than 96% for predicting the presence or absence of cancer cells in the axillary lymph nodes.

Axillary Lymph Node Dissection

Axillary lymph node dissection is an alternative, as well as a follow-up procedure, to SLNB. If the SLNB shows that the cancer has spread to the lymph nodes, an ALND may be performed to determine how many lymph nodes are affected.

Unlike SLNB, in this procedure, multiple nodes are removed at once. The procedure removes more tissue and requires more work around the blood vessels and nerve bundles. Although both procedures have the following side effects, more patients reported persistence of these side effects following ALND than those having only sentinel lymph node removal:

•  Arm swelling and numbness
• Limitations in range of motion
• Time until return-to-normal activities
• Seroma
• Axillary pain

Your doctor may also recommend ALND if you have lymph nodes that feel abnormal or are enlarged.

(Source: Mammotome)


Watch Dr. Charles E. Cox perform a sentinel lymph node biopsy in the video below:

Hooked on Hope 2011

This year's Hooked on Hope was a huge success! Thank you again to everyone involved. Watch the video below to see some of the inspiring messages from speakers at the event.




For more information on Hooked on Hope's events, go to their website and join us in getting Hooked on Hope!

Alcohol Consumption and Breast Cancer: How can it affect me?

Recent news about alcohol consumption and breast cancer raises questions about how much a person should or shouldn't drink. Dr. Rache Simmons explains how the findings in a recent study could affect you.

What is a Breast Cancer Patient Navigator?

I have been asked frequently, “What exactly do you do??” The answer, quite frankly, is…..a little bit of everything!

Every day brings with it a different set of issues and challenges as I assist our patients through this very confusing and sometimes daunting maze of health care. On any given day you might find me in the Women’s Center recovery room at the bedside of a patient and her family after her breast cancer surgery…or in the chemo lab sitting with a patient as she is being given her treatment…perhaps at the Breast Care Center to be there for a woman that has just learned she has breast cancer, or in Radiation Oncology helping a patient apply for Medicaid or other financial assistance. Many times they are here from out of town and need assistance with lodging during their treatments. While a large part of my role is centered on the breast cancer patient, I also navigate our other cancer patients as they undergo radiation therapy treatments. Since this was a new role, it was a “learn as you go” experience in the beginning. Three years later, this role has expanded to include navigation of all of our cancer patients.

The role of cancer navigation may be new to our facility, but it has been a real concept for quite some time. The idea originated in 1990 by Dr. Harold Freemen at Harlem Hospital Center in New York City. The goal of the program, funded by an ACS grant, was to ensure that a patient with a suspicious breast cancer related finding would receive timely diagnosis and treatment. Additionally, the hospital provided free and low cost screening mammography, as well as outreach and public education efforts in the community. With all this in place, the 5-year survival rate for patients diagnosed with breast cancer at Harlem Hospital jumped to 70% in 2000 compared to 39% in 1986! From this pilot program, patient navigation has grown into a national movement and encompasses programs sponsored by ACS, NCI, and Centers for Medicare and Medicaid services.

So, what exactly does a Breast Cancer Patient Navigator do?

v  A Coordinator of patient-care activities to support the transition from diagnosis to treatment.

v  A provider of educational information and support to all patients concerned about their breast health.

v  An educational and emotional consultant for women with benign breast diseases

v  A supporter of the cancer patient and the family in understanding and coping with the strong emotions that accompany a cancer diagnosis. She remains a constant caregiver and overseer of the patient’s educational, emotional and social needs.

v  A provider of educational resources for the patient and the family to answer their questions and address their fears during the cancer experience.

v  A facilitator of physicians’ recommendations for patient care to help ensure patient compliance and understanding.

v  A triage manager in assessing patients’ educational and social needs identifying healthcare barriers and appropriately referring to the proper source of help.

v  An educator for other medical personnel in understanding benign and malignant diseases, their treatment and the patient’s emotional and social recovery from the disease.

v  A public educator on the early detection of breast disease and breast self-exam skills.

v  A public advocate for the needs of cancer patients and their families.

When the plans for our Breast Care Center were in early stages, it became evident that in order to be successful, this was how we needed to model our breast program--and so the role of navigator was established. Studies have shown that hospitals with navigators in place have increased patient satisfaction, increased physician referral, but more importantly, increased survival rates. I am proud to say we have accomplished the same goals set forth by Harlem Hospital 20 years ago. We offer free screening mammograms to the uninsured women of our community through our “Heroes ’n Heels” program. We have established a library of books for our patients to educate them on all aspects of cancer treatments, as well as prevention and nutrition. The education does not just exist for the patient; I also incorporate education and support for the family and caregiver of the patient. We have initiated a lymphedema program in the Physical Medicine department for our post mastectomy and lumpectomy patients.

Imagine being given a diagnosis of cancer…the shock, the fear, and the disbelief are numbing. You don’t know what to do next---who to call…what appointment should I make? Which doctor to make it with? What other tests do I need? How will my films and reports get there? What about disability? Can I receive financial assistance? Am I going to die? What about my children? How do I get to my treatments? Can I work through my treatments? Will I lose my hair? Where do I get a ...wig? These are just a few of the concerns my patients have when they are diagnosed.

When a patient at the Breast Care Center is given a diagnosis of breast cancer, I am there with the Radiologist to offer her a folder full of pamphlets and books, support group information, appointments, etc. Depending on which surgeon their referring physician prefers, an appointment has been made for them. A breast MRI is already ordered and, if necessary, an authorization is in process. She will get a personalized card in the mail from me, the first of many I send to my patients as they go through this journey. I follow this patient and her family through her entire experience--from surgery to treatment--into survivorship. I offer the same support for the already diagnosed cancer patient as they begin their radiation treatments.

The rewards of this job are immeasurable. There is not a day that I don’t give thanks for my health and that of my family. My patients teach me the priceless treasure of not taking that for granted. I am blessed beyond measure that these brave people allow me, someone they did not even know before the moment that their lives changed so dramatically, into a very private and intimate experience. They have no idea how honored I am by it and how each and every one of them have changed my life.


By Theresa Winsey, CBPN-IC

For Theresa's contact information, visit our website.

A Story of Survival!

thinkpink

In the latest edition of Think Pink, from The Ledger a former patient of Dr's. Mary Gardener and Charles Cox shares her remarkable story of survival.

Here is a link to her story. Check it out!

Stories From Community Survivors-- Gail Allen

To see the entire issue of Think Pink, click HERE. There are some great articles about patient survivors, body image, breast reconstruction, and information from the American Cancer Society on many resources they provide for breast cancer patients.

Lymphedema

Dr. Cox is a pioneer in sentinel lymph node biopsy and lymphatic mapping. He helped develop the techniques used by physicians everywhere to minimize the number of lymph nodes taken out of breast cancer patients undergoing surgery. Before this, it was standard for patients to have all of their axillary (arm pit) lymph nodes removed. This put large numbers of breast cancer patients at high risk for developing lymphedema.

Even with newer techniques for surgical treatment and detection of metastatic cancer, those being treated for breast cancer still have an increased risk for developing lymphedema.Watch the videos below to learn about what lymphedema is and how it can be managed.




Here are some helpful exercise and stretching tips. You can find more of these stretches and exercises on the breastcancersister's Youtube channel.

 


A quick overview of how to self massage as part of the prevention and management of lymphedema.




Go to our website for more helpful information on lymphedema.

Dr. Cox Receives Lifetime Achievement Award

Congratulations to Dr. Charles E. Cox on winning the Lifetime Achievement Award from the Tampa Bay Business Journal's 2011 HEALTH CARE HEROES. This is another testament to the impact Dr. Cox has had on the breast cancer community.

To see other categories awarded at the event, go to TBBJ's website. We feel privileged to have such great physicians in the Tampa Bay area, and Dr. Cox is among the best not only in Tampa Bay, but around the world.

Exciting Things Happening at USF Breast Health

We are working on many projects that will have a huge impact on patient care. Dr. Cox outlines some of this work in his message below:

Planned projects such as the Genomic Risk Analysis trial are underway in collaborations with Morton Plant, Florida Hospital Tampa (FHT) and USF Health. This is a study that will define for clinicians the roles of all the known risk predicting genomic assays (OncotypeDx®, Mammaprint® and MammaStrat®) doing an head to head comparison to determine the concordance, synergy and potential discordance of these different approaches for determining long-term risk of recurrence. These studies are utilized to predict which patients would or would not benefit from chemotherapy. The Agendia/ USF MINT (Multi Institutional Neoadjuvant Trial) is in the IRB and promises to begin soon. It is the "book end" to the above studies and is a study that will determine which patients requiring chemotherapy will get maximal benefit from that treatment with the aid of a Genomic Signature. We hope to collaboratively achieve this goal with the leader in the industry for breast genomic discovery, Agendia®. The MINT Trial will be opened throughout Florida and the United States as the IRB approvals are completed. We have lined up several international sites in Tokyo, Beijing, India, Lima and possibly Rio de Janero, all with personnel that have been trained here at USF and who have exceptional research capability. We intend to partner with the Florida Cancer Specialists to provide the oncologic treatment and help in the accrual of patients requiring neoadjuvant chemotherapy.

Planning is also underway with Dr. Steve Shivers to create a registration trial for a new gene test for risk assessment (OncoVue®), which measures DNA SNIPS in buccal washings that will determine a patients’ overall risk for developing breast cancer.

These studies are supported and could not be accomplished without the superb expertise of the leading breast pathologists of this community: Drs. Santo Nicosia, Geza Acs, Vesna Vrcelj and Nicole Esposito. These studies will truly launch them all into the spotlight of American breast pathology.

Doctors Gardner and Reed are diligently initiating a new program of breast cancer screening and detection with the help of BSGI (Breast Specific Gamma Imaging) and PEM evaluations of the breast. These technologies along with their unparalleled expertise in breast imaging continue to bring the highest level of care to this community.

We are the leading accruer on the National American College of Surgeons’ Cryoablation Trial with the hard work of my brother John. We are completing several manuscripts and have submitted our chapter to the Devita Textbook of Oncology on trends in breast cancer surgical therapy. We have begun the process for intraoperative brachytherapy with Dr. Greenberg and the Women's Program at FHT with planning underway to be able to use the Pepin Heart Institute operating rooms for conducting those treatments. Planning for institution of Microvascular Flap Reconstruction with the use of the newly revised SPY technology is also underway with collaborative efforts from Drs. Albear, Han and Lee at the FHT with the Pepin Heart Institute.

Our superb office staff makes the compassionate care of our patients their highest priority and brings a level of professionalism and efficiency to unparalleled expression.  Dr. John Cox’s computer genius and high tech skills of office management continue to provide the most efficient and capable utilization of technology to bear on the patient care arena. Jeff King is making strides in the development of new research and data accrual methods to streamline the acquisition of patient information from now multiple outside sources.

My sincerest thanks for all the support and efforts that have been made to help us achieve a superb level of care to the women of Tampa Bay and South Florida. There is no question that we have the "Dream Team" for breast cancer care. With continued support there is no telling the greatness of accomplishments that we can achieve to bring the highest quality of care to breast cancer patients.

Charles E. Cox, M.D., FACS

Welcome Everyone!

Welcome to the USF Breast Health blog! We are excited to share with you educational and inspirational information. We hope this can be a place of value for patients and the community. Please feel free to leave comments! We would love to hear from you!

Our annual fundraising event, Hooked on Hope just ended and we are thankful for your continued support! We are excited to use the donations we received to support our patients' needs.

ABC Action News anchor Linda Hurtado shared her experience with finding out she had cancer in a special report last night. Her example and courage is inspiring and we hope the community takes this video to heart.

To follow Linda's story go to her Taking Action Against Breast Cancer website.