Axillary Lymph Node Dissection
What is axillary dissection?
The armpit is also called the axilla.
The axilla contains lymph glands as well as nerves and blood vessels to the upper limb passing through it.
Lymph glands in the axilla help in fighting infections and cancer from the head and neck area and sometimes the upper torso.
Axillary dissection is a procedure in which lymph glands in the axilla are surgically removed.
It is also called lymphadenectomy.
This operation is required when cancer has spread to the axilla (stage 3).
How do I know if cancer has spread to the axilla?
Axillary cancer usually presents with an armpit lump.
Such lumps can be picked up in several ways:
You may have noticed the lump yourself or others have pointed it out.
It could be picked up during your routine examinations at your follow up appointments.
It may also be picked on your routine regular staging scans.
Suspected cancer spread is confirmed by a needle sample test performed with ultrasound guidance.
What does it mean if I have axillary node cancer?
Confirmed axillary metastasis is a sign that the disease has progressed to stage 3 at least.
You will require updated scans to rule out spread to distant organs such as the brains, lungs and liver.
Your care will be discussed at a specialist skin cancer meeting where all your scans are discussed and a management plan made.
Treating axillary node cancer is a joint effort between my team and Oncologists.
You will be referred to the Oncologists to discuss other treatments that may be appropriate in addition to surgery (discussed below).
If axillary metastasis is found through SLNB, you may be offered Oncology treatments instead of surgery.
However, metastases that can be felt through the skin or visible on scans usually requires axillary dissection.
How is axillary dissection performed?
Axillary dissection is performed under general anaesthetic.
It requires long incisions to allow safe removal of the glands.
Care is then taken to peel away the axillary lymph gland from the important nerves and blood vessels.
You will usually have two drains in the axilla, and dissolving stitches are used.
Axillary dissection alone is usually a 2 to 3 hour surgery.
What is the recovery and follow up after axillary dissection?
Patients usually stay in hospital for 3-5 days on average.
You will receive pain killers and other medications as required.
Drains are usually removed when they drain less than 30 mls of wound fluid in 24 hours.
Most patients are walking, washing and doing gentle tasks by themselves after 2-3 days.
Follow up with the Christie dressings clinic will be arranged for about a week following surgery, and more appointments will be made if required.
You will also receive a nursing follow up telephone consultation at 6 weeks.
There will usually be minimal restrictions to your activites but these will be specified for your circumstances.
What risks does axillary dissection have?
The risks of anaesthetics will be discussed with you by the anaesthetic teams, but may include chest infections and clots in the legs or lungs.
Your specific risk will be discussed with you after anaesthetic assessment, which is offered to patients who might have higher anaesthetic risks.
The incision will form a scar which will need about 18months or more to fully mature.
You will find that your shoulder will be stiff to start with and will feel tight due to the scar.
Wounds can also become infected. Most can be treated with oral antibiotics from home but rarely, some need admission and/or surgery to wash the wound.
There is risk of injury to several nerves and large blood vessels but this is exceedingly rare.
There will be some numbness to the inner arm and around the scar.
Most wounds heal uneventfully but healing may be delayed at the junction of incisions.
There may be prolonged drainage of wound fluid from the drains either delaying discharge or you may go home with one drain.
Seromas or wound fluid collections can also happen after discharge and these can be drained in the dressing clinic.
I think my skin cancer may have spread to the axilla, what do I do?
If you notice swellings in your axilla following a skin cancer diagnosis, you can contact my secretary directly or speak with the skin cancer Specialist Nurse.
Seeing your GP may delay your review with my team.
It is also approriate to contact your dermatologist.