What is a sentinel lymph node?

www.breastcancer.org explains it well:

The dictionary defines "sentinel" as a guard, watchdog, or protector. Likewise, the sentinel lymph node is the first node "standing guard" for your breast. In sentinel lymph node dissection, the surgeon looks for the very first lymph node that filters fluid draining away from the area of the breast that contained the breast cancer. If cancer cells are breaking away from the tumor and traveling away from your breast via the lymph system, the sentinel lymph node is more likely than other lymph nodes to contain cancer.

When I was diagnosed with breast cancer my head was spinning when my surgeon offered me to participate in a clinical trial. The trial would put women in two groups. One would have just the sentinel node removal and the other group would have a full axillary dissection.

Just two months after her mother lost her battle with gall bladder cancer, Liane was diagnosed with breast cancer. It all happened earlier this year -- and while Liane is still mourning the loss of her mother, she is also still managing the madness of her own disease. Liane is surviving with courage, with determination, with the same powerful spirit that powered her mother's fight.

Liane lives in a small city -- population 43,000 -- in northern Alberta Canada. She has been happily married for 18 years and has two daughters, ages 13 and 15, and a golden retriever named Sunny. Liane loves to garden, cook, read, and spend time with family. She normally works full-time in a real estate and property management office but has been blessed with six months off for treatment. Liane is already -- without a doubt -- a survivor.

Kim Taylor is a 45-year-old single mother who lives in Suwannee County, Florida and is proud to have successfully raised one daughter -- a graduate of the University of Florida. Kim enjoys outdoor activities like camping as well as sewing, crafting, and carpentry projects. She is most at peace spending time with her family, working as a youth volunteer -- and raising awareness for breast cancer. It's a interest she acquired just two years ago, compliments of a personal encounter with the disease that has taught her to let the little things go, to appreciate every sunrise, to make every moment matter.

Researchers in Spain conducted a study among 1606 women with node-negative breast cancer. The results were published in the Annals of Oncology. What the researchers wanted to find out is whether the number of lymph nodes removed during axillary lymph node dissection influences risk of recurrence. Axillary lymph node sampling is a necessary procedure to stage a patient diagnosed with breast cancer. Women who underwent sentinel lymph node biopsy were not included in the study.

The researchers discovered that there was an increased risk of local breast cancer recurrence if fewer than six lymph nodes were removed. If the surgeon removes less than six lymph nodes there is a risk that other lymph nodes that could contain cancer can be missed. This can result in under staging and the patient not receiving the correct treatment plan.

In order to be confident that the patient does indeed have node negative breast cancer it is important to remove at least six lymph nodes for evaluation.

Positron emission tomography (PET) can measure metabolic activity of tissue. Cancer cells tend to have a higher metabolism than normal tissue, which can be determined on PET for more accurate detection of cancer.

Using the PET scan after diagnoses of breast cancer to check lymph nodes for cancer was looked at in a study that was published in the Archives of Surgery. What the study found out is that the PET scan can detect 60 percent of patients with positive nodes. These patients that know they have positive nodes might be able to start therapy and avoid the axillary dissection or the sentinel node biopsy. These surgical procedures can often have side effects. By avoiding these surgeries a patient that knows they have positive lymph nodes won't have to wait for surgery and extra time to heal to start chemotherapy or other treatments.

If a patient has a negative PET scan showing no cancer in the lymph nodes the axillary dissection or the sentinel node biopsy should be performed since the PET can only pick up 60 percent of patients cancer in the lymph nodes. The patients could still have microscopic cancer cells that the PET can't pick up so in this case surgery is needed.

Getting accurate information on whether or not the cancer was confined to the breast has a big impact on the treatment plan.