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Lymphatic Vessels
These vessels lay just below the surface of the skin, and may be a
structure similar to a blood vessel (vein or artery) or may merely be the
space between body cells. Lymphatic Vessels are located all over our body,
but they are more concentrated in certain areas. The breasts contain a greater
concentration of lymphatic vessels than any other part of the body. The
image only shows a sample of what one might expect to find in just one
breast. The vessels continue under the areola, but for the sake of clarity
they were not drawn here.
Lymph Nodes or Glands
(Subclavian, Interpectoral, Axillary, Parasternal, etc.)
Lymph Nodes gather the lymphatic fluid (and the debris that the
fluid may be carrying from the body cells), and transport any debris or
waste products into the blood stream, to be eliminated, if possible. When
an infection "up the line" from a lymph node occurs, the associated
node will often be swollen and can be felt through the skin during a
Breast Self Examination.
This is evidence
that the node is doing what it is intended to do. The Axillary nodes (in
the armpit) in
particular are the ones that may be partially removed surgically when
cancer is found in the breast. The reason for this is that a major portion
of the lymphatic circulation from the breast goes toward the upper outer
quadrant of each breast and then moves back to the axillary nodes.
Therefore, the thinking is that if any cells are "out and about", they
will most likely go to the axillary nodes and be caught up for elimination
from the body. A dozen or two of these nodes (there may be as many as 60
or more nodes in the armpit) are excised and evaluated to determine if a mass in the breast might be malignant, and
the malignancy has become metastatic (started to spread to other parts of the body). Lymph nodes
may be from the size of the head of a pin to the size of a lima bean. If
swollen, they can easily triple in size. During a
Breast Self Examination
the nodes should be monitored for swelling, which could indicate an
infection or a malignancy in the breast and warrant further investigation.
Currently, a process called Sentinel Node Biopsy
(SNB) is being used to reduce the number of lymph nodes that have to be removed during a lymph node
biopsy. It is not that simple to remove a specific number of lymph nodes,
due to the difficulty of finding them hidden among the fatty tissues. In a
SNB, a dye is injected directly
into the location of the suspicious mass in the breast, and the lymphatic
vessels that are
charged with the duty of cleansing that particular location will pick up
that dye after a short while and take it back to their node. When the
biopsy is done, the
node with the dye is more likely to be identifiable, making the removal of a
larger number of nodes unnecessary. The thought behind this is that when a
malignancy in the breast (or any other part of the body for that matter)
starts to metastasize (send off "seeds" or loose cells to start
cancers elsewhere in the body) the lymphatic system will sweep them up and
take them to the associated lymph node. The same thing happened to the dye
that was injected. Once the associated lymph node is found, it is excised
(removed surgically) and dissected under a microscope to see if it has any
of those wandering malignant cells. If ANY cells have left the malignant
mass, it is extremely likely that the associated lymph node will have
picked some of them up. if one or more malignant cells are found, more
have likely been released and chemo-therapy most likely will be
prescribed. if no malignant cells are found in the "sentinel node", it is
accepted that there have most likely not been any malignant cells released
from the breast mass, and chemo-therapy will probably NOT be prescribed. If you
are facing a lymph node dissection, I strongly suggest that you ask your
surgeon about having a Sentinel Node Biopsy. The benefits of this are a
much lower likelihood of developing lymphedema in the associated arm.

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