Early (operable) breast cancer is defined as the presence of tumour/s not more than five centimetres in diameter, with lymph nodes (either impalpable or palpable) that are not fixed, and with no evidence of distant metastases.1 Treatment of early breast cancer involves surgery to remove the tumour (a lumpectomy or mastectomy) and management of the axilla (the armpit area). The axilla is examined to assess the stage of the tumour (whether it has spread from the breast to surrounding lymph nodes – usually in the armpit), in order to determine further treatment options and prognosis.
Traditionally, the standard surgical method of axilla assessment has been removal of lymph nodes (axillary dissection) for examination by a pathologist. However, axillary dissection is associated with clinically significant morbidity, particularly lymphoedema.2 NBOCC has published clinical practice guidelines recommending sentinel node biopsy (a less invasive surgical procedure) to assess the axilla in women with tumours three centimetres or less in diameter and clinically negative nodes.2 Sentinel node biopsy may not be suitable for all women.
Following staging, further management of the axilla may be required, involving axillary dissection (if this was not part of staging) or radiotherapy. Staging and managing the axilla will also inform future treatment planning with the wider multidisciplinary team.