The Effect of Treatment Selection in Breast Cancer on the Development of Arm Edema

Breast cancer is the most common type of cancer in women. For this reason, it ranks first in cancer surgeries performed on women. Breast cancer is a type of cancer that spreads primarily through lymph nodes. The first place it metastasizes is most commonly the lymph nodes in the armpit.

The clinical stage of breast cancer when it is first diagnosed is very important for treatment planning. Clinical staging is determined by manual and radiological examinations of the size of the mass in the breast, its extent, whether the cancer has involved the skin and chest wall, and its spread to the lymphatic pathways and distant organs. Radiologically, mammography, ultrasonography, tomography, magnetic resonance (MR) and PET-CT are frequently used methods. In the stage called "Early Stage Breast Cancer" (Stage I and II), the cancer is small in size in the breast and there are no suspicious lymph nodes palpable under the armpit or detected by US, or the number of suspicious lymph nodes is one or two.

Early stage breast cancer is an operable stage and the patient is operated on first. According to the type of surgery performed afterwards, the pathological staging of the tumor obtained as a result of the examination of the surgical specimens, and the biological characteristics of the tumor; Additional treatments are applied with chemotherapy, radiotherapy, hormonotherapy and targeted therapy agents. In the third stage, the aim is to shrink the tumor and regress the stage of the disease with chemotherapy and systemic treatments. Afterwards, surgery is planned. In the fourth or metastatic stage, surgery is performed only in special cases.

There have been serious developments in the treatment of breast cancer, especially after the 1980s. Firstly, instead of mastectomy surgery (removal of the entire breast), which was previously performed on all patients, no matter how small the tumor was and how early the diagnosis was, breast-conserving surgery methods were developed in which the tumor was removed with wide, clean borders in suitable patients. Secondly, armpit surgery, which was previously performed on every patient. Instead of lymph dissection (removal of the entire lymph nodes in a certain area under the armpit), "sentinel (sentinel) lymph node biopsy" was developed and in the patient who was taken into surgery, the lymph nodes in the armpit that first received the lymph were determined, removed and examined with methods using special dye and nuclear material, and examined. If there is no tumor spread, a method of preserving previously removed lymph nodes in the armpit has been developed. Sentinel lymph node biopsy is a relatively minor procedure for the patient compared to armpit dissection.

Arm edema (lymphedema) that develops after breast surgery is an undesirable condition that negatively affects the quality of life of patients. Especially in patients who had to receive radiotherapy to the armpit and whose treatment was started late, the response to treatment is very low and the patient may become almost unable to use her swollen arm.

The 3rd stage of breast cancer is called "locally advanced breast cancer". . At this stage, there is tumor spread to many lymph nodes in the armpit. In patients requiring surgery at this stage, axillary lymph dissection must be performed. As a result, the patient faces a serious risk of arm edema. The way to avoid axillary dissection in patients at this stage is "neoadjuvant chemotherapy", which is a treatment modality that has become the standard approach today. In this approach, the patient's treatment begins with drug treatments. The aim is to first regress the tumor and the lymph nodes affected by the tumor under the arm with medication, and then perform surgery. This method has two surgical advantages:

1- Shrink the tumor of patients with very large tumors in their breasts and perform breast-conserving surgery,

2- Treat the tumor lymph nodes under the arm with medications and is to have the chance of sentinel lymph node biopsy instead of armpit lymph dissection. If it is determined that the tumor in the sentinel lymph nodes has been completely cleared, it is to save the patient from armpit lymph dissection.

Today, chemotherapy and other drugs used in the treatment of breast cancer are very effective. For this reason, the results are quite satisfactory. According to the characteristics of breast cancer that determine the response to chemotherapy, it is determined that the armpit is completely cleared with medication in up to 50% of patients with armpit involvement. The reflection of this situation in practical application; If surgery were to be performed at first, axillary dissection would have to be performed and in 50 out of 100 patients who are at risk of serious lymphedema, the armpit would be more painful and life-threatening. They are protected from the risk of serious lymphedema, which they may not be able to get rid of for a long time.

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