New Surgical Technique Helps Spare Patients’ Lymph Nodes and Avoid Lymphedema

No matter what treatment patients choose, breast cancer is not generally a walk in the park. But patient outcomes and quality of life are improving a little bit more all the time, thanks to new research and treatment options.

One of the latest treatments to be invented may help breast cancer patients avoid having an up-front invasive surgery and could have a lifelong positive impact by reducing the chances of developing lymphedema.

When breast cancer spreads, its first stop is generally the lymph nodes of the armpit. In roughly 40 to 75 percent of cases, the cancer that has spread to the lymph nodes can be eradicated using chemotherapy, but, up until now, there was no way to know whether the treatment had been 100 percent effective without permanently removing a large number of lymph nodes from the armpit. That meant surgery was required and that the patient might lose several completely healthy lymph nodes.

Without all their lymph nodes intact, patients can easily develop lymphedema, a lifelong disease that can be treated and maintained but not cured. In fact, up to 70 percent of patients will develop some sort of complication, such as lymphedema. Lymphedema is a buildup of the lymph fluid that lymph nodes usually clean out of the body, leading to swelling, tingling, and other symptoms in the arms or other affected extremities.

“The standard surgical approach for patients with breast cancer that has spread to the lymph nodes has been axillary lymphadenectomy (ALND), which involves removing most of the lymph nodes in the axilla,” explains Dr. Abigail Caudle, MD, who first pioneered the TAD technique at MD Anderson. “Unfortunately, this approach is associated with significant complications which can impact a patient’s quality of life, including swelling, pain, and decreased range of motion. Some patients have an excellent response to chemotherapy and may have no disease remaining in the lymph nodes. We suspect that these patients may not benefit from having all of their lymph nodes removed, although the studies looking at this question are not yet available.”

The treatment, known as Targeted Axillary Dissection (TAD), involves inserting a tiny magnetic seed into specific lymph nodes that are known to contain cancer. The seed allows surgeons to monitor the cancer, so they can see how it responds to neoadjuvant chemotherapy. If it shrinks or disappears, surgery on the lymph nodes may not be necessary. And if the patient does not need to have their lymph nodes removed, they’re far less likely to develop lymphedema issues in the future.

This procedure replaces a total axillary dissection or axillary lymphadenectomy, meaning the removal of the lymph nodes, which would generally take place if a patient were discovered to have cancer in their lymph nodes. Doctors at MD Anderson Cancer Center have performed the TAD procedure in the hopes of saving some patients from invasive procedures and the development of long-term complications.

“The challenge has been how to identify these patients that might benefit from less aggressive surgery. By specifically removing the exact lymph nodes that had confirmed cancer at the time of diagnosis, as well as the lymph nodes most likely to contain disease, we can now accurately assess whether there is cancer remaining in the lymph nodes and consider no further surgery if there is no evidence of cancer,” says Dr. Caudle.

The device, called Magseed®, is very small, only a fraction of the size of a grain of rice. On top of helping surgeons track cancer’s shrinkage or growth, it also marks the areas where cancer was found so that later surgeries can remove the affected areas without damaging healthy lymph nodes.

“There is a sea-change afoot in the treatment of breast cancer as patients become increasingly educated about the options available to prevent side effects of treatment. Foremost on this list are procedures and technologies that can prevent lymphedema—an incurable, debilitating, progressive, and disfiguring swelling that can occur when the lymphatic system is damaged during surgery, radiation, or chemotherapy. Women who win their battle against breast cancer routinely state that lymphedema can be worse than their cancer. Their cancer was cured. Their lymphedema is forever. In this modern world, every woman deserves the full benefits of our knowledge to mitigate the onset of the life-long disease of lymphedema,” explains William Repicci, LE&RN President & CEO.

There are other nanotechnologies like this one out there, but this is the most widely studied non-radioactive seed, and for good reason. A variety of multinational studies have showed that it is highly effective in increasing the ease and accuracy of marking lymph nodes, and the success rate of surgical retrieval of the seeds remains at 100 percent. The technology is now available in more than 40 countries around the world.

“This pioneering surgery exemplifies the importance of new technologies such as Magseed in moving breast cancer treatment forward,” says Eric Mayes, CEO of Endomag. “These technologies have already helped over 200,000 patients globally access a better standard of cancer care. We’re committed to continually learning from physicians around the world and providing access to cutting-edge clinical applications that will make a difference to these patients for years to come.”

It’s refreshing to see a breast cancer technology have such a substantial impact on people’s lives. We hope this device will soon be widely available across the globe to help improve the quality of life and cancer treatment experiences for people everywhere going through breast cancer and other types of cancer.

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