Preview of Thursday's surgery: Lymph node biopsy

Cancer is all about chaos, as cells run amok, split up and skedaddle in all directions, like ants boiling out of a nest that’s been poked with a stick.

But sentinel lymph node surgery is predicated on the idea that breast cancer spreads (or metastasizes) in an orderly way, more like a line of ants on a mission to infiltrate an open peanut butter jar. Its first stop en route to other body parts is likely to be the lymph nodes, clusters of bean-shaped thingies (not the actual medical term) that filter lymph and other fluids. Their nearest location to the breast is under the adjacent arm.

One medical term I’ve now mastered is “axillary,” the fancy-pants word for armpit.

Just a few years ago, invasive breast cancer like mine was treated with an axillary node dissection – removing most or all of the dozen-plus lymph nodes in the armpit to see if the cancer had spread there.

But doctors figured out that cancer always made an initial pit stop in a few “sentinel nodes.” Nowadays, it’s possible to remove and biopsy just those sentinel nodes. If they’re cancer-free, then that should be true for the rest of the nodes. Taking out only one to five sentinel nodes reduces the pain and potential complications such as swelling, stiffness and, most ominously, lymphodema, associated with the full axillary lymph node dissection.

Here’s how it will work: When we get to the hospital on Thursday, we’ll report to the department of nuclear medicine –- marked by that black-and-yellow trefoil I remember well from elementary school drills where we hid under our desks and covered our heads with our arms to prepare in case the Soviets dropped the bomb on New York City.

The tumor site in my breast will be injected with a radioactive substance (I persist in calling it “uranium,” because that’s a familiar word to me but it’s actually technetium-99). After about two hours, the “uranium” should make its way to my sentinel lymph nodes. To make them even easier to find, a blue dye will also be injected.

In the operating room, Dr. C will use a Geiger counter (that is literally what it is, not just my attempt to substitute words from my limited store of scientific terms) to locate the sentinel nodes, which presumably will get it to beep up a storm, and will also be identifiable by their new, true-blue hue.

She’ll cut out those sentinel nodes and send them stat to an Alta Bates pathologist. He or she will check them on the spot for signs of malignancy while I’m still anesthetized.

Within 20 minutes, Dr. C will get a call telling her either that the sentinel nodes are cancer-free –- or that they’re not. If the former, we’ll be done for the day. If the latter, she’ll make a bigger incision and remove many more nodes, i.e., do an axillary node dissection.

Finding cancer in my lymph nodes would make this a whole new ball game. Instead of NotSoBigC, we’d be dealing with capital C, Big C.

Needless to say, I devoutly hope for the “all clear.”

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Next post: A preview of the other part of Thursday’s surgery