Sentinel Lymph Node Mapping: A New Hope in The Uterine Cancer Care Block

by Dr Vikas Jain, Senior Consultant Surgical Oncology, HCG Manavata Cancer Center, Nashik
Cancer refers to the abnormal and uncontrolled growth of cells that destroy the healthy cells in the surrounding areas. While cancer can be genetic, it is primarily a lifestyle disorder and can be prevented by making certain lifestyle modifications. When detected early, cancer can be cured. With advances in medical science, oncology breakthroughs have made it easier not only to save the lives of those with this deadly condition, but also provide good Quality of life.

Uterine cancer occurs when there is an abnormal growth of cells in the uterus that begins in the layer of cells forming the inner lining or endometrium of the uterus. Being overweight and the early onset of menstruation are the most common risk factors for uterine cancer. Signs of uterine cancer include on & off vaginal bleeding after menopause or bleeding between periods. It is considered to be a common kind of cancer among women and usually affects women who already had menopause, are obese and from high socio-economic strata.

While surgery to remove the uterus is the main treatment for most, a few advanced cases may need chemotherapy or radiation therapy. What determines the best treatment option is the spread of cancer beyond the uterus, particularly in the glands near the uterus called lymph nodes. These lymph nodes get removed during the conventional surgical treatment of uterine cancer. The presence of cancer in the lymph nodes plays a vital role in determining whether chemo or radiation therapy is required or not following the surgery.

The need for Sentinel Lymph Node Mapping, an advanced technique in conventional surgery
Despite the progression of treatment advancement from open radical surgery to robotic minimal invasive ones, the removal of lymph nodes post cancer detection is part of conventional method of surgery. This procedure of removing lymph nodes from both sides of the uterus leads to several post-operative complications. Like, moderate risk of venous thromboembolism (blood clotting in veins of legs and thighs), risk of Lymphedema (swelling due to building up of lymph fluid in the body) among 45% of patients undergoing lymph node excision surgery and lymphocele (collection of lymph fluid in closed spaces) which can eventually lead to pressure and pain in lower back and hip region, may compress urine tubes and result in swelling in kidneys & further infections. These complications worsen in case of a greater extent of lymph excision surgery. In order to avoid such complications an advanced form of surgery - Sentinel Lymph Node Mapping is used.

All about Sentinel Lymph Node Mapping
Sentinel Lymph Node Mapping is the first step of a sentinel node biopsy, a minimally invasive surgery that detects if the cancer has spread beyond the primary tumour site. The sentinel node being the first draining center of cancer from the uterus or cervix, it becomes the most usual place for cancer cells to spread. Lymphatic mapping is done to find the sentinel node for identifying the spread of cancer to the lymph node during the surgery.

What happens during mapping procedure?
●      A small amount of special dye is injected in cervix (opening of uterus) while under anesthesia just before laparoscopic Radical hysterectomy.
●      Following the prick, surgeon goes back for laparoscopy & detects the enlightened lymph nodes under Infra-red camera.
●      Only the enlightened lymph node is removed without disturbing other channels and sent to laboratory for frozen reporting.
●      Within 30mintutes results are open to decide whether she needs all lymph nodes removal. If no cancer cell detected in lymph node, no further lymph node removal is done.