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Surgery and Staging
Once the cancer has been diagnosed a surgical oncologist will initiate staging of the patient, most often with radiologic investigations, to determine if the cancer has spread beyond the primary site.
Sentinel node biopsy may also be indicated to stage specific cancers.
Sentinel Node Biopsy
A sentinel lymph node is the first node to which a cancer is most likely to spread from a primary tumour. Cancer cells may show up in the sentinel node before spreading to other nodes. Removal of the sentinel node (a sentinel node biopsy) and pathological examination can determine if the cancer has spread to the lymph nodes. This is valuable information for staging and decision making about further surgery. If the sentinel node biopsy is negative the patient may be spared a more extensive surgical clearance of the draining nodal basin and the accompanying side effects
Sentinel node excision is usually done at the time the primary cancer is removed. Only if the sentinel node study is positive does the patient require complete nodal dissection.
For melanoma or breast, the biopsy of 2 or 3 pertinent nodes may eliminate the morbidity of an en bloc resection if the sentinel node is negative.
