Q. I am a junior resident (registrar) in Surgery and I recently read that during the spread of breast cancer (or most cancers for that matter), the cancer cells spread from the primary tumor to the lymph nodes and other distant sites. If this is true, why do surgeons insist on axillary clearance during mastectomy? Since according to my reading the tumor cells will not spread from the axillary lymph nodes.

A. Breast cancer can spread through the bloodstream or lymph system. Sampling the lymph nodes during surgery helps determine the likelihood that the cancer has spread beyond the breast tissue itself. This is considered critical to planning treatment after surgery, namely whether radiation or chemotherapy is likely to be helpful.

http://www.familydoctor.org/healthfacts/018/

http://cancernet.nci.nih.gov/cancer_types/breast_cancer.shtml

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