New breast cancer treatment available

By | November 16, 2005 12:00 am

Missy Jones
Dr. Rick Gibbs and White County Community Hospital have teamed up to offer the latest advancements in breast cancer treatment, which will reduce the need for many mastectomies and lumpectomies.
Gibbs, a thoracic and general surgeon, is offering a new procedure in breast cancer treatment. Gibbs said the procedure is
“quickly becoming the standard of care in breast cancer treatment, although not all hospitals are currently doing it.”
The procedure is called sentinel lymph node removal. By locating and removing the sentinel node, the patient’s operation can be less extensive. Because the amount of dissection is limited, complications are minimized.
When a patient is diagnosed with cancer, one of the concerns is that it typically spreads to the lymph nodes.
Knowing if cancer is in the lymph nodes determines the staging, treatment determination, and prognosis of the patient’s long term outcome.
The sentinel lymph node is defined as the first node in the path of drainage from a particular area. If the sentinel node contains no cancer, there is a 92 percent to 94 percent chance the rest of the nodes will be negative as well.
The surgery involves two steps.
First, the patient is injected with a labeled nuclear medicine called technetium. The medicine is injected around the primary mass, and the lymph node absorbs it. A scan is used, and the area around the sentinel node lights up.
The skin is then marked at the designated area, and the patient is sent to surgery.
During surgery an incision is made, and a gama probe is inserted.
The probe is connected to a monitor that displays a numeric reading.
When placed over the sentinel node, the radioactive count goes up. The site of the “hot” node may have a count of 800, while other areas of the body will only register about 10 to 20.
After locating the sentinel node, the node and part of the surrounding tissue is dissected. A pathologist immediately inspects the lymph node. If it is negative, the patient’s operation is complete.
If the node contains cancer cells, the rest of the nodes must be removed by performing a traditional mastectomy or lumpectomy.
With the advances in mammograms and breast cancer awareness, advanced stage breast cancer is now much less common. Since breast cancer is being detected earlier and caught in the early stages, the idea is to remove the mass with limited operation, and to still be able to accurately dissect the cancer with less risks.
In the past, those with breast cancer had two choices. One option was to have a mastectomy, which involves removing the entire breast and dissecting out all the axillary (under-arm) content, including all of the surrounding lymph nodes. There are usually between 15 to20 nodes at each site.
The second option is a lumpectomy or segmental resection. This process removes the infected mass and the surrounding area of normal tissue.
All of the axillary content is removed, but the patient is left with a nipple and an areola.
Since all of the breast tissue is not removed in this procedure, radiation treatments are necessary.
Both of these treatments have similar long-term results. These traditional treatments may result in many complications, because all of the lymph nodes are removed. The possible risks include: swelling of the arm, weakness in the arm due to nerve damage, and lymphedema or chronic fluid build up in the arm and axilla caused by interrupted lymph flow.
The concept of sentinel lymph node treatment gives the assurance of accuracy in diagnosing, whether or not other lymph nodes are involved.
“If the sentinel node is negative, chances are high that the other nodes down stream are negative also,” said Gibbs.
When Gibbs came to Sparta, he asked the hospital to supply the necessary equipment for the new treatment. Gibbs performed White County’s first sentinel lymph node removal approximately two weeks ago.
Gibbs graduated from University of Georgia and Mercer University School of Medicine.
He completed his general surgery residency at Caroway Methodist Hospital in Birmingham, Ala. His cardio-thoracic residency was obtained from Vanderbilt Hospital, in Nashville.
Gibbs’ wife Sara is his nurse and surgical assistant.
Sara graduated from Roane State with a nursing degree and obtained her surgical assistance training from Vanderbilt. The couple met while working at Vanderbilt.
The Gibbs moved to Sparta, from Clarksville, in March 2005. They have two sons, Collin and Conner.
Gibbs can be reached at 837-4057. Office hours are 8 a.m.-5 p.m., Monday-Friday.

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