Avera Medical Minute: Sentinel Node biopsy creates less invasive surgery for women

SIOUX FALLS, S.D. - Technology has changed the way we do so many things in life. It has even helped experts in the medical industry be more efficient. A warning for some people, some of the contents in this story may be graphic to viewers.

Janet King is feeling better than she has over the past couple years.

"You put up with stuff as it happens, and you don't realize how bad it is until after you've been treated," she said.

In May of 2018, she was experiencing some discolored discharge. Her gynecologist diagnosed her with uterine cancer, which is also known as endometrial cancer.

"Try not to panic about anything. I think my husband was more upset about this than I was," she said.

Dr. Luis Rojas is a gynecologic oncologist at Avera.

"This is a cancer that tends to spread most commonly and early on through the lymph nodes that are in the pelvis and in the abdomen," he said.

Janet needed a hysterectomy. That means Dr. Rojas removed her ovaries and fallopian tubes. For this cancer, surgeons used to remove all of a woman's lymph nodes in case the cancer spread to them as well. But one of the side effects of removing them all is lymphedema, which causes the legs to swell.

"For years, our professional society has been trying to, how can we bypass this? How can we acquire the information we need and not cause the side effects that we're causing," Dr. Rojas said.

Within the past three years, he started doing a procedure that only takes the lymph node that has the highest likelihood of having cancer cells.

"It's as accurate as removing all the lymph nodes," he said.

Dr. Rojas maps the lymph nodes by injecting a fluorescent solution into the cervix. Under a robotic console, the lymph nodes that have the highest likelihood of cancer light up.

"If there's another lymph node upstream or in another area that's enlarged or looks abnormal, we also remove that," Dr. Rojas said.

It's important to keep the other lymph nodes because they work as a filtering system for the uterus.

"It will act as a defense system so if there's an infection in the pelvis, the body defends itself," he said.

Dr. Rojas said patients, like Janet, with a low grade endometrial cancer are the best candidates for this procedure. She had it on June 20th, 2018.

"Final pathology showed that her lymph nodes were negative and she had a low grade tumor that was not invading the uterus too deep. So she really didn't require any major treatments afterwards," Dr. Rojas said.

That's the goal of the procedure, to find out if any further treatment is needed.

"It's not like going through chemo or anything like that or radiation. So this was straight forward; just getting over the surgery itself and that was it," King said.

She said she's so relieved now that she's in the clear after hearing she had cancer the first time. She has much more energy now and is looking forward to trying out some yoga this spring because of it.