Lymph node involvement in breast cancer


Lymph node involvement (or lymph node metastases) in breast cancer is when cancer cells from the tumor have spread through the lymphatic system and have settled in the lymph nodes. Whether there is lymph node involvement is decisive for the therapy of the cancer and the prognosis.

Read more on the topic: Breast Cancer Diagnosis - How Good Are My Chances of Recovery?

For this reason, one or more lymph nodes are usually removed during the surgical tumor removal in order to then examine them for malignant tumor cells under the microscope. The most common lymph node metastases in breast cancer are in the armpits and below and above the collarbones (axillary, supraclavicular and infraclavicular lymph nodes).

In some cases the affected lymph nodes can already be felt through the skin as enlarged, coarse and immovable nodes.

Read more on the topic: Metastasis in breast cancer

How often are the lymph nodes involved?

The frequency with which the lymph nodes of breast cancer are affected at the time of diagnosis depends primarily on when the tumor was discovered.

In the early stages and with smaller tumors, lymph node involvement is rare and the chances of recovery are very good.

If, on the other hand, the tumor has had a long time to spread unnoticed, larger tumors often involve lymph node involvement. The type of tumor (histological growth pattern, degree of differentiation, tumor genetics, receptor status) also influences the spread of tumor cells into the lymph nodes.

Read more on the topic: Breast cancer stages

In general, the later the tumor is recognized, the more frequent lymph node involvement. For this reason, the health insurance company takes over the biennial mammography for early cancer detection for women over the age of 50.

More information can be found here:

  • Breast cancer screening
  • Recognize breast cancer
  • Signs of breast cancer

What are the symptoms of lymph node involvement?

The infestation of lymph nodes by malignant cancer cells does not initially have to cause any symptoms and can go undetected for a long time. For this reason, if breast cancer is suspected, an ultrasound scan of the axillary lymph nodes is carried out. However, the final confirmation can only be obtained through microscopic examination of one Lymph node biopsy done. In some cases, however, the lymph node involvement is already noticed by the patient herself.

In breast cancer, the lymph nodes in the armpit (axillary lymph nodes) or the lymph nodes above and below the collarbones (supraclavicular and infraclavicular lymph nodes) are most commonly involved. Lymph node involvement appears as a visible or palpable, rough swelling of variable size under the armpits. The lymph nodes here are usually so small that they cannot be felt from the outside. Due to the infestation and multiplication of cancer cells, they increase in volume and bake with the environment, so that when they are touched they appear fixed and immovable. The size can be limited to the size of a marble or the size of a golf ball. The enlarged lymph nodes in breast cancer are usually not painful; painfulness would more likely indicate an inflammatory cause.

You will find more information on this topic here:

  • Breast cancer pain
  • Symptoms of breast cancer

What does a lymph node involvement mean?

The axillary lymph node status, i.e. whether the lymph nodes in the armpit are already infected with cancer cells, is the most important prognostic factor in breast cancer. Unfortunately, the prognosis and survival usually worsen if one or more lymph nodes are affected. The reason for this is that the tumor, which was once confined to the breast, has become a systemic disease, as the cancer cells have already spread via the lymphatic system to the axillary lymph nodes.

A purely surgical removal of the breast tumor is not enough to fight the cancer. In the event of lymph node involvement, the axillary lymph nodes and possibly other lymph nodes must also be removed. Furthermore, due to the infestation of the lymph nodes, chemotherapy is usually necessary to kill cancer cells throughout the body.

Read more about this: Treatment options for breast cancer

In the case of pure lymph node involvement without organ metastases (e.g. in the liver or bones), however, the therapeutic approach is in most cases curative, i.e. aims at a complete healing. A combination of chemotherapy, radiation, hormone therapy and antibody therapy can significantly improve the prognosis. The chances of recovery depend on the type of tumor, its size and the number and location of the affected lymph nodes. Breast cancer with lymph node involvement is curable, but an extended therapy regimen is necessary to achieve this cure.

You might also be interested in: Side effects of chemotherapy for breast cancer

What is the sentinel lymph node?

The sentinel lymph node is the lymph node that tumor cells reach first as they spread through the lymphatic system. If this lymph node is free of tumor cells, so are all the others and lymph node involvement can be excluded.

This is used diagnostically by injecting a radioactive tracer into the area around the tumor before the tumor is removed. The tracer accumulates in the sentinel lymph node so that it can be identified with the help of special detectors. The sentinel lymph nodes are individually removed and examined for malignant cells under a microscope. If it is free of tumor cells, there is no need to remove any additional lymph nodes.

What is the chance of recovery / survival rate if a lymph node is affected?

In the case of cancer, the chances of a cure are often given in the form of the 5-year survival rate. The number indicates the percentage of patients who are still alive 5 years after diagnosis. The 5-year survival rate for breast cancer patients with lymph node involvement is between approx. 50% and 90%. The decisive factor here is how many lymph nodes are affected and where they are located. The size of the actual tumor as well as its properties (malignancy, growth rate, receptor status) and the age and general condition also influence the chances of recovery. In general, it is therefore difficult to commit to a percentage.

For more information, see: Life expectancy in breast cancer

Therefore, the treatment concept and the wishes and ideas should always be discussed individually with the patient. However, it should be emphasized that the therapeutic approach for breast cancer with lymph node involvement (without organ involvement) is curative in most cases, i.e. the treatment aims at a complete cure.

Which might also interest you: Breast Cancer Follow-Up Care

What is the treatment if the lymph node is affected?

If a lymph node is already infected with tumor cells, local (local) tumor removal is not sufficient. In addition to the actual tumor in the breast, the affected lymph nodes must also be cut out. The extent of the lymph node removal depends on the infestation and must be decided individually in each case.

In addition, the tumor bed, i.e. the affected breast, should be irradiated, provided that it can be preserved by removing the tumor.

Read more about this: Irradiation for breast cancer

Since the flushing of cancer cells into other tissues and organs with the existing lymph node involvement cannot be ruled out, systemic (usually intravenous) chemotherapy must be carried out. The aim of chemotherapy is to kill cancer cells that have spread out and which can hide anywhere in the body. This is to prevent further metastasis.

In addition to chemotherapy, there are a number of other drugs that can be used depending on the type of tumor. On the one hand, this includes hormone therapy, which removes the female sex hormones that are essential for the tumor.

In addition, there has been a specific antibody therapy (trastuzumab) that removes another growth stimulus from the cancer cells for not that long.

Before doing this, however, it must be examined which of the drugs can be used sensibly in the present cancer disease and which ones only cause further side effects for the patient.

Is a lymph node involvement actually a metastasis?

Instead of the term lymph node involvement, the term lymph node metastasis can also be used synonymously. The term metastasis (Greek for migration) describes the settlement of a malignant tumor in a distant tissue or organ.

A distinction is made between lymph node metastases and organ metastases. Lymph node metastases result from the spread of cancer cells in the lymph vessels, whereas organ metastases result from the spread of cancer cells in the bloodstream.In breast cancer, metastasis usually first takes place in the lymph nodes and only later in organs such as the liver, bones, lungs or brain. An infected lymph node is also a metastasis, but has a much better chance of recovery than if organ metastases are already present.