Breast cancer that has spread to lymph nodes

Testing your lymph nodes is one predictor of breast cancer prognosis. Lymph node-positive breast cancer is a type of cancer that has spread from the original tumor to the nearest lymph nodes, near or in your armpit. When breast cancer spreads to lymph nodes it's called metastatic. Metastases are responsible for 90% of breast cancer deaths, and aggressive treatment is usually the standard of care.

This article will outline the causes and symptoms of lymph-node positive breast cancer, and share information about diagnosis, treatment, coping strategies, and determining overall prognosis.

Causes

Breast cancer starts out with just a few cells, which group together in your breast tissue and may show up in the ducts and lobes. As these cells grow and divide, they may also invade nearby tissue—including lymph nodes.

Your lymph system works with your circulating blood to provide nutrients to all your cells, as well as remove cellular waste products. Lymph nodes are in various locations, including breast tissue itself.

The lymph nodes are the "pit stops" on this highway system, where the lymphatic fluid is filtered, mixed with immune cells (lymphocytes), and passed back into your circulating lymph fluid.

A growing tumor may shed a cell or a clump of cells. It can use your blood or lymph system as a network of highways for traveling throughout your body. So, if a cancer cell makes it to your lymph nodes, it's also possible that it could travel to other parts of your body.

Symptoms

If you get an infection, your lymph nodes near the affected area may swell because they have collected germs. And if you develop breast cancer, the lymph nodes in your armpit are the most common area that cancer cells will lodge, which also causes the nodes to swell.

Symptoms include:

• Swelling under the armpit
• Swelling in your arm or hand (lymphedema)
• Swelling in your collar bone area

The key symptom separating lymph node-positive breast cancer from other types of breast cancer is swelling in the lymph nodes under your arm.

Breast tumors most commonly drain toward your axilla or underarm area. Checking this should be part of a clinical breast exam, as well as your monthly self-exam. Although swollen lymph nodes might be evidence that cancer has spread beyond your breast, the only way to know for sure is to have some removed and tested.

Although axillary lymph nodes are usually the first place breast cancer spreads to, breast cancers towards the middle of your chest may instead drain to lymph nodes between the breasts.

Diagnosis

Lymph node-positive breast cancer is diagnosed via a biopsy, conducted either during a breast surgery or as a separate procedure.

Prior to surgery for breast cancer, when the cancer is first diagnosed, if abnormal lymph nodes are found on exam or imaging, a needle biopsy is often performed and can diagnose the breast cancer as being lymph-node positive.

Procedures performed during the surgery itself include sentinel lymph node biopsy and axillary lymph node dissection. "Axillary" means "of the armpit," and the axillary lymph nodes are typically the first place breast cancer spreads to. You have many axillary nodes, and the first ones cancer is likely to move into are called the sentinel lymph nodes.

Research suggests that finding cancer cells in your sentinel lymph nodes is an excellent predictor of whether cancer will be found in any of your remaining lymph nodes.

In a sentinel lymph node biopsy, those first nodes are identified by a dye and radioactive marker that are injected into the breast. Those nodes are then removed and checked for cancer.

An axillary lymph node dissection is an alternative to a sentinel lymph node biopsy. In this procedure, a surgeon removes all of the lymph nodes that they can find in your armpit (rather than just the sentinel nodes) and then examines them to see whether cancer is present.

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Lymph Node Status

The pathology report about your lymph node status tells whether or not any sign of cancer is present in the lymph nodes that were removed. You may hear words such as macrometastases or micrometastases when your surgeon discusses your nodes:

• Macrometastases are cancer in the lymph nodes that is visible to the naked eye.
• Micrometastases can only be seen under the microscope.

Negative

If your lymph nodes are clear of cancer, your lymph node status is called negative and rated N0 according to the TNM staging of breast cancer.

If you have a negative sentinel node biopsy, you likely won't need to have an axillary lymph node dissection. If you have a small tumor and clear nodes, it's less likely that you will need chemotherapy.

Positive

If you have cancer cells in your lymph nodes, your cancer is considered lymph node-positive. Based on TNM staging, your tumor would be called either N1, N2, or N3 depending on how many lymph nodes contain cancer cells and how far away from the tumor the positive nodes are found.

If you have cancer cells in your sentinel lymph node, axillary node dissection may be included along with breast cancer surgery, if surgery is part of your treatment plan.

Treatment

Treatment is designed to kill off as many of your cancer cells as possible. Having lymph nodes involved usually means you'll be advised to have adjuvant systemic therapy such as chemotherapy to kill any additional cancer cells that persist in your body.

Having just one cancer cell in your body is one too many. Adjuvant treatment refers to treatment that is given not because any cancer is seen, but because it is suspected that there may be additional cancer cells present.

For those who have estrogen-receptor-positive tumors, hormonal therapy is usually recommended for five to 10 years after treatment. This may be tamoxifen for those who are premenopausal and an aromatase inhibitor for those who are postmenopausal.

Unlike chemotherapy, hormone therapy reduces not only the risk of early recurrence (recurrences within five years of diagnosis) but late recurrence as well.

With early-stage breast cancers that are estrogen-receptor positive, the chance that the cancer will return after five years is greater than the chance that it will recur in the first five years after treatment.

Another category of medications called bisphosphonates was recently approved for postmenopausal women who have early-stage breast cancer. The bisphosphate medication Zometa (zoledronic acid) appears to reduce the risk of developing bone metastases. (The bones are the most common site of metastases with breast cancer.)

Radiation therapy may or may not be recommended depending on the number of positive lymph nodes and other findings related to your tumor.

Prognosis

Prognosis, also called outlook, is one way a healthcare provider talks about the odds for survival after you've completed treatment.

If you had clear lymph nodes and a small, low-grade tumor, your prognosis after treatment is quite good. On the other hand, if you had several lymph nodes involved or a larger tumor, your treatment will likely be more aggressive, and your outlook will be harder to determine until after you've finished all treatments.

Nodal involvement (number of axillary nodes positive for cancer) is a strong and independent negative prognostic factor. The five-year survival rate is decreased in patients with positive axillary lymph nodes versus the patients with negative axillary lymph nodes. The higher the number of axillary lymph nodes involved, the higher the chance of recurrent disease.

No matter what your diagnosis is, know that survival rates are improving, treatments are becoming more efficient and effective, and even metastatic breast cancer, for some, can be managed for a long period of time.

Coping

Facing the possibility or reality of lymph node involvement only adds to the emotions that come with the idea of a breast cancer diagnosis itself.

While it may feel overwhelming, you can learn to cope with this fear in positive ways. It's also important to advocate for yourself when going through treatment.

Talk to your healthcare provider, social worker, or consider joining one of the many breast cancer support groups, through the American Cancer Society, Komen, and more about any problems you may have coping.

Being aware of the risk of recurrence (which remains steady for at least 20 years in women with estrogen-receptor-positive tumors) may prompt you to adopt healthy lifestyle habits and have regular medical exams. It can also be helpful when you feel tempted to stop treatment, especially medications such as aromatase inhibitors due to bone aches.

That said, sometimes the fear of recurrence can interfere with your quality of life. Your healthcare provider can help you find a good therapist who can help you work through your fears. Finding a good support group or online support community is also very helpful.

Summary

Lymph-node involvement is a major predictor of breast cancer prognosis, and knowing your lymph node status can help you and your medical team develop a treatment plan. A biopsy is often the first step in determining what your lymph node status is.

Although this may be overwhelming, support groups and in-hospital staff are available to walk you through your cancer journey.

A Word From Verywell

If you have positive lymph nodes with early-stage breast cancer, treatments will likely be more aggressive and may include chemotherapy, hormonal therapy, targeted therapy, and radiation.

Thankfully, many people with lymph node-positive cancer remain cancer-free after treatment, and a positive lymph node status does not automatically mean your cancer will come back. 

Frequently Asked Questions

• Is breast cancer metastatic if it spread to the lymph nodes?

  Once breast cancer has spread beyond its original location, often the breast ducts, it is considered metastatic. Metastatic breast cancer is incurable but very treatable and people can live with this chronic disease.

• What are the signs if you have a cancerous lymph node?

  Swelling in the armpit is the tell-tale symptom of a cancerous lymph node. Other symptoms include swelling in your hand, arm, or collar bone area.

• Can lymph nodes be removed if they are cancerous?

  Yes, you can have the cancerous lymph nodes removed through surgery. After that, you may go through other treatments like chemotherapy or radiation to keep the cancer cells from spreading further.

• What happens if a lymph node biopsy is positive?

  If you have cancer cells in your sentinel lymph node, axillary node dissection may be included along with breast cancer surgery, if surgery is part of your treatment plan.

What is the prognosis for breast cancer that has spread to the lymph nodes?

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