Breast Cancer Lymph Nodes: Diagnosis, Treatment, Side Effects and Prevention
- Ezgi Aydın
- Feb 24, 2023
- 15 min read
Millions of people worldwide are affected by the common disease known as breast cancer.
The lymphatic system, where it all starts, is a vital pathway for the spread of breast cancer throughout the body.
Little, bean-shaped lymph nodes are an integral aspect of the lymphatic system and the immune system of the body.
For early detection, treatment, and prevention of breast cancer, it is essential to comprehend the connection between lymph nodes and the disease.
We will delve further into breast cancer lymph nodes in this blog, covering everything from their structure and function to diagnosis, therapy, and prevention.
What is Breast Cancer and What are Its Effects on Lymph Nodes?
Breast cancer is a type of cancer that develops in the breast tissue. With more than two million new cases reported each year, it is the type of cancer most frequently found in women around the world.
In a process known as metastasis, it has the ability to spread to many body areas, including the lymph nodes. A component of the lymphatic system, lymph nodes are tiny, bean-shaped organs found all over the body.
They are in charge of capturing hazardous elements, such as cancer cells, and filtering lymphatic fluid. Breast cancer cells that escape from the original tumor and enter the lymphatic system run the risk of becoming trapped in the lymph nodes, where they could develop further and spread.
This process, often referred to as lymph node involvement or metastasis, is crucial for figuring out the stage of breast cancer and the available treatments.
Anatomy of the Lymphatic System
Overview of the lymphatic system
In order to maintain fluid balance and defend the body against infections and diseases, the lymphatic system is an intricate network of organs, veins, and tissues. It runs parallel to the blood arteries and is a component of the body's circulatory system.
The thymus gland, lymph nodes, tonsils, lymphatic veins, and spleen are all components of the lymphatic system. White blood cells, proteins, and lipids are all present in lymphatic fluid, which is carried throughout the body by lymphatic vessels, which are tiny tubes.
Little, bean-shaped lymph nodes, which filter lymphatic fluid and capture germs, viruses, and cancer cells, are found along lymphatic vessels. T cells, which are crucial for the body's immune system, are produced by the thymus gland, which is situated in the chest.
In the abdomen, the spleen filters blood and eliminates worn-out or damaged red blood cells. In the back of the throat, there are tonsils that aid in infection defense.
Knowing the lymphatic system's architecture and operation is essential to comprehending how breast cancer might affect lymph nodes.
Structure and function of lymph nodes
Lymph nodes are dispersed all throughout the body, with the neck, armpits, and groin having the largest concentrations. A network of lymphatic vessels inside lymph nodes, which are typically less than 2 cm in diameter, transport lymphatic fluid into and out of the node.
The cortex and the medulla are the two halves of the lymph node's structure. Lymphocytes, specialist white blood cells that aid in the defense against infections and sickness, are present in the cortex. Immune cells called macrophages, which take in and digest foreign material, are found in the medulla.
Filtering lymphatic fluid and capturing hazardous elements including bacteria, viruses, and cancer cells are the roles of lymph nodes. When anything foreign enters the body, lymphatic fluid transfers it to the closest lymph node where immune cells identify it and either destroy it or send it to further lymph nodes for more filtration.
Breast cancer cells that separate from the original tumor may move through the lymphatic system and become imprisoned in the lymph nodes, where they may continue to develop and proliferate.
Role of lymph nodes in the body
By filtering lymphatic fluid and capturing dangerous particles, the lymph nodes are essential to the body's immune system. Foreign substances, such as bacteria, viruses, and cancer cells, are stopped at lymph nodes.
The specialized white blood cells known as lymphocytes found in lymph nodes aid in the defense against infections and illness. The lymph nodes create more lymphocytes to assist in warding off intruders when the body is exposed to an illness or disease.
The lymphatic system can catch cancer cells that have detached from the main tumor and are moving through it; if this happens, the cancer cells may continue to spread and proliferate in the lymph nodes.
Breast Cancer and Lymph Nodes
How breast cancer spreads to lymph nodes
In a process known as metastasis, breast cancer can spread to lymph nodes. When cancer cells separate from the initial tumor and spread to other areas of the body via the lymphatic system, this is known as metastasis. Breast lymphatic tubes can become infiltrated by breast cancer cells that have detached from the main tumor.
The lymphatic system can subsequently transport these cancer cells to close-by lymph nodes. Moreover, cancer cells are able to pass through the bloodstream and go to distant parts of the body such the lungs, liver, or bones. The more lymph nodes that have cancerous cells in them, the more advanced the cancer is thought to be.
It is sometimes possible to find breast cancer cells in lymph nodes before a tumor in the breast, which emphasizes the value of routine breast cancer screening and early detection.
Significance of Lymph Node Involvement in Breast Cancer
Lymph node involvement in breast cancer is significant since it may have an impact on the patient's prognosis and available treatments. When breast cancer cells invade neighboring lymph nodes, it means the disease has started to expand outside of the original tumor.
This is frequently a sign of a more advanced malignancy that may need more intensive therapy. The cancer is often seen to be in an early stage if just a few lymph nodes are affected, and it is thought to be more advanced if numerous lymph nodes are afflicted.
Ultimately, establishing the optimal course of treatment and forecasting the patient's long-term outlook depend heavily on the lymph node involvement in breast cancer.
Types of lymph node involvement in breast cancer
1. Sentinel lymph nodes
The initial lymph nodes to which cancer cells from a primary tumor are most likely to disseminate are known as sentinel nodes. In order to detect the lymph nodes that drain the breast tissue, a specific dye or radioactive substance is injected close to the tumor location.
A frequent approach to determine whether cancer cells have spread to the lymph nodes is sentinel lymph node biopsy. One or more sentinel nodes are taken out during this surgery so the surgeon can examine them under a microscope. If cancer cells are discovered in the sentinel nodes, it means the main tumor has not been the only place the cancer has spread to.
Patients can avoid some of the possible negative effects of a more extensive lymph node surgery by merely removing a few sentinel lymph nodes.
2. Axillary lymph nodes
The underarm region contains a collection of lymph nodes called axillary lymph nodes, also known as underarm lymph nodes, which are frequently the source of breast cancer metastases. Breast cancer frequently spreads to the axillary lymph nodes initially before moving on to other body sites when it extends beyond the primary tumor.
If cancer cells have migrated to numerous nodes, a more thorough axillary lymph node dissection may be required. To much axillary lymph node removal, however, might result in lymphedema, a condition in which lymphatic fluid builds up in the arm and causes swelling and discomfort.
Consequently, when determining the scope of lymph node surgery, clinicians carefully assess the possibility of lymphedema.
3. Internal mammary lymph nodes
A collection of lymph nodes known as internal mammary lymph nodes are situated beneath the breast tissue, close to the breastbone. Although they are not as frequently affected by breast cancer as the axillary lymph nodes, these lymph nodes can nonetheless be in rare situations.
Breast cancer cells that have migrated past the main tumor can metastasize in the internal mammary lymph nodes. Depending on the extent of the involvement and the patient's general condition, there are various treatment options for internal mammary lymph node involvement.
Diagnosis of Lymph Node Involvement in Breast Cancer
Physical examination
The diagnosis of lymph node involvement in breast cancer often includes a physical exam.
During a physical examination, the doctor will look for lumps or other anomalies in the breast tissue and its surrounding regions, especially the lymph node-rich areas behind the arm and beneath the collarbone.
In order to identify whether the lymph nodes are swollen or hard, which may be a sign of cancer spread, the doctor will also check their size and texture.
Imaging tests
Ultrasound
For the diagnosis of lymph node involvement in breast cancer, ultrasound is a frequent imaging procedure. High-frequency sound waves are employed during an ultrasound to provide images of the breast tissue and lymph nodes.
The lymph nodes' size, texture, and any abnormalities, such as enlargement or an irregular shape, that can point to the spread of cancer, can all be assessed using ultrasonography.
It frequently works in tandem with other imaging procedures like mammography and MRI to provide a more thorough analysis of the breast tissue and lymph nodes.
A questionable lymph node can also be guided by ultrasound during a biopsy, which involves removing a tiny sample of tissue for microscopic analysis to determine whether cancer cells are present.
MRI
The breast tissue and lymph nodes can be seen in great detail using magnetic resonance imaging (MRI), a sophisticated imaging procedure. The body is imaged in great detail and in three dimensions during an MRI using radio waves and a powerful magnetic field.
To offer a more thorough evaluation of the breast tissue and lymph nodes, MRI is frequently combined with other imaging techniques including mammography and ultrasound.
CT scan
The lymph nodes are included in the detailed images of the body produced by a computed tomography (CT) scan, an imaging technique that employs X-rays and computer technology. When cancer has spread to the lymph nodes in the chest, abdomen, or pelvis,
CT scans are especially helpful in detecting the disease.
A patient undergoes a CT scan while lying on a table that slides into a device that produces several X-ray images of the body from various angles.
The body is then meticulously cross-sectioned using the photos that were combined by a computer. Due to its ability to spot even tiny nodules that other imaging tests might not be able to see, CT scans are an effective technique for identifying cancer that has migrated to the lymph nodes.
A biopsy of a suspect lymph node, in which a small sample of tissue is taken for examination under a microscope to determine whether cancer cells are present, can also be guided by CT scans. CT scans are a non-invasive, rapid imaging examination that can be done in an outpatient setting.
They do, however, involve radiation exposure, which some patients might find concerning.
PET scan
A PET (positron emission tomography) scan is a sort of imaging test that produces images of the inside of the body using a special kind of camera and a radioactive tracer. A small quantity of a radioactive chemical is put into the patient's bloodstream prior to the PET scan.
This chemical, referred to as a radiotracer, is taken up by the organs and tissues of the body, where it releases energy in the form of positrons, positively charged particles.
These positrons can be picked up by the PET scan camera, which produces three-dimensional images of the metabolic activity of the tissues and organs under investigation.
Because they can identify aberrant metabolic activity that could point to the existence of malignant tissue, PET scans are frequently used to diagnose cancer.
They can also be used to monitor and diagnose other problems like heart disease and neurological disorders as well as to assess the efficacy of cancer treatment. Due to the extremely low dose of radiation utilized and how quickly it is excreted from the body, PET scans are typically regarded as safe procedures.
But, there are potential hazards, just as with any medical operation, such as an allergic reaction to the radiotracer or radiation exposure.
Biopsy
Fine needle aspiration biopsy
A tissue sample can be obtained using a minimally invasive method called a fine needle aspiration biopsy (FNAB). A small sample of cells or tissue is taken during a FNAB by inserting a thin, hollow needle into the area of interest, such as a lump or tumor.
To find out if there are any aberrant cells present, the sample is then inspected under a microscope.
Infections, inflammation, and malignancy are all frequently diagnosed by FNAB. Also, it is used to direct additional treatment and track the development of some illnesses. The FNAB procedure has few risks and minor side effects. Nonetheless, there is a slight possibility of bleeding, infection, or harm to the nearby tissues.
The FNAB technique can frequently be completed without sedation or anesthesia on an outpatient basis and is quick and relatively painless. Within a few days, FNAB results are typically available, enabling quick diagnosis and therapy.
Core needle biopsy
A tissue sample is obtained using a core needle biopsy (CNB), a minimally invasive procedure, for use in diagnosis or additional testing. A CNB involves inserting a bigger, hollow needle into the area of interest, such as a lump or tumor, and removing a small cylinder of tissue.
To find out if there are any aberrant cells present, the sample is then inspected under a microscope. Cancer, inflammatory diseases, and infections are all frequently diagnosed with CNB. Also, it is used to direct additional treatment and track the development of some illnesses.
CNB is a comparatively simple and risk-free operation. The danger of bleeding, infection, or harm to the surrounding tissues is minimal. Within a few days, CNB results are typically available, enabling quick diagnosis and therapy.
CNB can offer a larger and more representative tissue sample as compared to FNAB, which may be helpful for more precise diagnosis and therapy planning. The patient may have more discomfort with CNB, and problems are somewhat more likely.
Surgical biopsy
A surgeon will extract a sample of tissue during a surgical biopsy to be examined.
This kind of biopsy is frequently utilized when the target tissue is deep within the body or difficult to reach with a needle biopsy. Excisional biopsy, incisional biopsy, and needle localization biopsy are a few examples of the various surgical biopsies.
A full region of interest is removed by the surgeon during an excisional biopsy, whereas only a portion is taken out with an incisional biopsy. To find and remove a specific area of tissue that is challenging to access, utilize a needle localization biopsy.
Typically, general anesthesia is used for surgical biopsies, and the patient may need to spend some time in the hospital. With surgical biopsies, there is a chance of bleeding, infection, and injury to the surrounding tissues, but these risks are typically minimal.
Compared to needle biopsies, surgical biopsy offers a bigger and more representative sample of tissue, which might be helpful for more precise diagnosis and treatment planning.
Nevertheless, a surgical biopsy is a more invasive process that could cause more pain and require more time to heal. If you want to learn. how to understand the results of your breast biopsy, click here!
Treatment of Lymph Node Involvement in Breast Cancer
Surgery
Sentinel lymph node biopsy
To ascertain whether breast cancer has spread to the lymph nodes, a surgical procedure known as a sentinel lymph node biopsy (SLNB) is performed. The surgeon performs an SLNB by injecting a small quantity of radioactive material and/or a blue dye into the region surrounding the breast tumor.
The lymphatic system absorbs this material, which aids in locating the "sentinel" lymph node—the first lymph node to which breast cancer is most likely to spread. In order to determine whether there are any cancer cells present, the surgeon next removes the sentinel lymph node and looks at it under a microscope.
Detecting the presence of cancer cells in the sentinel lymph node can assist determine whether the disease has migrated to other lymph nodes in the body. Although there are few risks associated with SLNB, there is a slight chance of infection, hemorrhage, or tissue injury to the surrounding tissues.
Since it can help establish whether the cancer has progressed outside the breast and direct subsequent treatment choices, SLNB is frequently employed in the treatment of early-stage breast cancer. With less extensive lymph node surgery being required, SLNB can help patients recover more quickly and with fewer complications.
Axillary lymph node dissection
Breast cancer patients who undergo axillary lymph node dissection (ALND) have a group of lymph nodes in the armpit (axilla) surgically removed. Many lymph nodes from the axilla are taken out during an ALND, and the surgeon analyzes them under a microscope to check for the presence of any cancer cells.
When cancer is found in the sentinel lymph node following a sentinel lymph node biopsy (SLNB), or when there is a high possibility that lymph nodes will be involved given the size or features of the tumor, ALND is frequently performed. A more involved procedure than SLNB, ALND entails a larger chance of negative outcomes such infection, hemorrhage, and nerve injury.
Nevertheless, ALND can offer more precise details regarding the degree of lymph node involvement and can aid in determining the necessity for additional treatments like chemotherapy or radiation therapy. If SLNB demonstrates no sign of lymph node involvement or if the likelihood of lymph node involvement is minimal based on tumor features, ALND may occasionally be avoided.
Lymph node surgery complications
Complications are a possibility with lymph node surgery, including procedures like axillary lymph node dissection (ALND) and sentinel lymph node biopsy (SLNB). The most frequent side effects following lymph node surgery include localized discomfort, edema, bruising, and numbness.
Patients occasionally develop surgical site infections that can be managed with medications. Blood clots, nerve damage, lymphedema (swelling brought on by fluid accumulation in the lymphatic system), and bleeding are among more potential risks.
Lymphedema, which can result in persistent swelling and discomfort in the affected limb and may call for ongoing therapy such as compression clothing or manual lymphatic drainage, can be a particularly unpleasant consequence. Individuals who have lymph node surgery should be aware of these potential side effects and talk to their medical team about them in advance.
Radiation therapy
When lymph nodes are involved in breast cancer, radiation therapy is frequently used as a treatment. It shrinks tumors and employs high-energy radiation to kill cancer cells. After lymph node surgery, such as axillary lymph node dissection (ALND), radiation therapy can be utilized to eradicate any cancer cells that may still exist in the lymph nodes or surrounding tissue.
When surgery is not an option or the cancer has advanced past the axillary lymph nodes, it can also be utilized as the primary treatment for lymph node involvement. Using a device known as a linear accelerator, radiation therapy is often given externally over the course of several weeks in daily sessions.
Fatigue, skin irritability, and brief swelling or discomfort in the treated area are possible side effects of radiation therapy. Although they are uncommon, more severe adverse effects like injury to the heart or lungs can occasionally happen.
Chemotherapy
Breast cancer patients who have lymph node involvement may benefit from chemotherapy, especially if their cancer has gone beyond the axillary lymph nodes or is at a high risk of coming back. Chemotherapy, which can be given intravenously or orally, uses potent medications to kill cancer cells.
Wherever cancer cells are identified, the medications destroy them by moving throughout the body. To help lower the chance of cancer recurrence, chemotherapy can be administered in conjunction with other treatments such surgery and radiation therapy.
Chemotherapy frequently causes nausea, vomiting, hair loss, exhaustion, and an elevated risk of infection. Although uncommon, more severe adverse effects like nerve, heart, or renal damage can occasionally happen. Although chemotherapy can be a challenging course of treatment, it can be a successful alternative for treating breast cancer with lymph node involvement.
Targeted therapy
When lymph nodes are implicated in breast cancer, a therapeutic option called targeted therapy is used to target particular chemicals or pathways that are essential to the development and spread of cancer cells. Drugs used in targeted therapy can be administered either alone or in addition to chemotherapy and other forms of therapy.
Monoclonal antibodies, tyrosine kinase inhibitors, and PARP inhibitors are a few examples of the several types of targeted therapy medications that may be used to treat lymph node involvement in breast cancer. The cancer's stage, the genetic make-up of the cancer cells, and the patient's general health all influence the treatment that should be prescribed.
Because targeted therapy is intended to exclusively affect cancer cells and spare healthy cells, it may be less likely to cause adverse effects than chemotherapy. However typical adverse reactions to medications used in targeted therapy include weariness, diarrhea, skin rashes, and elevated blood pressure.
Although they are uncommon, more severe adverse effects like damage to the heart or lungs can occasionally happen.
Side Effects and Complications of Lymph Node Involvement Treatment
Depending on the exact therapeutic strategy employed, the management of lymph node involvement in breast cancer may result in a variety of problems and side effects. Pain, swelling, numbness, or stiffness in the arm or shoulder are typical adverse effects of lymph node surgery, such as sentinel lymph node biopsy or axillary lymph node dissection.
These procedures can result in infection or nerve injury. Fatigue, skin irritation, and brief swelling or pain in the treated area can all be side effects of radiation therapy.
Although they are uncommon, more severe adverse effects like injury to the heart or lungs can occasionally happen.
These difficulties and side effects can be reduced with proper management and monitoring, which will also increase the treatment's overall success.
Preventing Lymph Node Involvement in Breast Cancer
An essential objective in the management and therapy of the disease is to avoid lymph node involvement in breast cancer. Breast cancer can be found early on when it is more likely to be treated and less likely to have spread to the lymph nodes thanks to routine mammograms and self-examinations.
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The chance of developing breast cancer can also be decreased by eating a good diet, working out frequently, and keeping a healthy weight. Tamoxifen and aromatase inhibitors are two examples of drugs that can be taken to assist lower the risk of breast cancer in women who are at high risk.
Moreover, preventative mastectomy or ovarian removal may be advised for women who have specific genetic abnormalities that enhance their risk of developing breast cancer.
Overall, preventing lymph node involvement in breast cancer and improving patient outcomes can be achieved through early detection, care, lifestyle modifications, and drugs that lower the risk.
What is to Conclude About Breast Cancer Lymph Nodes?
In conclusion, breast cancer lymph nodes are essential for the early detection, care, and management of the disease. The presence of lymph nodes can reveal the type and stage of the cancer and affect the available treatment options.
To locate and remove diseased lymph nodes, popular surgical methods include sentinel lymph node biopsy and axillary lymph node dissection. Other therapies used to treat lymph node involvement include radiation therapy, chemotherapy, targeted therapy, and hormone therapy.
Although these medicines may have side effects and problems, with the right care and monitoring, these risks can be reduced and patient outcomes can be enhanced.
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