Surgery To Remove Lymph Nodes
Breast cancer can spread to other parts of the body. If it does spread, it usually first spreads to the lymph nodes in the armpit close to the breast. These lymph nodes drain the lymphatic fluid from the breast and arm.
It is important to know if there are cancer cells in the lymph nodes in the armpit and how many. This helps the doctors work out the stage of your cancer and plan the best treatment for you.
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Risk Factors For Distant Recurrence
There are several risk factors that raise the risk of recurrence overall . These include:
- Tumour size: Larger tumours are more likely to recur than smaller ones both early and late.
- Positive lymph nodes: Tumours that have spread to lymph nodes are more likely to recur at any time than those that have not.
- Age at diagnosis: Breast cancer recurrence is more common in younger women.
- Treatments received and response to treatments: Both chemotherapy and hormonal therapy reduce the risk of recurrence
- Tumour Characteristics: More aggressive cancers are more likely to recur than less aggressive tumours , especially in the first five years. We also take into account the receptor status and an estimate of proliferation .
There are also factors that do not appear to affect the risk of recurrence. Recurrence rates are the same for women who have a mastectomy or lumpectomy with radiation and are also the same for women who have a single vs. double mastectomy.
What Is Secondary Breast Cancer In The Bone
When cancer that started in the breast has spread to the bones, its called secondary or metastatic breast cancer in the bone.
Some people also refer to it as bone metastases or bone mets.
The bones most commonly affected are the:
- Spine
- Pelvis
- Upper bones of the arms and legs
The cells that have spread to the bone are breast cancer cells. Its not the same as having cancer that starts in the bone.
Breast cancer cells can spread to the bone through the lymphatic system or the blood.
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N Categories For Breast Cancer
N followed by a number from 0 to 3 indicates whether the cancer has spread to lymph nodes near the breast and, if so, how many lymph nodes are involved.
Lymph node staging for breast cancer is based on how the nodes look under the microscope, and has changed as technology has gotten better. Newer methods have made it possible to find smaller and smaller groups of cancer cells, but experts haven’t been sure how much these tiny deposits of cancer cells influence outlook.
Its not yet clear how much cancer in the lymph node is needed to see a change in outlook or treatment. This is still being studied, but for now, a deposit of cancer cells must contain at least 200 cells or be at least 0.2 mm across for it to change the N stage. An area of cancer spread that is smaller than 0.2 mm doesn’t change the stage, but is recorded with abbreviations that indicate the type of special test used to find the spread.
If the area of cancer spread is at least 0.2 mm , but still not larger than 2 mm, it is called a micrometastasis . Micrometastases are counted only if there aren’t any larger areas of cancer spread. Areas of cancer spread larger than 2 mm are known to influence outlook and do change the N stage. These larger areas are sometimes called macrometastases, but are more often just called metastases.
NX: Nearby lymph nodes cannot be assessed .
N0: Cancer has not spread to nearby lymph nodes.
N1c: Both N1a and N1b apply.
N3: Any of the following:
N3a: either:
N3b: either:
How Will I Know If My Breast Cancer Spreads
Your doctor will use specific kinds of tests to find out if your cancer has gone to other places in your body. First, your doctor will want to know how youâre feeling. They will ask you about any symptoms youâre having and your overall health. They might also look at the size of your tumor and check your lymph nodes.
After that, the doctor may give you:
Blood tests. They look for signs of anything abnormal thatâs happening in your body. For example, results from a liver function test can let your doctor know that breast cancer may have gone to your liver. High levels of some substances in your blood hint that the cancer has spread to your bones.
Imaging scans. These tests make detailed pictures of the inside of your body. They help your doctor pinpoint any cancer spread. These tests include:
- X-ray
- PET scan
- Bone scan
Biopsy. Your doctor removes a small amount of tissue from your body and looks at it under a microscope to see if there are any cancer cells in it.
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How Do You Know When Cancer Has Spread To The Lymph Nodes
When cancer has spread to a lymph node, it will usually become swollen and enlarged, will feel hard and may or may not be tender to the touch, Dr. Santamaria says. A swollen lymph node may still only be about the size of a grape or larger. However, while some lymph nodes will be visible or noticeable when they become enlarged, many are not, such as those inside the chest or abdomen.
Cancer In Nearby Lymph Nodes
Sometimes cancer is found in lymph nodes that are near to where the cancer started. For example, breast cancer cells may travel to lymph nodes in the armpit or above the collar bone .
If a surgeon removes a primary cancer, they often remove some of the nearby lymph nodes. The lymph nodes are examined to see if there are any cancer cells in them.
The risk of the cancer coming back may be higher if the nearby lymph nodes contain cancer cells. Your doctors may suggest you have more treatment after surgery to reduce the risk.
Cancer in lymph nodes that are further away is called secondary cancer. Cancer found in nearby lymph nodes is usually treated differently to cancer in lymph nodes that are further away from the primary cancer.
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Where Can Breast Cancer Spread
The most common places for breast cancer to spread to are the lymph nodes, bone, liver, lungs and brain. The symptoms you may experience will depend on where in the body the cancer has spread to. You might not have all of the symptoms mentioned here.
Remember other conditions can cause these symptoms. They don’t necessarily mean that you have cancer that has spread. But if you have symptoms that you are worried about, discuss them with your GP, cancer specialist, or breast care nurse so that you can be checked.
When Cancer Goes Beyond Your Breast
If your doctor told you that your breast cancer has spread to other parts of your body, it’s at a more advanced stage than if it’s only in your breasts. How far it has spread is one of the things your doctor will consider when they tell you the “stage” of your cancer. It’s considered “metastatic” if it has spread far from your breasts. Every case is different. For some women, it becomes something they live with for a long time. For others, focusing on pain management and quality of life is the main goal.
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Examples Using The Full Staging System
Because there are so many factors that go into stage grouping for breast cancer, it’s not possible to describe here every combination that might be included in each stage. The many different possible combinations mean that two women who have the same stage of breast cancer might have different factors that make up their stage.
Here are 3 examples of how all of the factors listed above are used to determine the pathologic breast cancer stage:
If Your Breast Cancer Has Spread
Even if your breast cancer has spread to other parts of your body, it does not necessarily mean its not treatable. If the cancer cannot be removed, the goal of treatment is to improve symptoms, improve quality of life and extend survival.
Some women live with breast cancer for several years as they learn to adjust and accept that theyll be on treatment for an indefinite period of time, explains Dr. Roesch. Your cancer team will help you learn and cope with what you can expect on this journey.
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What Is A Sentinel Lymph Node Biopsy
A sentinel lymph node biopsy is a procedure in which the sentinel lymph node is identified, removed, and examined to determine whether cancer cells are present. It is used in people who have already been diagnosed with cancer.
A negative SLNB result suggests that cancer has not yet spread to nearby lymph nodes or other organs.
A positive SLNB result indicates that cancer is present in the sentinel lymph node and that it may have spread to other nearby lymph nodes and, possibly, other organs. This information can help a doctor determine the stage of the cancer and develop an appropriate treatment plan.
Inoperable Breast Cancer Is Often Still Treatable
Stage 3C breast cancer is divided into operable and inoperable stage 3C breast cancer. However, the term inoperable is not the same as untreatable.
If your physician uses the word inoperable, it may simply mean that a simple surgery at this time would not be enough to get rid of all the breast cancer that is within the breast and the tissue around the breast. There must be healthy tissue at all of the margins of the breast when it is removed. Keep in mind that the breast tissue goes beyond the breast mound it goes up to the clavicle and down to a few inches below the breast mound. There must also be tissue to close the chest wound after the surgery is performed.
Another treatment method may be used first to shrink the breast cancer as much as possible before surgery is considered.
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When Does Cancer Spread To The Lymph Nodes
The rate that cancer spreads to a persons lymph nodes may depend on the cancer they have.
Some cancers can spread more quickly to the lymph nodes. Other cancers are slow to develop, and may spread at a slower rate.
Certain cancers may only spread to lymph nodes on rare occasions. Research indicates that osteosarcomas, a form of bone cancer, only spread to the lymph nodes in 411% of cases.
Cancer can affect people in different ways, so it can be hard to predict how it may spread.
When a doctor discusses a persons cancer with them, they may refer to the stage it is at. Different stages of cancer indicate how far it has spread from its original location.
The National Cancer Institute states that the stages of cancer are:
- Stage 0: Stage 0 cancer, also called carcinoma in situ , is when abnormal cells are present, but have not spread.
- Stage 1, 2, and 3: Stages 1 to 3 indicate that there is cancer present. The higher the stage, the larger and more spread out the cancer is.
- Stave 4: Stage 4 cancer is when the cancer has spread to areas that are distant from the original tumor.
Healthcare professionals also break stage 3 into multiple categories, including 3a, b, and c. The stage at which cancer has spread to the lymph nodes varies. According to the United Kingdoms National Health Service, the cancer may have spread to the lymph nodes at stage 3.
| Number beside the N |
- for melanoma
Discovering and treating cancer early can
What Is My Prognosis
This is a very common question that isnt always easy to answer. There are many factors involved in working out prognosis. Remember that a prognosis is just a figure at the point at which you receive it. For most people, the prognosis gets better with time.
Sometimes we use a five-year figure because we know that if cancer comes back, most of the time it comes back within five years. If the cancer has not come back within five years, then the chance of it coming back within ten years is quite low, and if it does not come back within ten years, then you have an almost normal life expectancy.
Its a bit like buying a second hand car. You dont really know how long its going to last, but if it lasts year after year without breaking down, then the car starts to look more and more reliable to make that long trip.
Working out prognosis can be difficult.
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What Is Stage 1 Breast Cancer
This breast cancer is the earliest stage of invasive breast cancer. In stage 1, the tumor measures up to 2 cm and no lymph nodes are involved. At this stage, the cancer cells have spread beyond the original location and into the surrounding breast tissue.
Because a stage 1 tumor is small, it may be difficult to detect. However, breast self-exams and routine screening are always important and can often lead to early diagnosis, when the cancer is most treatable.Stage 1 breast cancer is divided into two categories:
Stage 1A: The tumor measures 2 cm or smaller and has not spread outside the breast.
Stage 1B: Small clusters of cancer cells measuring no more than 2 mm, are found in the lymph nodes, and either there is no tumor inside the breast, or the tumor is small, measuring 2 cm or less.
At stage 1, TNM designations help describe the extent of the disease. For example, there may or may not be cancer cells in the lymph nodes, and the size of the tumor may range from 1 cm to 2 cm. Most commonly, stage 1 breast cancer is described as:
- T: T1, T2, T3 or T4, depending on the size and/or extent of the primary tumor
- N0: Usually, cancer has not spread to the lymph nodes.
- M0: The disease has not spread to other sites in the body.
Stage 1 breast cancer survival rate
The survival rate for stage 1A breast cancer may be slightly higher than for stage 1B. However, all women with stage 1 breast cancer are considered to have a good prognosis.
Less Lymph Node Surgery Equivalent Survival
The trial, called ACOSOG Z0011, was designed to compare whether sentinel lymph node biopsy alone provided equivalent survival benefits to ALND after breast-conserving surgery among a subset of women who also received radiation and systemic therapy. The research team enrolled 891 participants into the study from 1999 to 2004.
Women who had stage I or II cancer and metastases in only one or two sentinel nodes were eligible to join the study. All women had undergone SLNB at the time of breast-conserving surgery.
Half of the trial participants received no further surgery, and the other half underwent ALND. Almost 90% of women in both groups had radiation therapy after surgery, and almost all received some type of systemic therapy.
In the initial results from the trial, published in 2010 and 2011, women who had only SLNB did not have worse overall survival than women who underwent full ALND. The two groups also had similar rates of disease-free survival and cancer recurrence in the lymph nodes.
These early results were absolutely practice changing, and at this point the overwhelming majority of surgeons are not doing a full axillary lymph node dissection in patients with one or two positive nodes, said Larissa Korde, M.D., head of Breast Cancer Therapeutics in NCIs Division of Cancer Treatment and Diagnosis.
However, the cancer research community had lingering concerns about the trial, the authors of the new paper explained.
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Metastatic Breast Cancer: What You Should Know
What does it mean to have metastatic, or stage 4, breast cancer? A Rogel Cancer Center oncologist explains the diagnosis and how its treated.
After hearing a diagnosis of metastatic breast cancer, a rush of questions emerges. But often, its not until long after leaving the doctors office.
Metastatic means the cancer has spread beyond the breast and immediate lymph nodes to other organs or tissues in the body, most often the bones, brain, lungs or liver. Its considered stage 4 breast cancer, which means the cancer has progressed to its most advanced stage.
But even though its moved to other organs, it still behaves like breast cancer and is treated with breast cancer therapies.
More than 154,000 U.S. women are estimated to have metastatic breast cancer, according to the Susan G. Komen organization. Men can have metastatic breast cancer too, but its rare.
To help patients fill in information gaps, N. Lynn Henry, M.D., Ph.D., the breast oncology disease lead for the University of Michigan Rogel Cancer Center, explains the nuances of stage 4 metastatic breast cancer.
What are the differences between metastatic breast cancer, stage 4 breast cancer and advanced cancer?
If any doctor uses the term advanced, ask for clarification, Henry adds.
When does metastatic breast cancer appear?
What are the symptoms?
Symptoms of bone metastases:
Lymph Nodes And What They Do
Lymph vessels send lymph fluid through nodes throughout the body. Lymph nodes are small structures that work as filters for foreign substances, such as cancer cells and infections. They contain immune cells that can help fight infection by attacking and destroying germs that are carried in through the lymph fluid. Lymph nodes are located in many parts of the body, including the neck, armpit, chest, abdomen , and groin. They contain immune cells that can help fight infection by attacking and destroying germs that are carried in through the lymph fluid.
There are hundreds of lymph nodes throughout the body. Each lymph node filters the fluid and substances picked up by the vessels that lead to it. Lymph fluid from the fingers, for instance, works its way toward the chest, joining fluid from the arm. This fluid may filter through lymph nodes at the elbow, or those under the arm. Fluid from the head, scalp, and face flows down through lymph nodes in the neck. Some lymph nodes are deep inside the body, such as between the lungs or around the bowel, to filter fluid in those areas.
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