Determining Lymph Node Involvement
To determine if lymph nodes are involved in your breast cancer, your surgeon will remove one or several underarm lymph nodes so they can be biopsied and then examined under a microscope.
Lymph nodes can be checked in two different ways. The most common and least-invasive method is called sentinel lymph node biopsy. The other is called axillary lymph node dissection.
In most cases, lymph node surgery is done as part of the main surgery to remove the breast cancer. There are times, however, it may be done as a separate operation.
What Is Metastatic Breast Cancer
Metastasis is the process by which cancer cells spread. In the case of metastatic breast cancer, the cancer originated in breast tissue, then spread to other parts of the body.
Metastatic cancer is further described as local, regional or distant, depending on the location of the cancer cells in relation to the original tumor.
- Localized metastatic breast cancer often means the breast cancer has spread to nearby lymph nodes.
- The more distant locations include the bones, lungs, skin, liver and brain, although its possible for other parts of the body to be affected.
Its important to remember that every cancer is unique and that your experience may not necessarily be the same as that of another breast cancer patient. With a personalized treatment plan, metastatic breast cancer is typically treatable. A recent National Cancer Institute study found that the number of U.S. women living longer with distant metastatic breast cancer is growing, thanks to advances in treatments.
Its also important to prepare yourself with information about the disease, its symptoms and how its detected and treated.
Newly Diagnosed Or Worried About A Symptom
In the days or weeks after a diagnosis of secondary breast cancer, you may feel distressed and find it hard to think clearly.
You can read our information for people newly diagnosed with secondary breast cancer, including where to find support.
If you havent been diagnosed but are worried about a symptom, find out more about the signs and symptoms of secondary breast cancer.
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Exercise And Secondary Breast Cancer In The Lung
Some people with secondary breast cancer in the lung have no symptoms while others have a combination of pain, sickness, loss of appetite, hiccups, tiredness and fatigue. While physical activity may help reduce some symptoms its important to listen to your body and not push yourself too hard. Gentle, regular activity, such as walking, is often most effective.
If youre currently having treatment you may need to exercise at a slightly lower level. Stop if it hurts or feels like youre working too hard.
When choosing your exercise, try to focus on aerobic activities such as walking, swimming or cycling. Activities such as dancing and gardening can also be beneficial. You could also include some light toning or conditioning exercises such as stretching or low-impact yoga. The most important thing is to choose something you can safely enjoy.
About The Lymph Nodes
The lymphatic system helps protect us from infection and disease. It also drains lymph fluid from the tissues of the body, before returning it to the blood.
The lymphatic system is made up of fine tubes called lymphatic vessels. They connect to groups of lymph nodes throughout the body.
Lymph nodes are small and bean-shaped. They filter bacteria and disease from the lymph fluid. When you have an infection, lymph nodes often swell as they fight the infection.
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Breast Cancer And Lymph Nodes
Sometimes, cancer can spread through the lymphatic system. If breast cancer cells spread outside the breast, they are most likely to go to lymph nodes in the armpit.
You will usually have tests to look for cancer cells in the lymph nodes. There are also lymph nodes near the breastbone and above the collarbone.
The lymph nodes near the breast:
A New View Of Cancer Metastasis
In the lymph nodes, immune cells learn what to attack and what to protect .
But this study suggests that, in lymph nodes invaded by cancer, immune cells learn to protect the cancer cells rather than attack them, Dr. Engleman said. This phenomenon is called immune tolerance.
The research team suspects that those specialized cellsonce theyre educated by the tumorleave the lymph node, go all over the body, and instruct the immune system not to attack other cancer cells, he explained.
If thats the case, it would make distant organs more hospitable to the cancer, he said.
Thus, we propose a new model of metastasis we call Metastatic Tolerance, tweeted the studys lead scientist, Nathan Reticker-Flynn, Ph.D., of Stanford University.
Theres missing pieces about how exactly the T-regulatory cells get sent around the body, Dr. Dueck noted. But the idea is that there might be tolerance from the immune system by the time the cells get to distant organs.
With this new view of metastasis, the two prevailing theories on lymph nodes can be reconciled, Dr. Dueck explained. By spreading to lymph nodes and turning immune tolerance on, its easier for cancer cells in the primary tumor or in the lymph nodes to metastasize to distant organs.
Dr. Engleman and his team think it may be possible to develop therapies that switch off this tolerance. If used at the right time, such therapies could prevent cancer metastasis.
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Why It Spreads And Recurs
You may be wondering why breast cancer cells travel at all. Or, why normal cells don’t spread around our bodies. Cancer cells differ from normal cells in many ways. One of these is that normal cells have what is known as “adhesion molecules.” These adhesion molecules act like glue and keep cells where they belong in a particular part of the body.
Normal cells also have “boundaries” or ways in which cells communicate with each other. This is like one country saying to another “you don’t belong here.” Cancer cells, in contrast, don’t respect these cellular communications, essentially ignoring the “fences” between different tissues.
Yet another confusing topic when talking about breast cancer spread is why it can happen years or even decades later. We know that, especially with estrogen receptor-positive breast cancers, cancer can seemingly disappear only to recur many years after the original tumor. Nobody is certain exactly how this happens, but there are theories about recurrence that suggest that some breast cancer cells are hardier than others and that these cancer “stem cells” are able to lie dormant even through treatment.
What Are The Types Of Breast Cancer
Breast cancers are classified by the types of cells in which they develop, and whether they are invasive or noninvasive. Invasive cancers grow into nearby tissue while noninvasive tumors are slow-growing and remain localized.
Breast cancers are also grouped by the presence of mutations in certain genes such as HER2 and BRCA1 and whether they grow in response to estrogen and progesterone, the female hormones. Breast cancers that grow in response to hormones have proteins known as hormone receptors on them.
Breasts consist of milk glands and ducts, connective and fat tissue. Most breast cancers start in the milk-producing glands and ducts in the breast. The types of breast cancers include:
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Removing Most Or All Of The Lymph Nodes
An operation to remove most or all of the lymph nodes under the arm is called an axillary lymph node dissection or axillary clearance.
You have a general anaesthetic for this operation. You will be asleep the whole time.
The surgeon makes a small cut in your armpit to remove the lymph nodes. Generally, they remove between 10 and 15 lymph nodes. But the number of nodes in the armpit varies from person to person.
The surgeon sends the lymph nodes to the laboratory. A pathologist checks them for cancer cells. You get the results at your follow up appointment, about 2 weeks after surgery.
Some people will have radiotherapy to the lymph nodes instead of surgery.
What Do The Sentinel Lymph Node Biopsy Results Mean
If the result of your sentinel node biopsy is negative, this means that no cancer cells were found in the biopsied lymph node. This is a good sign that your cancer hasnt spread to nearby lymph nodes or other organs.
A positive result on your biopsy means that the pathologist found cancer cells in the lymph node. This usually indicates that your cancer has spread from its original location to the sentinel lymph node and possibly other lymph nodes or organs.
The results of your sentinel lymph node biopsy will help your doctor determine the stage of your cancer and develop an appropriate treatment plan.
The results of your lymph node biopsy may also be done at the same time as the removal of a primary tumor, and your doctor may decide to remove more than one lymph node for testing.
When several lymph nodes are removed for testing, its called a lymph node dissection.
Theres a chance your doctor will not be able to identify a sentinel lymph node. But mapping is about 90 percent accurate in identifying the sentinel node, with only about a 10 percent false-positive rate.
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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.
What Is Stage Iii Breast Cancer
In stage III breast cancer, the cancer has spread further into the breast or the tumor is a larger size than earlier stages. It is divided into three subcategories.
Stage IIIA is based on one of the following:
- With or without a tumor in the breast, cancer is found in four to nine nearby lymph nodes.
- A breast tumor is larger than 50 millimeters, and the cancer has spread to between one and three nearby lymph nodes.
In stage IIIB, a tumor has spread to the chest wall behind the breast. In addition, these factors contribute to assigning this stage:
- Cancer may also have spread to the skin, causing swelling or inflammation.
- It may have broken through the skin, causing an ulcerated area or wound.
- It may have spread to as many as nine underarm lymph nodes or to nodes near the breastbone.
In stage IIIC, there may be a tumor of any size in the breast, or no tumor present at all. But either way, the cancer has spread to one of the following places:
- ten or more underarm lymph nodes
- lymph nodes near the collarbone
- some underarm lymph nodes and lymph nodes near the breastbone
- the skin
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Stage Iii Breast Cancer Locally Advanced
A stage 3 breast cancer is sometimes referred to as a locally advanced breast cancer.
Stage III breast cancers are actually a heterogeneous group of cancers but account for about 7% of all initial breast cancer diagnosis.
Basically, a stage III breast cancer is one in which there is:-
- a primary tumor of greater than 5cm in diameter with no apparent metastasis
- OR the tumor is between 2cm and 5cm in diameter with evidence of rather significant metastasis.
Another way of looking at it is that stage III breast cancers either have a large but operable breast tumor . Or sometimes Stage III breast cancers present with a medium-size breast tumor which is more difficult to fully treat and cure with surgery alone.
What Happens When Cancer Spreads To The Lymph Nodes
We all know we have them, but many of us will probably admit, we have no idea what they are, what they do or what it means when cancer spreads to the lymph nodes.
We have hundreds of lymph nodes spread throughout the body including the neck, armpit, chest, abdomen and groin. Shaped like a small bean, they are part of the body’s immune system that help fight infection and disease. As fluid passes through the lymphatic system, the lymph nodes are tasked with the important job of filtering out toxins and fighting infection by attacking and destroying germs. The fluid is then returned to the large veins in the chest.
As some cancers become more advanced, they are more prone to spread to the lymph nodes through the tiny lymphatic ducts. These include cancers of the breast, skin , gastrointestinal tract, liver, pancreas, lungs, head and neck as well as endocrinological, urological and gynecological cancers. Cancer can also start in the lymph nodes. These are called lymphomas.
“In general, cancers that have spread to the lymph nodes are typically stage 2 or 3,” says Juan Santamaria, MD, Nebraska Medicine surgical oncologist. “Many of these cancers are still treatable and even curable at this stage. Cancer that has spread widely through the body is considered metastatic and is called a stage 4 cancer.”
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Secondary Cancer In Distant Lymph Nodes
Cancer cells can break away from the primary cancer and travel through the lymphatic system to lymph nodes further away from where the cancer started. These are known as distant lymph nodes. If cancer cells settle in the distant lymph nodes, it is known as secondary or metastatic cancer.
When the cancer cells in the distant lymph nodes are examined under a microscope, they look like cells from the primary cancer. For example, when a lung cancer has spread to distant lymph nodes, the cancer cells look like lung cancer cells.
The aim of treatment in this situation is usually to destroy as many cancer cells as possible. This can help control the cancer.
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How You Have A Sentinel Lymph Node Biopsy
A few hours before the operation, you have an injection of a small amount of mildly radioactive liquid into your breast close to the cancer. You usually have this in the nuclear medicine department in the hospital. The radioactive liquid is called a tracer.
During the operation, your surgeon may also inject a small amount of blue dye into the breast. The dye and the tracer drain away from the breast tissue into nearby lymph nodes.
The surgeon can see which group of lymph nodes the dye reaches first. They also use a radioactive monitor to see which group of lymph nodes the tracer gets to first.
Your surgeon removes between 1 to 3 nodes. They are sent to the laboratory to be looked at by a specialist called a pathologist.
The dye can stain your breast slightly blue. It gradually fades over a few weeks or months. The dye also turns your urine green for a few days.
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What Are The Signs Of Breast Cancer
While breast is more common in older women, it does affect the younger generation and men too with around 20 per cent of cases occurring in females under 50 and 350 male cases diagnosed in the UK annually.
While 90 per cent of such lumps are not cancerous, it is vital to get them checked by your GP at the earliest opportunity detecting the disease early can mean treatment is more effective.
It is therefore vitally important to be âbreast awareââ know what feels normal for you, and therefore what changes to look out for.
The most common signs to know include:
- A lump or swelling in the breast, upper chest or armpit. You might feel the lump, but not see it.
- Changes in the size or shape of the breast
- A change in skin texture i.e. puckering or dimpling of the skin
- A change in the colour of the breast â the breast may look red or inflamed
- Rash, crusting or changes to the nipple
- Any unusual discharge from either nipple
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Support For Living With Secondary Breast Cancer In The Lung
Everyones experience of being diagnosed with secondary breast cancer is different, and people cope in their own way.
For many people, uncertainty can be the hardest part of living with secondary breast cancer.
You may find it helpful to talk to someone else whos had a diagnosis of secondary breast cancer.
- Chat to other people living with secondary breast cancer on our online Forum
- Meet other women with a secondary diagnosis and get information and support at a Living with Secondary Breast Cancer meet-up
- Live Chat is a weekly private chat room where you can talk about whatevers on your mind
You can also call Breast Cancer Nows Helpline free on 0808 800 6000.
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A Little Bit About The Internal Mammary Lymph Nodes
The internal mammary nodes are located behind the ribs. Ribs are made of bone, but in the front, they turn into cartilage just before they join the sternum.
So, each rib attaches to the sternum with cartilage and each of these cartilage bars is around 5 cm long. Thus, it can be very difficult to remove an internal mammary node. There is an internal mammary artery and vein along with the lymph ducts and other veins.
If you need to remove an internal mammary node, the cartilage in front needs to be cut out. Cartilage, unfortunately, does not grow back or heal and this will leave a gap which makes the rib essentially useless.
So, it is a judgement call by the surgeon as to whether or not one should attempt a surgical approach to remove internal mammary nodes with positive metastasis. This is because surgical removal is just too damaging to the function of the chest and ribs.
However, electron beam radiotherapy is an effective treatment for internal mammary nodes. The electrons penetrate to about the correct depth to reach the internal mammary nodes.
Treatment of Stage IIIa Breast Cancer
The treatment for women with stage IIIa breast cancers tends to be a modified radical mastectomy and locoregional radiotherapy.
Often, chemotherapy is given as adjuvant therapy, but in some cases , pre-operative chemotherapy is also recommended. Breast conservation is generally not a good option with stage IIIa breast cancers.
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