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Lymph nodes are an important part of the human immune system, as they filter lymph from pathogens and produce protective white blood cells and antibodies. Everybody has between 500 and 600 lymph nodes. Some of them, such as the cervical and axillary nodes, are close to the skin, so doctors can palpate them during examinations.
Cancer often metastasizes the lymph nodes. For many patients, therefore, it is important to know about the proper treatment of the disease. Find out from this article about the role of lymph nodes in the development of cancer and the most effective treatment strategies.
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What do lymph node metastases signal?
Checking your lymph nodes for metastases is an important part of a cancer diagnosis. The presence or absence of malignant cells in them tells the doctor a lot about the extent of the disease and the prognosis for treatment. The number and location of the affected nodes are used in the standard cancer stages classification known as TNM. The letter N in this abbreviation indicates the degree of involvement of the lymph nodes and can range from N0 (not involved) to N3 (cancer found in distant lymph nodes or extensive regional involvement).
Lymph node metastases can occur in almost any type of cancer.
The spread of cancer to the lymph nodes can take place in different ways:
Regional lymph nodes
The nearest lymph nodes are usually the first zones to which cancer spreads. For example, breast cancer often metastasizes to the axillary lymph nodes and cervical cancer – to the pelvic lymph nodes.
When resecting a primary tumour, doctors usually remove neighbouring lymph nodes to check whether cancer has spread to them. Sometimes a biopsy of sentiel lymph node is also carried out, indicating the extent to which the lymphatic system is affected.
Distant lymph nodes
Through the blood or lymphatic tracts, cancer cells can reach distant lymph nodes, and from them – other organs. This process occurs more often in the later (3-4) stages of the disease.
Lymph node metastases are dangerous for two reasons. Firstly, they help cancer to spread throughout the body. Subsequently, tumours can form in distant organs – bones, liver, lungs, brain, etc.
Secondly, by entering the lymph nodes, cancer cells interfere with the maturation of the body’s immune cells, disrupting its ability to recognise malignant agents. This makes it easier for metastases to form, and the primary tumour can accelerate its growth.
Diagnosing cancer always involves checking the lymph nodes. Doctors usually prescribe a biopsy of the regional lymph nodes and a full-body PET or CT scan.
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Do metastases in lymph nodes hurt?
When lymph nodes are affected by cancer, they tend to enlarge, become sensitive and even be painful. However, if they contain only a small number of cancer cells, patients may not notice anything, although the node will still be considered cancerous. In addition, enlarged lymph nodes located deep within the body are more difficult to detect – unless they begin to press on neighbouring organs.
Many infections can cause lymph node pain, so don’t panic if they get bigger. However, if you have already been diagnosed with cancer, make sure you tell your oncologist about this.
In addition to pain and enlargement, lymph node metastases can cause these symptoms:
Reddening of the skin;
Difficulty breathing;
Chest pain;
Thrombosis;
Limb swelling;
Weakness and loss of appetite.
Does chemotherapy help with lymph node metastases?
Standard chemotherapy has limited effectiveness in treating lymph node metastases. This is because it’s hard for drugs to enter the lymphatic system from the blood and they don’t accumulate well in lymph nodes. To fight the disease more effectively, doctors in advanced cancer centres inject chemo directly into the lymph vessels and complement it with other treatments.
The choice of drugs to be used to treat lymph node metastases depends on the type and stage of the primary tumour. Because the cells in metastases are the same as those that form the original tumour, the same drugs work on them. There are guidelines and recommendations that offer different chemotherapy protocols for different groups of patients. Often enough, if one set of drugs has stopped working because cancer has developed resistance, it is possible to choose another.
Timely treatment of lymphatic metastases is important to achieve remission and prevent disease recurrence.
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Other treatments for lymph node metastases
Other methods used to treat lymph node metastases include surgery, radiation therapy, immunotherapy and targeted therapy.
Surgical treatment of lymph node metastases
In some cases, lymph node metastases can be surgically removed. This is called lymph node dissection. The feasibility of the operation depends on the type of cancer. For example, the International Breast Cancer Study Group does not recommend lymph node resection for breast cancer if only 1-2 tumours smaller than 5 cm have been found. In such cases, surgery does not significantly affect the prognosis, but only puts extra stress on the body. At the same time, in the treatment of melanoma and gastric cancer, removing the lymph nodes improves the patient’s prognosis.
Lymph node dissection does not usually affect a person’s immunity. However, some patients may experience lymphedema – swelling associated with an abnormal outflow of lymph in the body. Treatment for this condition can be conservative or surgical.
The presence of lymph node metastases is considered an adverse factor and the chance that the disease will return after surgery is high. Because of this, chemotherapy or radiotherapy is usually given after the surgery to kill any residual cancer cells that may have remained in the body.
Radiation therapy for lymph node metastases
Lymph node tumours usually respond well to radiotherapy. This method uses concentrated beams of radiation to kill cancer cells.
Foreign clinics use the latest generation of radiotherapy machines. Their advantages include:
More precise beam targeting;
Reduced number of side effects;
Adaptation to the patient’s breathing, allowing the method to be used to treat tumours located in sensitive areas such as near the lungs.
The method is also used as a palliative treatment. About 60% of patients can get rid of pain caused by the pressure of the lymph node tumour on nearby tissues.
Immunotherapy for lymph node metastases
Immunotherapy is one of the most modern methods of cancer treatment, allowing the disease to be cured even when traditional methods (chemotherapy and surgery) have not had the expected effect. Immunotherapy affects a person’s immune system, helping them to fight cancer on their own. Because of this, the drugs aren’t as toxic as chemotherapy and cause fewer side effects. In addition, immunotherapy can increase the efficiency of other medicines taken by the patient.
The selection of drugs is based on examinations of the tumour tissue. One of the markers that doctors measure is VEGF-C – its level predicts the body’s response to immunotherapy.
Targeted therapy for lymph node metastases
Targeted therapy is another advanced technology used in the fight against metastases. It differs from standard chemotherapy in that it can distinguish healthy cells from those affected by cancer. This makes the treatment more effective and the side effects less pronounced.
In some cases, targeted therapy is so effective that it destroys tumours completely without the help of chemotherapy.
The mechanism of targeted therapy depends on the presence of specific proteins in the malignant cells, so an analysis of the tumour tissue is always carried out before the drugs are prescribed. There are approved drug protocols for each cancer type.
Hormone therapy for lymph node metastases
Some cancers, such as breast cancer or prostate cancer, depending on hormone levels. For them, hormone therapy can also be used to fight metastases.
Cryotherapy for lymph node metastases
In some cases, oncologists use cryoablation to remove localised lymph node metastases. This method involves using very low temperatures to freeze and remove disease-causing tissue.
The prognosis for lymph node metastases
The prognosis for treatment of lymph node metastases depends on the type of cancer, the location of the metastases (regional or distant), the age of the patient, the body’s response to treatment and other factors.
According to the American Association of Cancer Surgeons (ACS), the prognosis of patients with localised metastases depending on the type of cancer is as follows:
| Oncology | Five-year survival rate |
|---|---|
| Breast cancer | 86% |
| Melanoma | 66% |
| Non-small cell lung cancer | 35% |
| Small cell lung cancer | 16% |
In general, the presence of lymph node metastases is considered an unfavourable sign. These patients have a higher risk of recurrence of the disease.
Where do I go for treatment?
Resume
Lymph node metastases often occur in cancer patients as cancer spreads through the body. They are considered an unfavourable factor and increase the risk of later recurrence of the disease. The main signs are enlarged and painful lymph nodes, but some people may be asymptomatic.
The difficulty in treating lymph node metastases is that chemotherapy does not reach the lymphatic vessels well through the blood and does not accumulate well. Therefore, to treat them, chemo can be injected directly into the lymph and supplemented with radiotherapy, targeted therapy, and immunotherapy.
Early surgical removal of lymph nodes in most cancers does not affect the life expectancy of the patient, but it does reduce the risk of complications.
For cancer treatment abroad, the international MediGlobus platform recommends visiting clinics in Turkey, Spain, Germany, Austria, Israel and South Korea. Specific recommendations can be found on our website or by contacting our coordinating doctors directly for a free consultation.
To make an appointment for treatment of cancer metastases abroad, click on the button below and fill in the form. Our coordinators will call you back as soon as possible. They will provide you with all the necessary information and help with travel arrangements.
Sources:
- 1. National Cancer Institute: Cancer in Lymph Nodes May Help Tumors Spread by Enlisting Immune Cells
- 2. Frontiers in Oncology: Growth and Immune Evasion of Lymph Node Metastasis
- 3. American Cancer Society: Lymph Nodes and Cancer
- 4. Scientific Reports: New concept for the prevention and treatment of metastatic lymph nodes using chemotherapy administered via the lymphatic network
- 5. Radiation Oncology: Palliative radiotherapy for painful lymph node metastases
