Lymph node metastases

Definition - What are lymph node metastases?

Lymph node metastases are defined as cancer cells originating from a malignant tumor of another organ that have spread to the lymph nodes where they settle. It is important to distinguish these from malignant lymphomas, for which the cancer primarily originates from cells in the lymph nodes or other lymphoid cells. 

Just how often lymph node metastases develop from a cancer depends on what type of tumor it is. Sarcomas, many of which involve bone, cartilage, or muscle tissue, seldom spread to lymph nodes. It's quite different with carcinomas, that include some of the most common cancers, for instance breast, prostate, lung and colorectal cancers. The risk of lymph node metastases is significantly higher in this group.

Causes - How and where do lymph node metastases develop?

Normal adult cells lack the ability to detach from tissues and migrate to other organs. Mutated cancer cells have acquired this ability to invade adjacent organs or to reach blood or lymphatic vessels, from where they can spread to various organs throughout the body.

The lymphatic system reaches throughout the body and functions as a transport network, while filtering toxins and microorganisms. As all organs are drained by the lymphatic system, cancer cells can spread to surrounding lymph nodes from anywhere.  

The primary lymph node reached by lymphatic vessels originating from a particular organ is known as the sentinel lymph node. If lymph node metastases are suspected in a cancer patient, this sentinel lymph node is examined. Finding no tumor cells in this node indicates that the subsequent lymph nodes are also free of metastases.

Symptoms - What are the manifestations of lymph node metastases?

Most often, lymph node metastases are noticeable as a painless swelling of one or more lymph nodes. According to the location of the primary tumor, they can be located in the armpit, on the side of the neck or in the groin, for example. Unlike normal physiological swollen lymph nodes caused by an immune reaction, the findings last for several weeks and may grow significantly in size. In case the swollen lymph nodes cannot be moved against the surrounding tissue, it also is a hint for a tumor. 

Occasionally, such enlarged lymph nodes may be the first symptom of cancer. But other symptoms might already have occurred, not caused by the lymph node metastases, but the primary tumor or by metastases affecting other organs. Such symptoms can differ greatly depending on the organ. For instance, prostate cancer can present with difficulty urinating, while lung cancer can cause a recurrent cough, or bone metastases can lead to pain in the affected bone. Nevertheless, some general symptoms occur in all cancers: 

• Fever 
• Fatigue 
• Weight loss 
• Night sweats

Therapy - What kind of treatment for lymph node metastases is offered by a specialist?

The treatment of lymph node metastases is dependent on the therapeutic approach of the primary tumor. Various therapy strategies are available to treat a tumor. Very often, a combination of several of them is employed.

• Surgery 
• Chemotherapy
• Radiotherapy 
• Hormone therapy
• Antibody therapy

Staging always takes place before the start of cancer therapy. This means that the extent of the tumor is evaluated as accurately as possible with the help of a clinical examination, radiological imaging (e.g. CT or MRI), laboratory parameters obtained from the blood, and if necessary the pathological examination of a tissue sample. As part of this, lymph node metastases are identified. Also, the tumor cell genome can be analysed to determine, for example, if the tumor will respond to hormone or antibody therapy.

Drug therapies, namely chemotherapy, hormone therapy and antibody therapy, target tumor cells throughout the body. In fact, chemotherapy targets all rapidly dividing cells, causing more side effects than other forms of therapy. Therefore, drugs inevitably target not only the cancer cells of the primary tumor, but also those that have metastasized to lymph nodes or other organs. 

Should lymph node metastases be detected during staging, they are usually treated with radiation therapy. During surgery, the metastatic lymph nodes are removed along with the primary tumor as well. In case of uncertainty whether lymph node metastases are present, sentinel lymph node is removed and examined for pathology during surgery. If that lymph node is tumor-free, the remaining ones can be left in place. Otherwise, the lymph nodes of the nearest lymph node locations are also removed.

Which doctors & clinics specialize in lymph node metastases?

If you're concerned about a swollen lymph node, you should see your GP first. who will be able palpate the lymph node and rule out other causes of enlarged lymph nodes, including infection with Epstein-Barr virus or toxoplasmosis.

Your GP will refer you to a specialist for additional investigations if a lymph node metastasis is suspected. This may be an oncologist, the field concerned with cancer, or a radiologist, so that imaging studies can be performed to obtain a more detailed picture of the lymph node, or to search for a primary tumor. If the localization of the swollen lymph node already raises suspicion of a particular cancer, such as swollen lymph nodes in a woman's armpit which are typical of breast cancer, the patient may also be referred to the department dealing with the organ in question - in this case it would be gynecology.

Treatment of cancer is generally carried out by a multidisciplinary team what includes radiologists, radiotherapists, surgeons and oncologists, among others.

If you're in need of a doctor, you expect the best medical care possible. So of course patients are curious to find out what clinic to go to. As there is no objective way to answer this question and a legitimate doctor would never claim to be the best, patients must rely on a doctor's experience.

Let us help you find an expert for your condition. All listed doctors and clinics have been reviewed by us for their outstanding specialization in the field of lymph node metastases and are looking forward to your inquiry or wish for treatment.