Question about lymph node involvement

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Hybrids
Hybrids Member Posts: 42
edited April 2018 in IDC (Invasive Ductal Carcinoma)
HI all,

I've been getting a little confused by some terminology I'm seeing regarding lymph nodes. I was just diagnosed on Friday evening, so don't know anything other than the fact I have IDC and two axillary lymph nodes showed thickening on the mammo & ultrasound. They biopsied one of the lymph nodes when they biopsied my breast. When the Dr called about the diagnosis, she didn't specifically say the biopsy showed the lymph node had cancer as well as the breast and I didn't think to ask. The conversation was just regarding the biopsy coming back positive for IDC, but I'm sure it's a given or she would've mentioned the lymph node biopsy came back fine.

I'm seeing articles talk about "lymph node involvement" but I'm also see language like "spread to areas outside the breast and axillary lymph nodes". When medical journals/articles reference "lymph node involvement", does that mean any lymph node involvement or does it mean any lymph nodes that are not axillary (or by the breast)? It's a little confusing.

Thanks.

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  • Runrcrb
    Runrcrb Member Posts: 577
    edited April 2018

    Hybrids,

    The lymphatic system helps to clean up the insides of your body. Fluids move around your body through the vascular and lymph systems. When you have IDC, the invasive means it's broken outside the duct. You will likely have a sentinel node biopsy done. For this, they will inject a dye into your breast a few hours prior to surgery. The dye follows the route to the "sentinel" nodes (first ones). This allows the surgeon to extract those and a few others (farther in the chain of nodes). If there is no sign of cancer in the sentinel nodes. then it's considered not in the lymph system. if in the sentinel nodes, they will likely biopsy others too. I had cancer in the sentinel nodes but not any others. Axillary are the first set of lymph nodes that the breast drains to. Most articles are talking about axillary when discussing breast cancer and lymph nodes.


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  • Hybrids
    Hybrids Member Posts: 42
    edited April 2018

    Thank you! That really helps explain it.

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  • Hybrids
    Hybrids Member Posts: 42
    edited April 2018

    Thank you. That really helps explain it. I'll look up the sentinel node biopsy. I've seen it mentioned but didn't look up the meaning. There's so much to learn about all of this.

    I wish you well on your journey.

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  • SpecialK
    SpecialK Member Posts: 16,486
    edited April 2018

    hybrids - I would get copies of the pathology reports, there should be a separate report for the breast biopsy and one for the FNA biopsy of the suspicious node(s) as well, I wouldn't assume the node was positive until you see a pathology report that indicates this. There are different kinds of lymph node involvement, and they mean different things. The lymphatic system is body-wide, just like your vascular system. For purposes of breast cancer diagnosis, there are nodes within the breast (intramammary), up by the collarbone (supraclavicular) adjacent to the breast tissue, and nodes in the axilla (axillary) under your arm. Within the axilla there are levels of lymph nodes. A number of years ago, if you had a positive breast cancer diagnosis that was invasive (ILC or IDC), all of the axillary lymph nodes were removed during surgery. The sentinel node(s) are contained in level 1, but axillary clearance surgery (ALND) generally removes all the nodes in levels 1 & 2, leaving level 3 alone unless it is indicated there is cancer there as well. Progress brought the Sentinel Lymph Node procedure, designed to sample a limited number of axillary lymph node(s) in level 1 to see if cancer was present, in order to spare removal of all axillary nodes unnecessarily and therefore minimize risk of lymphedema and other potential complications. SNB is accomplished by injecting dye and/or tracer into the breast on the day of surgery, or sometimes the day prior, and following the dye/tracer to the node(s) closest to the breast, removing the node(s) that take up the dye/tracer, and giving a cursory pathology look while you are in the operating room, with a more involved look later in the lab. Based on what is seen In the OR a determination is made about whether to remove any additional nodes. Staging of breast cancer takes positive nodes into consideration, but it is important to note that having positive axillary nodes can still classify you as having "early sage" breast cancer. Final staging occurs post-surgically when the full pathology picture is known. Here is a graphic showing the lymph system, the axillary node system, and a link to the info on BCO regarding SNB.

    https://biologydictionary.net/lymphatic-system/

    https://ars.els-cdn.com/content/image/1-s2.0-S0363018811000971-gr1.jpg

    http://www.breastcancer.org/treatment/surgery/lymph_node_removal/sentinel_dissection

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