Lymph Node-Positive Breast Cancer

Lymph node-positive breast cancer is a type of cancer that has spread from the original tumor to at least one of the nearest lymph nodes, near or in your armpit. This cancer spread occurred in 26% of the more than 250,000 breast cancer cases reviewed in a 2023 study.

Testing with a sentinel node biopsy (close to the cancer) is common, to determine if there's a locally advanced breast cancer or already a metastatic breast cancer that's spread elsewhere in the body. A lymph-node positive breast cancer may require more aggressive treatment.

This article will outline the causes and symptoms of lymph-node positive breast cancer, and share information about diagnosis, treatment, coping strategies, and determining overall prognosis.

Symptoms of Lymph Node-Positive Breast Cancer

If you get an infection, your lymph nodes near the affected area may swell because they have collected germs. If you develop breast cancer, the lymph nodes in your armpit are the most common area where cancer cells will lodge, which also causes the nodes to swell.

The key symptom separating lymph node-positive breast cancer from other types of breast cancer is swelling in the lymph nodes under your arm. Symptoms also include:

• Swelling in your arm or hand (lymphedema)
• Swelling in your collarbone area

Breast tumors most commonly cause drainage toward your axilla or underarm area. Checking this should be part of a clinical breast exam, as well as your monthly self-exam. Although swollen lymph nodes might be evidence that cancer has spread beyond your breast, the only way to know for sure is to have some removed and tested.

Although axillary lymph nodes are usually the first place breast cancer spreads to, breast cancers towards the middle of your chest may instead drain to lymph nodes between the breasts.

Causes of Lymph Node-Positive Breast Cancer

Breast cancer starts out with just a few cells, which group together in your breast tissue and may show up in the ducts and lobes. As these cells grow and divide, they may also invade nearby tissue—including lymph nodes.

Your lymph system works with your circulating blood to provide nutrients to all your cells, as well as remove cellular waste products. Lymph nodes are in various locations, including breast tissue itself. There, the lymphatic fluid is filtered, mixed with immune cells (lymphocytes), and passed back into your circulating lymph fluid.

A growing tumor may shed a cell or a clump of cells. It can use your blood or lymph system as a transport network throughout your body. So, if a cancer cell makes it to your lymph nodes, it's also possible that it could travel to other parts of your body.

How Is Lymph Node-Positive Breast Cancer Diagnosed?

Lymph node-positive breast cancer is diagnosed via a biopsy, conducted either during breast surgery or as a separate procedure.

Prior to surgery for breast cancer, when the cancer is first diagnosed, if abnormal lymph nodes are found on exam or imaging, a needle biopsy is often performed and can diagnose the breast cancer as being lymph-node positive.

Procedures performed during the surgery itself include sentinel lymph node biopsy and axillary lymph node dissection. "Axillary" means "of the armpit," and the axillary lymph nodes are typically the first place breast cancer spreads to. You have many axillary nodes, and the first ones cancer is likely to move into are called the sentinel lymph nodes.

Research suggests that finding cancer cells in your sentinel lymph nodes is an excellent predictor of whether cancer will be found in any of your remaining lymph nodes. A sentinel rather than axillary lymph node procedure, when appropriate, also may lead to fewer complications with lymphedema after treatment.

In a sentinel lymph node biopsy, those first nodes are identified by a dye and radioactive marker that are injected into the breast. Those nodes are then removed and checked for cancer.

An axillary lymph node dissection is an alternative to a sentinel lymph node biopsy. In this procedure, a surgeon removes all of the lymph nodes that they can find in your armpit (rather than just the sentinel nodes) and then examines them to see whether cancer is present.

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Lymph Node Status

The pathology report about your lymph node status tells whether or not any sign of cancer is present in the lymph nodes that were removed. You may hear words such as macrometastases or micrometastases when your surgeon discusses your nodes:

• Macrometastases are cancer in the lymph nodes visible to the naked eye.
• Micrometastases can only be seen under the microscope.

Negative

If your lymph nodes are clear of cancer, your lymph node status is called negative and rated N0 according to the TNM staging of breast cancer.

If you have a negative sentinel node biopsy, you likely won't need to have an axillary lymph node dissection. If you have a small tumor and clear nodes, it's less likely that you will need chemotherapy.

Positive

If you have cancer cells in your lymph nodes, your cancer is considered lymph node-positive. The stage of breast cancer with positive lymph nodes depends on how many cancer cells are found.

Based on the TNM staging at surgery, your tumor would be called either N1, N2, or N3 depending on the total affected lymph nodes and how far away from the tumor the positive nodes are found.

If you have cancer cells in your sentinel lymph node, axillary node dissection may be included along with breast cancer surgery, if surgery is part of your treatment plan.

How Is Lymph Node-Positive Breast Cancer Treated?

Treatment is designed to kill off as many of your cancer cells as possible. Having lymph nodes involved usually means you'll be advised to have adjuvant systemic therapy such as chemotherapy to kill any additional cancer cells that persist in your body.

For those who have estrogen-receptor-positive tumors, hormonal therapy is usually recommended for five to 10 years after treatment. This may be tamoxifen for those who are premenopausal and an aromatase inhibitor for those who are postmenopausal.

Unlike chemotherapy, hormone therapy reduces not only the risk of early recurrence (recurrences within five years of diagnosis) but late recurrence as well.

With early-stage breast cancers that are estrogen-receptor positive, the chance that the cancer will return after five years is greater than the chance that it will recur during the first five years after treatment.

Another category of medications called bisphosphonates was recently approved for postmenopausal people who have early-stage breast cancer. The bisphosphate medication Zometa (zoledronic acid) appears to reduce the risk of developing bone metastases. (The bones are the most common site of metastases with breast cancer.)

Radiation therapy may or may not be recommended depending on the number of positive lymph nodes and other findings related to your tumor.

What Is the Prognosis for Breast Cancer Spread to Lymph Nodes?

Prognosis, also called outlook, is one way a healthcare provider talks about the odds for survival after you've completed treatment.

If you had clear lymph nodes and a small, low-grade tumor, your prognosis after treatment is quite good. On the other hand, if you had several lymph nodes involved or a larger tumor, your treatment will likely be more aggressive, and your outlook will be harder to determine until after you've finished all treatments.

No matter what your diagnosis is, know that survival rates are improving, treatments are becoming more efficient and effective, and even metastatic breast cancer, for some, can be managed for a long period of time.

Coping With a Lymph Node-Positive Diagnosis

Facing the possibility or reality of lymph node involvement only adds to the emotions that come with the idea of a breast cancer diagnosis itself.

While it may feel overwhelming, you can learn to cope with this fear in positive ways. It's also important to advocate for yourself when going through treatment.

Talk to your healthcare provider or social worker, or consider joining one of the many breast cancer support groups, through the American Cancer Society, Komen, and more about any problems you may have coping.

Being aware of the risk of recurrence (which remains steady for at least 20 years in people with estrogen-receptor-positive tumors) may prompt you to adopt healthy lifestyle habits and have regular medical exams. It can also be helpful when you feel tempted to stop treatment, especially medications such as aromatase inhibitors due to bone aches.

That said, sometimes the fear of recurrence can interfere with your quality of life. Your healthcare provider can help you find a good therapist who can help you work through your fears. Finding a good support group or online support community is also very helpful.

Summary

Lymph-node involvement is a major predictor of breast cancer prognosis, and knowing your lymph node status can help you and your medical team develop a treatment plan. A biopsy is often the first step in determining what your lymph node status is.

If you have positive lymph nodes with early-stage breast cancer, treatments will likely be more aggressive and may include chemotherapy, hormonal therapy, targeted therapy, and radiation.

Many people with lymph node-positive cancer remain cancer-free after treatment, and a positive lymph node status does not automatically mean your cancer will come back. Family, support groups, and in-hospital staff can help to support you during and after your treatment.