Secondary cancer in the lymph nodes

Sometimes cancer cells can spread from where the cancer started. They may travel through the lymphatic system to lymph nodes in another part of the body.

Symptoms depend on which lymph nodes are affected. The most common symptom is enlarged or swollen lymph nodes. Other symptoms might include breathlessness or backache, for example if there are enlarged lymph nodes deep inside the chest or tummy. Sometimes there are no symptoms and the secondary cancer might be picked up by a routine scan.

You may have a computerised tomography (CT) scan, magnetic resonance imaging (MRI) scan, or positron emission tomography (PET) scan to diagnose secondary cancer in the lymph nodes. Some people will also have a lymph node biopsy.

Treatment depends on your general health and the type of primary cancer you had. You may have:

  • chemotherapy
  • hormonal therapy
  • radiotherapy
  • targeted therapy
  • surgery.

You may have a combination of these treatments.

Finding out that your cancer has spread or come back can be a shock. Everyone has their own way of dealing with feelings, but help is available if you need it.

The lymphatic system

The lymphatic system helps to 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 that connect to groups of lymph nodes throughout the body.

The lymphatic system
The lymphatic system

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Lymph nodes (sometimes called lymph glands) are small and bean shaped. They filter bacteria (germs) and disease from the lymph fluid. When you have an infection lymph nodes often swell as they fight the infection.


What is secondary cancer in the lymph nodes?

Secondary cancer in the lymph nodes is when cancer cells have spread to the lymph nodes from a cancer that started somewhere else in the body.

This information is not about cancer that starts in the lymph nodes, which is called lymphoma.

We hope this information answers your questions. If you have any further questions, you can ask your doctor or nurse at the hospital where you are having your treatment.

Cancer in nearby lymph nodes

Cancer that starts in one part of the body (primary cancer) can spread to other parts of the body. It spreads through the bloodstream or the lymphatic system. If cancer cells travel through the lymphatic system, nearby lymph nodes can trap them.

When a surgeon removes a primary cancer, they will often remove some of the lymph nodes near the cancer as well. The lymph nodes are examined to see whether there are any cancer cells in them. If your doctor knows whether there are cancer cells in nearby lymph nodes, it can help them assess the risk of the cancer coming back. Your doctors may suggest you have more treatment after surgery to reduce the risk of the cancer coming back.

Cancer in the nearby lymph nodes is different to secondary cancer in distant lymph nodes.

Secondary cancer in distant lymph nodes

Cancer cells may break away from the primary cancer and travel through the lymphatic system to distant lymph nodes in another part of the body. This is known as secondary or metastatic cancer.

When the cancer cells in the lymph nodes are examined under a microscope, they will look like cells from the primary cancer. For example, when a lung cancer has spread to lymph nodes, the cancer cells in the lymph nodes look like lung cancer cells.


Signs and symptoms of secondary cancer in the lymph nodes

The most common symptom of cancer in lymph nodes is that one or more lymph nodes becomes enlarged or feels hard. But if there are only a small number of cancer cells in the lymph nodes, they may feel normal.

If the enlarged lymph nodes are deep inside the chest or tummy, the lymph nodes cannot be felt. But they may put pressure on surrounding organs or structures, which can cause symptoms like breathlessness or backache. However, often there are not any symptoms.

Sometimes cancer in lymph nodes can block the flow of lymph fluid in that part of the body. If it is blocked in the arm or groin, it may cause a build-up of fluid, which can cause swelling in the arm or leg. This condition is called lymphoedema.

If lymph nodes press on the blood vessels, they can slow the flow of blood through the vessels. This can sometimes lead to a clot forming in a blood vessel.

Some people get the general symptoms of a cancer coming back, such as loss of appetite, weight loss and tiredness.

Sometimes during a routine scan, a lymph node or a group of lymph nodes may look bigger than they should. This may be a sign that there is a secondary cancer in the lymph nodes.

It is important to remember that lymph nodes can be enlarged for other reasons, such as infections.


Diagnosing secondary cancer in the lymph nodes

If a lymph node close to the surface of the skin is affected, you may be able to see it or feel it with your fingers. If an affected lymph node is deep inside the chest, tummy or pelvis, only a scan can find it.

If you have had cancer before, you may only need a scan to make a diagnosis of secondary cancer in the lymph nodes. This may be a CT, MRI, ultrasound or PET scan (see below).

Some people may need to have a lymph node biopsy. This test checks for cancer cells in the lymph node, but it is not always needed.

CT (computerised tomography) scan

A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of the body. The scan takes 10–30 minutes and is painless. It uses a small amount of radiation, which is very unlikely to harm you and will not harm anyone you come into contact with. You will be asked not to eat or drink for at least four hours before the scan.

CT scan
CT scan

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You may be given a drink or injection of a dye, which allows particular areas to be seen more clearly. This may make you feel hot all over for a few minutes. It’s important to let your doctor know if you are allergic to iodine or have asthma, because you could have a more serious reaction to the injection.

You’ll probably be able to go home as soon as the scan is over.

MRI scan

This test uses magnetism to build up a detailed picture of areas of your body. The scanner is a powerful magnet so you may be asked to complete and sign a checklist to make sure it's safe for you. The checklist asks about any metal implants you may have, such as a pacemaker, surgical clips, bone pins, etc. You should also tell your doctor if you've ever worked with metal or in the metal industry as very tiny fragments of metal can sometimes lodge in the body. If you do have any metal in your body it's likely that you won't be able to have an MRI scan. In this situation another type of scan can be used.

Before the scan, you'll be asked to remove any metal belongings including jewellery. Some people are given an injection of dye into a vein in the arm, which doesn't usually cause discomfort. This is called a contrast medium and can help the images from the scan to show up more clearly. During the test you'll lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It's painless but can be slightly uncomfortable, and some people feel a bit claustrophobic. It's also noisy, but you'll be given earplugs or headphones. You can hear, and speak to, the person operating the scanner.

Ultrasound scan

Ultrasound scans use soundwaves to build up a picture of the inside of the body. Once you are comfortable, a gel is spread on the skin over the area to be scanned. A small device that produces soundwaves is passed over the area. The soundwaves are then converted into a picture by a computer. This test is painless and only takes a few minutes.

PET (positron emission tomography) scan

This uses low-dose radioactive sugar to measure the activity of cells in different parts of the body. A very small amount of a mildly radioactive substance is injected into a vein, usually in your arm. A scan is taken a couple of hours later. Areas of cancer are usually more active than surrounding tissue and show up on the scan.

Excision biopsy

This is usually a small operation where the doctor will remove a lymph node, or a number of nodes. You have this under a local or general anaesthetic.

Fine needle biopsy

This is when the doctor takes a sample of cells from an enlarged lymph node, using a fine needle attached to a syringe. It is usually done in a clinic and you won’t need a general anaesthetic.

The cells are sent to a laboratory. A doctor who diagnoses illness by looking at cells (pathologist) will examine them under a microscope.

If your doctors think the affected lymph nodes are clearly linked to the primary cancer, you may not need to have a lymph node removed or a lymph node biopsy.


Treating secondary cancer in the lymph nodes

The treatment for secondary cancer in the lymph nodes depends on your situation, including the type of primary cancer you have had and your general health. It may include chemotherapy, hormonal therapy, radiotherapy, targeted therapy, surgery, or a combination of these treatments.

Chemotherapy

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. It is usually given into a vein (intravenously) or as tablets. The drug you have will depend on whether you have had chemotherapy before and how long ago you had it.

Hormonal therapy

If you have a cancer that relies on hormones to grow, such as breast cancer or prostate cancer, you may be given hormonal therapy. The type of hormonal therapy you have will depend on which hormonal treatments you have already been given.

Targeted therapy

Targeted therapy drugs target specific proteins on the cancer cells to stop them from growing. You may have a targeted therapy as an injection into a vein (intravenously) or as tablets.

Radiotherapy

Radiotherapy uses high-energy rays to destroy cancer cells in the area that is being treated.

Surgery

Surgery is sometimes used to remove affected lymph nodes. You may need to stay in hospital for a few days for this.

Supportive care

Supportive or palliative care is treatment that is used to manage symptoms caused by cancer. Your cancer doctor or GP can refer you to doctors and nurses who specialise in symptom control.


Your feelings

Finding out that your cancer has spread or come back can be a shock. You may feel many different emotions, including anger, resentment, guilt, anxiety and fear. These are all normal reactions, and part of the process many people go through when trying to come to terms with their illness.

Everyone has their own way of coping with difficult situations. Some people find it helpful to talk to family or friends, while others prefer to get help from people who are not so close to them. Some people prefer to keep their feelings to themselves. There is no right or wrong way to cope, but help is available if you need it. You can call our cancer support specialists on 0808 808 00 00.

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