Secondary cancer in the lymph nodes

Sometimes cancer cells can break away from where the cancer started and 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 abdomen. Sometimes there are no symptoms and the secondary cancer might be picked up by a routine scan.

You may have a CT, MRI or 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, or a combination of these treatments.

Finding out that your cancer has spread or come back can be a shock and you may have many different emotions. Everyone has their own way of dealing with feelings, but do ask for help if you need it.

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 have separate information about 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.


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.


Cancer in the lymph nodes

Sometimes cancer cells break away from the part of the body where the cancer started (primary cancer). They can travel in the lymphatic system into lymph nodes.

When a primary cancer is being removed with surgery, the surgeon often removes some of the lymph nodes near the cancer as well. They will be examined to see whether there are any cancer cells present. Knowing whether there are cancer cells in nearby lymph nodes helps the doctors assess the risk of the cancer coming back. Your doctors may suggest you have further treatment after your surgery to reduce the risk of the cancer coming back.

This is a different situation to secondary cancer in the lymph nodes.

Secondary cancer in the lymph nodes

Cancer cells may break away from the primary cancer and travel in the lymphatic system to lymph nodes in another part of the body. This is known as secondary or metastatic cancer. When cancer spreads to lymph nodes, the cancer cells in the nodes will look like cells from the primary tumour when they’re examined under the microscope. For example, when a lung cancer has spread to the lymph nodes, the cancer cells in the lymph nodes look like lung cancer cells. This affects the way they are treated.

Cancer cells can also break away from the primary cancer and travel in the blood stream to another part of the body.


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. However, 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 abdomen, they may put pressure on surrounding organs or structures. This can lead to symptoms like breathlessness or backache. But often there may not be any symptoms.

Sometimes a lymph node, or group of nodes, may appear larger than they should on a routine scan, such as an ultrasound scan, CT scan or MRI scan. This may be a sign that there is a secondary cancer in the lymph nodes.

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


How secondary cancer in the lymph nodes is diagnosed

If you’ve 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 or a PET scan.

Some people may also need to have a lymph node biopsy.

CT (computerised tomography) scan

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

You may be given a drink or injection of a dye that 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.

MRI (magnetic resonance imaging) scan

This test uses magnetism to build up a detailed picture of areas of your body. Before the scan you may be asked to complete and sign a checklist. This is to make sure it is safe for you to have the MRI scan. Before the scan, you will be asked to remove metal belongings including jewellery. Some people are given an injection of dye into a vein in the arm. This is called a contrast medium and can help the images from the scan to show up more clearly. During the test, you will be asked to lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It is painless but can be slightly uncomfortable, and some people feel a bit claustrophobic. It is also noisy, but you will be given earplugs or headphones.

PET (positron emission tomography) scan

A PET scan 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 few 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 usually have this under a 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. The needle biopsy is usually done in a clinic and you won’t need a general anaesthetic.

The cells will be sent to a laboratory to be examined under the microscope by a pathologist (a doctor who diagnoses illness by looking at cells).

If your doctors feel that 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.


Treatment for secondary cancer in the lymph nodes

The treatment for cancer that has spread to the lymph nodes depends on the individual situation, including your general health and the type of primary cancer you have had. 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 most commonly given into a vein (intravenous) or as tablets. The drug you have will depend on whether you've had chemotherapy before and how long ago.

Hormonal therapy

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

Targeted therapy

These 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 (intravenous) or as tablets.

Radiotherapy

Radiotherapy uses high-energy rays to destroy cancer cells in the area that’s 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.


Your feelings

Learning that your cancer has spread or come back may be even more devastating than hearing for the first time that you have cancer. You may have many different emotions, including anger, resentment, guilt, anxiety and fear. These are all normal reactions, and are part of the process many people go through in 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 seek help from people outside their situation. 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.

Our cancer support specialists can give you details of counselling services in your area.

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