Lung cancer often spreads to the lymph nodes before spreading to other regions of the body. What lymph nodes does lung cancer spread to, how does your doctor know if your lung cancer has spread to your lymph nodes, and what does that mean as far as your treatment and prognosis?
Why Does Lung Cancer Spread to Lymph Nodes?
Lung cancer can spread (metastasize) in three primary ways. It may spread through:
- The lymphatic system
- The bloodstream, or
- Locally near the tumor.
When lung cancer cells travel through the lymphatic system they are carried to lymph nodes where they can lodge and grow. Lung cancer often spreads first to lymph nodes near the tumor, known as regional lymph nodes, but may also spread to lymph nodes in distant regions. Some terms you may hear that describe lung cancer that has spread to lymph nodes near the tumor include “regional disease,” “local spread” or “locally advanced disease.”
What Lymph Nodes Does Lung Cancer Spread To?The lymph nodes that lung cancer spreads to first often depends upon the location of the tumor. If you read through any of your radiology reports, words describing lymph node involvement can be very confusing. A simplistic way to think about lung cancer that spreads to lymph nodes is to divide the nodes into three regions:
- Intrapulmonary lymph nodes – This term refers to lymph nodes that lie within the lungs. These can either be peripheral lymph nodes -- that is, the lymph nodes that are found in the outer regions of the lungs -- or hilar lymph nodes, which are present in the region of the chest where the bronchi and major arteries and veins enter the lungs (the hilum).
- Mediastinal lymph nodes – These are lymph nodes that are present in the area of the chest between the lungs (the mediastinum).
- Extrathoracic lymph nodes – Refers to lymph nodes found outside of the thorax (chest). These include: supraclavicular lymph nodes, located in the area just above the collar bone; and scalene lymph nodes, which are in the neck, near the uppermost rib.
Another way that lymph nodes are classified is based on the side of the body where they are located:
- Ipsilateral lymph nodes – This refers to lymph nodes on the same side of the body as the tumor.
- Contralateral lymph nodes – Lymph nodes on the other side of the chest from the tumor.
What Symptoms Does Lung Cancer That Has Spread to Lymph Nodes Cause?You may not have any symptoms specifically related to lung cancer spreading to your lymph nodes. If you do have symptoms, these may include:
- Swelling in your neck or in the area just above your collar bone.
- Shortness of breath due to pressure from swollen lymph nodes.
- Hoarseness due to pressure on nerves caused by swollen lymph nodes.
How is Lung Cancer in the Lymph Nodes Diagnosed?After a lung cancer is diagnosed, your physician will recommend tests to see if your tumor has spread to lymph nodes or to distant sites. Determining if, and what, lymph nodes your cancer has spread to is important for choosing the best possible treatment. Some tests that may be done include:
- CT Scan or MRI of your chest and abdomen
- PET Scan – Particularly if you have non-small cell lung cancer
- Endobronchial Ultrasound
- Lymph node biopsy – If lymph nodes can be accessed by a procedure such as an endobronchial ultrasound or mediastinoscopy, your doctor may take a sample of the lymph node to test it for cancer cells
How Does the Spread of Lung Cancer to Lymph Nodes Relate to Staging?TNM staging of lung cancer is a method of staging that takes into account the size of your tumor, presence of lymph nodes affected by the cancer, and any evidence of spread of your tumor to distant regions of your body. In TNM staging, the N stands for lymph node involvement
- N0 – No spread of tumor to lymph nodes
- N1 – The tumor has spread to nearby nodes on the same side of the body
- N2 – The tumor has spread to nodes further away, but on the same side of the body
- N3 – Cancer cells have spread to lymph nodes on the other side of the chest from the tumor, or to lymph nodes near the collar bone or neck muscles
How Are Lymph Node Metastases Treated?The treatment for lung cancer that has spread to lymph nodes depends upon the stage of your cancer and your general health. If lung cancer has spread to only a few nearby lymph nodes, surgical treatment may be considered. If a tumor has spread to lymph nodes further away or to distant regions, treatment options usually include chemotherapy and/or radiation therapy.
What is the Prognosis?The prognosis of a lung cancer that has spread to lymph nodes depends on several things, including which lymph nodes are affected, the type of lung cancer you have, the size of your tumor, whether your tumor has spread to other areas of your body, and your general health. Many clinical trials are looking for better ways to treat lung cancer that has spread to lymph nodes, and offer hope that the prognosis will improve in the future.
- Survival Rates Based on Lung Cancer Stage
- Factors That Affect Lung Cancer Survival
- Ways to Improve Lung Cancer Survival Your Doctor May Not Mention
- Where Does Lung Cancer Spread?
- Lung Cancer Spread to Brain
- Lung Cancer Spread to Bone
- Lung Cancer Spread to Liver
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American Cancer Society. Lymph nodes and Cancer. Updated 03/06/14. http://www.cancer.org/cancer/cancerbasics/lymph-nodes-and-cancer
Riquet, M. et al. Prognostic classifications of lymph node involvement in lung cancer and current International Association for the Study of Lung Cancer descriptive classification in zones. Interactive Cardiovascular and Thoracic Surgery. 2010. 11:260-264.
Van Schil, P. From Individual Lymph Nodes to Stations and Zones: East and West Reconciled?. Journal of Thoracic Oncology. 2009. 4(5):561-562.