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The lymphatic system is a part of the body’s defence system, or immune system. It consists of capillaries and vessels, which extend to twice the length of the arteries, veins and capillaries of the blood system, and these serve to drain off the fluid in which cells are bathed. The fluid is passed through lymph glands, or nodes, which are about the size and shape of a dried kidney bean, or smaller. The lymph nodes act as filters, removing bacteria and other substances. Once cleansed, the lymph is drained into the blood for recirculation.
The lymph system is crucial for defence against infections. One school of thought is that lymph nodes become ‘infected’ with cancer as it spreads. Another is that cancer cells are initially trapped in the nodes as part of the defence system for controlling the spread of the disease, and the nodes are instrumental in destroying those cells. It is because of this that the health of the lymph system is so important.
A lump in the armpit can be a fairly strong indicator of breast cancer and occasionally may be noticed before a lump is found in the breast. However, lumps in the lymph node area can also occur with benign, non-cancerous, breast disease and with infections of the nodes. It could also be that the nodes have swollen in a natural attempt by the body to resist the breast cancer, but this does not necessarily mean that the cancer has spread to the nodes.
Breast cancer cells are believed to migrate, or metastasize, quite early on in the disease process. It seems possible that lymph nodes which do not harbour cancer cells indicate a good level of natural resistance. By the same token, cancer in the nodes may suggest that the woman’s natural resistance is at a low ebb.
When surgery is performed on lymph nodes, in about 5 per cent of cases the drainage of lymph fluid is disrupted and results in swelling of the upper arm, or of the breast – this is called lymphoedema. Since the practice of using radiotherapy on the axillary, or underarm, area after surgery to that area has more or less been abandoned, the number of lymphoedema cases has plummeted.
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Once it is concluded that complete removal of the primary cancer growth, together with a margin of apparently normal tissues, is feasible, it is then important to check for any evidence of secondary growths. Lymphatic spread can be looked for by feeling the appropriate lymph node areas if they are close to the surface, or by checking them by special X-rays if they are deep-seated. What follows refers just to the lymph nodes that drain the site of your primary cancer growth. If these lymph nodes are enlarged, the cancer has probably spread to them. However, groups of cancer cells can also be present in normal sized nodes. The only way of being quite sure whether or not a node is involved is to examine it under the microscope. Of course, this can only be done if the node is removed. Therefore, if you have a type of cancer which often spreads through the lymph system, your surgeon will probably recommend removal of the nodes which drain the primary cancer site, even if these nodes are normal in size. Their removal will certainly be recommended if they are enlarged unless they are attached to nearby tissues, such as the overlying skin, indicating that the cancer is not confined within the nodes themselves. Complete removal is rarely possible if this has happened.

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