Lymph node metastases are the spread of cancer cells from a primary tumor (e.g., prostate cancer, colon cancer, or skin cancer). These metastases travel via the blood and lymphatic system to the lymph nodes, where they form secondary tumors. Learn more about the symptoms, risk factors, and innovative treatment methods of modern precision medicine on this page.
At the European Radiosurgery Center Munich (ERCM), we have extensive experience with lymph node metastases. Through advanced radiosurgical treatment with a precision robot, our patients benefit from extremely effective, precise, painless, and comfortable treatment.
Our experts will be happy to advise you on your personal treatment options. Please contact us.
estimated 500 to 600 lymph nodes , surrounded by dense connective tissue and connected to nerves, blood vessels, and lymphatic vessels [1, 2]. About half of all lymph nodes are located in the head and neck area. They are also frequently found under the armpits or in the groin.
Like the tonsils or the spleen, lymph nodes are lymphatic organs. The goal of the human lymphatic system is, among other things, to detect pathogens and prevent their spread throughout our body [2].
In response to immunological stimuli, blood and lymph flow can increase by approximately 25-fold and the size of individual lymph nodes by up to 15-fold [1].
Lymph node metastases occur when other cancers – the primary tumors – spread. The cancer cells reach the lymph nodes via the blood or lymphatic system. Sometimes the metastases are already present at the time of initial diagnosis; in other cases, they develop later – sometimes many years after treatment of the original cancer.
Metastases can therefore develop at different times during the course of a cancer. This does not happen automatically in every cancer, but only in a portion of those affected. [3] . Why this is so is not yet fully understood scientifically and is the subject of current research.
Lymph node involvement in the immediate vicinity of the primary tumor is usually not considered an advanced disease – the treatment of metastases in these cases aims at cure.
If there is evidence of lymph node metastases, surgical resection is typically performed and subsequent conventional radiotherapy is recommended to reduce the risk of recurrence [4].
In selected situations, lymph node metastases can also be treated with CyberKnife therapy on an outpatient basis. This can sometimes avoid microsurgical resection for affected patients – and thus the stress of a surgical procedure and the associated complications and side effects.
Here at ERCM, together with our medical partners, we have already treated many patients with lymph node metastases and therefore have extensive radiosurgical experience in this area.
In order to assess an existing cancer and its further progression, the occurrence of lymph node metastases is also relevant. They can have a significant impact not only on the stage of the disease, but also on the available treatment options – and, last but not least, on the prognosis [2].
Lymph node metastases can develop in the immediate vicinity of the original cancer. If they develop as distant metastases in other parts of the body, this usually indicates advanced cancer, which is often not curable [3].
Many different types of cancer are associated with lymph node metastases, including tumors of the stomach and intestines, prostate cancer, lung cancer, skin cancer (malignant melanoma), and breast, ovarian, and uterine cancer.
Modern research focuses on various scientific studies to better understand the exact mechanisms of metastasis.
The more concretely the effects of lymph node metastases on the further course of the disease can be described, the more precisely tailored therapy concepts can be offered [2].
Lymph nodes are found everywhere in the body, especially concentrated in the pelvic area, among other places.
Lymph nodes are often the first place where cancer cells that have detached from the original tumor settle. By bypassing or suppressing the body's normal immune functions, these metastases can grow in the first place – a process that often remains without specific symptoms. Lymph node involvement is often discovered during a follow-up examination [2].
Normally, lymph nodes are oval-shaped organs of the immune system, measuring only a few millimeters in size. When affected by tumors—but also during inflammatory processes or infections—they can swell and harden [5]. This often occurs in the neck, armpits, or groin area, for example.
Lymph node metastases arise as metastases from other primary cancers, such as those of the colon, lung, skin or prostate.
However, there are also cases in which the original primary tumor is not known [6].
Diagnostic procedures include a comprehensive individual patient history, a physical examination and an initial orienting ultrasound (sonography) [7].
The following are characterized:
computed tomography and/or magnetic resonance imaging enable more precise classification and measurement . Lymph node metastases, for example, often occur in regional clusters and are located close together. Assessing such conglomerates as accurately as possible is crucial for individual treatment planning and prognosis [7].
Particularly in cases of unusual tumor growth, positron emission tomography (PET) can often be used to better differentiate between benign neoplasms and malignant metastases of a primary tumor [4, 8].
A PET-CT combines a special positron emission tomography (PET) scan – a nuclear medicine technique – with computed tomography. Today, various PET-CT types are available for individual situations, all of which offer highly sensitive diagnostic procedures.
For example, since the introduction of molecular imaging techniques (e.g., choline and PSMA PET -CT), pelvic lymph node recurrences in prostate cancer patients can be better diagnosed and individually tailored treatment strategies can be implemented. This is also desirable for patients who wish to avoid or at least postpone anti-hormone therapy. [9]
Nevertheless, PET-CT diagnostics may also encounter certain limitations when it comes to detecting tumors in normal-sized lymph nodes – or in a situation with multiple underlying diseases, inflammatory or infectious conditions [10].
This means that if an uncertain situation requires detailed clarification, a CT-guided core needle biopsy may be necessary in certain cases. This is especially true when the results of such a lymph node biopsy have a decisive influence on the further treatment plan [4].
The treatment of lymph node metastases depends on various factors, such as the type and stage of the primary tumor, the extent of lymph node involvement, and general health.
Other aspects that play a role in the treatment decision include the patient’s age, personal preferences and wishes.
The optimal combination of treatment approaches suitable for you will always be carefully discussed and decided upon together with you and an interdisciplinary treatment team.
Established treatment methods include [8]:
In the surgical removal of lymph nodes, a distinction is made between [10]:
Cyber Knife therapy, as we perform it here at ERCM, can be a good treatment alternative depending on the lymph node region and size, for example, in metastatic prostate cancer.
In the context of multimodal oncological therapy strategies – which individually combine several treatment approaches – individual metastases can often be eliminated very effectively and safely with precision medicine CyberKnife therapy.
An inpatient hospital stay, follow-up treatment, or rehabilitation stay are generally not necessary. In most cases, you can resume your usual daily routine and activities after your treatment.
Various studies show promising results for the innovative treatment options offered by the CyberKnife precision robot. This non-invasive radiosurgical procedure enables targeted tumor treatment with minimal disruption to surrounding healthy tissue.
Often only a single session is required.
In addition, some patients with prostate cancer can sometimes avoid hormone therapy (HRT) [12]. Hormone therapies deprive the body of the male sex hormone testosterone, which can have significant adverse effects on those affected: Possible side effects associated with HRT include hot flashes, muscle loss, increased trunk fat, and bone loss (osteoporosis) [9].
Overall, CyberKnife therapy is a safe and effective therapy for the elimination of limited lymph node metastases in patients with prostate cancer [13, 14, 15] .
In summary, Cyberknife therapy can play an important role in the further course of the disease, especially in cases of a limited number of lymph node metastases [15]. Several study authors assume that appropriately combined and individualized therapeutic approaches can lead to long-term remission or cure for at least some patients.
We want to support you on your path to an optimal treatment plan that also allows you to achieve the best possible quality of life. The increasing complexity of treatment options means that the decision regarding your treatment is always made jointly with you and your treatment team, taking your individual life situation into account.
For treatment inquiries, please use the contact form. You can also reach us by phone during our opening hours or via our social media channels.
Your request will be processed individually and promptly.
Lymph node metastases occur when cancer cells detach from a primary tumor and migrate via the blood or lymphatic system to the lymph nodes. There, they settle and begin to grow, forming secondary tumors called metastases.
Lymph node metastases can occur in many types of cancer. Common examples, which are also often treated with ERCM, include metastases from prostate cancer or malignant melanoma.
Lymph node metastases often do not cause any specific symptoms. They are often discovered as painless swelling of one or more lymph nodes, for example, in the neck, armpits, or groin.
The lymph node region, the size of the lymph nodes and general health play a crucial role in deciding on the best possible individual treatment strategy.
Yes, lymph node metastases are always malignant because they represent colonies of cancer cells from a primary tumor.
The presence of lymph node metastases is an important factor in assessing the stage of a cancer and its prognosis. Metastases usually indicate a more advanced stage, which influences treatment options and the selection of the best possible treatment strategy.
Yes, lymph node metastases can recur after treatment; this is called recurrence. Recurrences are usually not in the same location, but may be in the immediate vicinity of the previously treated area.
[1] Society for Pediatric Oncology and Hematology (GPOH) Berlin, Guideline AWMF-Reg.-Nr. 025-020, Title: Lymph node enlargement, First published: 1/1997, Guideline coordination Ursula Creutzig (Hanover), Stephan Lobitz (Koblenz); Version: 5.0. Last updated: 30.04.2020.
https://register.awmf.org/de/leitlinien/detail/025-020
[2] Ji, H., Hu, C., Yang, X., Liu, Y., Ji, G., et al., Lymph node metastasis in cancer progression: molecular mechanisms, clinical significance and therapeutic interventions. Sig Transduct Target Ther. 2023;8:367.
https://doi.org/10.1038/s41392-023-01576-4
[3] Deutsches Krebsforschungszentrum (DKFZ) online, Metastasen bei Krebs (letzte Aktualisierung: 6.6.2024): https://www.krebsinformationsdienst.de/metastasen [letzter Zugriff: 11.12.2024]
https://www.krebsinformationsdienst.de/metastasen
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https://doi.org/10.7759/cureus.33096
[5] Deutsches Krebsforschungszentrum (DKFZ) online, Lymphknoten: https://www.krebsinformationsdienst.de/suche?tx_solr%5Bfilter%5D%5B0%5D=type%3AglossaryItem&tx_solr%5Bq%5D=lymphknoten [letzter Zugriff: 09.12.2024]
https://www.krebsinformationsdienst.de/suche?tx_solr%5Bfilter%5D%5B0%5D=type%3AglossaryItem&tx_solr%5Bq%5D=lymphknoten
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[8] Jereczek-Fossa, B. A., Jassem, J., Orecchia, R., Cervical lymph node metastases of squamous cell carcinoma from an unknown primary, Cancer Treatment Reviews 2004;30(2):153-164.
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[9] De Bruycker, A. , Spiessens, A., Dirix, P., Koutsouvelis, N., Semac, I., et al., PEACE V – Salvage Treatment of Oligo Recurrent nodal prostate cancer Metastases (STORM): a study protocol for a randomized controlled phase II trial, BMC Cancer. 2020;20,406.
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[10] Flentje, M., Schumann, C., Multimodale Ansätze in Diagnose und Therapie beim NSCLC Stadium III – Der aktuelle Standard, Onkologie heute Fortbildung aktuell 2018;F2. Verfügbar unter: https://cme.mgo-fachverlage.de/uploads/exam/exam_223.pdf [letzter Zugriff: 08.12.2024]
https://cme.mgo-fachverlage.de/uploads/exam/exam_223.pdf
[11] Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF Leitlinienprogramm Onkologie, S3-Leitlinie Prostatakarzinom, Langversion 7.0, 2024, AWMF-Registernummer: 043-022OL; https://www.leitlinienprogrammonkologie.de/leitlinien/prostatakarzinom/ [letzter Zugriff: 08.12.2024]
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[13] Ingrosso, G., Trippa, F., Maranzano, E., Carosi, A., Ponti, E., et al., Stereotactic body radiotherapy in oligometastatic prostate cancer patients with isolated lymph nodes involvement: a two-institution experience, Welt J Urol. 2017;35(1):45-49.
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