Your body’s small lymph nodes play a big part in the diagnosis, staging, and treatment of lung cancer — all factor in whether cancer has spread to these bean-shaped organs. This article will help you better understand how cancer can spread from lungs to lymph nodes and how this may affect your lung cancer treatment.

What Are Lymph Nodes?

You have hundreds of lymph nodes throughout your body. Usually, you can’t feel them unless they become swollen. Your lymph nodes are part of two important body systems — your lymphatic and immune systems.

Your lymphatic system is a network of organs and vessels that help your body manage lymph fluid (also called lymph). Lymph is a clear or white, watery fluid that drains from your tissues and blood and contains nutrients, cell waste, and other substances.

Your immune system is a network of organs and cells that help your body identify and destroy harmful substances, such as cancer cells, bacteria, and cells infected with viruses.

A series of lymph vessels helps direct lymph fluid to your lymph nodes to be filtered. In your lymph nodes, cellular waste gets filtered out and nutrients are recycled. Additionally, the immune cells in your lymph nodes look out for problems such as cancer cells and infections.

How Does Lung Cancer Spread to Lymph Nodes?

If a cancer cell breaks away from the primary tumor in your lung, your blood or lymph fluid can carry it to a different part of your body. Lymph nodes are often the most common place to which any cancer, including lung cancer, will spread. This makes sense because your lymph nodes are responsible for filtering and identifying any cancer cells in your lymph fluid.

Not every cancer cell that breaks off from a lung tumor will begin to grow in another part of the body. Most of the time, cancer cells are killed or die before they get a chance to start growing in a new place. Cancer cells that begin growing in your lymph nodes or other parts of your body must undergo changes that allow them to break off from the original tumor, attach to another part of the body, and escape detection by your immune system.

Lymph Nodes Near the Lungs

The lymph nodes closest to your lungs do most of the work of filtering and killing cancer cells from the original tumor. This is why cancer cells that can spread may first reach the lymph nodes close to the original tumor.

These include lymph nodes located:

• In the space between your lungs
• Near your collarbone
• In the air tubes of your lungs
• At the point where the bronchus (main air tube) enters your lungs
• In the area where your trachea (windpipe) divides

Testing for Lung Cancer in the Lymph Nodes

If cancer has spread to a lymph node, it usually gets bigger. Sometimes, you can feel or see enlarged lymph nodes. However, you may need a test that takes an image of the inside of your body to find enlarged lymph nodes deeper within you. Examples of imaging tests that look for enlarged lymph nodes include CT scans and positron emission tomography (PET) scans.

If an enlarged lymph node is found, your care team can order a lung biopsy to confirm whether it has cancer cells. During a biopsy, the lymph node or a sample of its tissue is removed. You may also have one or more lymph nodes removed during surgery to remove your tumor. This is called a lymph node dissection. The tissue sample is examined under a microscope to look for cancer cells.

If cancer is found in your lymph nodes, you may need more testing to find out how far lung cancer has spread.

Cancer in Lymph Nodes and Lung Cancer Staging

Staging is part of the process of getting a lung cancer diagnosis. Your lung cancer stage helps describe how much cancer you have and where it’s located. Your cancer stage helps predict which treatments may be right for you and the likely course of your disease, or your prognosis.

The TNM system is a common classification system used to determine lung cancer stage. In the TNM staging system, each letter stands for a different factor relating to cancer:

• “T” stands for “tumor size and location”
• “N” stands for “(lymph) nodes”
• “M” stands for “metastasis (spread) to distant organs”

A value is assigned to each of these factors to help your care team stage your cancer. Stages are different in different types of lung cancer. In general, less advanced lung cancer will have a lower stage.

Non-Small Cell Lung Cancer Stages

Non-small cell lung cancer (NSCLC) has five stages, ranging from early (stage 0) to the most advanced (stage 4).

In stages 0 and 1 NSCLC, cancer hasn’t spread to your lymph nodes or another part of your body. If you have stage 2, 3, or 4 NSCLC, your cancer may have spread to your lymph nodes.

In stage 2 NSCLC, the tumor is usually bigger than in stage 1 and may have started to spread to nearby lymph nodes.

In people with stage 3 NSCLC, cancer has often spread to the lymph nodes in the space between your lungs.

Stage 4 is the most advanced stage of NSCLC, in which cancer has spread to other parts of the body.

Small Cell Lung Cancer Stages

If you have small cell lung cancer (SCLC), your cancer stage is described as either limited or extensive.

In limited-stage SCLC, just one lung is affected and the cancer hasn’t spread, so it’s easier to treat with radiation therapy. In extensive-stage SCLC, the cancer has spread to the other lung or other organs, or tissue involvement extends beyond a size that can be targeted by a single radiation port (a specific area on the body where radiation is aimed).

How Does Cancer in Your Lymph Nodes Affect Treatment?

After your oncologist has determined your stage of lung cancer, they can help find the right treatment plan for you.

If you have stage 0 or 1 NSCLC, your treatment may include surgery or radiation therapy. Surgery may not be helpful for people with SCLC that has spread to the lymph nodes.

If your cancer has spread to your lymph nodes or other parts of your body, a combination of treatments is used to help fight your cancer. Treatment options include:

• Surgery
• Radiation
• Chemotherapy
• Immunotherapy
• Targeted therapy

Talk to your cancer care team about how your lung cancer stage can affect your treatment plan. They’ll help you understand which options may be right for your particular case and help you have the best possible quality of life while living with lung cancer.

Talk With Others Who Understand

MyLungCancerTeam is the social support network for people with lung cancer and their loved ones. On MyLungCancerTeam, more than 12,000 members come together to ask questions, give advice, and share their stories with others who understand life with lung cancer.

Has your lung cancer spread to lymph nodes? How did it affect your treatment plan? Share your insights in the comments below, or start a conversation by posting on your Activities page.