Lymph nodes could reveal who’s most at risk of breast cancer spreading

Changes in lymph nodes may help show which breast cancer patients face higher or lower risk of the disease spreading, researchers have found.

The findings could support more tailored care, new treatments and help more people avoid unnecessary treatment.

Dr Simon Vincent is chief scientific officer at Breast Cancer Now, which funded the research:

He said: “These findings suggest that changes to the structure of the lymph nodes are more than just a consequence of the cancer. They can also play an active role in helping breast cancer progress.

“With one person tragically dying from breast cancer every 45 minutes in the UK, we urgently need research like this so that we can better understand who is most at risk of their cancer progressing and becoming incurable. Only then we can find ways to stop it.

“With a better understanding of how lymph nodes change as breast cancer spreads, we could find new targets for future treatments for types of breast cancer that are harder to treat.”

Lymph nodes, a key part of the immune system, help the body fight infections and cancer. In breast cancer, the lymph nodes in the armpit are often the first place the disease spreads to.

At the moment, everyone with invasive breast cancer has to undergo surgery to remove lymph nodes so doctors can check for cancer cells.

Invasive breast cancer means cancer that has spread beyond where it first developed in the breast into nearby tissue.

While this is effective, it can lead to long-term side effects such as swelling of the arm, known as lymphoedema, and may be unnecessary for some patients, particularly those with early-stage disease or those whose cancer responds well to treatment.

The study analysed 331 lymph node samples from people with different types of breast cancer and compared them with healthy lymph nodes from people free from the disease.

It found that breast cancer could change the structure of a network that supports the lymph nodes.

Crucially, some of these changes could occur before doctors were able to spot any cancer cells in the network.

Some changes were linked to a better chance of survival, while others were associated with a poorer prognosis.

Dr Amy Llewellyn and Dr Kalnisha Naidoo from King’s College London, together with professor Sophie Acton at University College London, compared the 331 samples with healthy lymph nodes in people free from the disease.

They looked at fibroblastic reticular cells, known as FRCs, a group of cells in lymph nodes that provide their structure, control fluid flow and activate different immune cells.

The study showed that the structure of this FRC network could change before the cancer had spread and differed depending on the type of breast cancer, any spread and whether someone had received chemotherapy.

Chemotherapy uses medicines to kill cancer cells or slow their growth.

The researchers said the findings could help doctors better understand who is most at risk of breast cancer spreading.

Dr Llewellyn said the first large-scale analysis of FRC in human lymph node tissue from breast cancer patients was addressing the “urgent need” for a better understanding of the area’s biology.