Enlarged Axillary Lymph Node
The patient presenting with an enlarged axillary node should be first evaluated with a detailed history and physical examination. Imaging studies should then be ordered depending on the patient’s symptoms and physical examination findings. If breast cancer is suspected or the patient does not have a recent screening study done, a mammography and ultrasound should be ordered. A core needle biopsy of the lymph node is performed. Tumor markers help identify the primary cancer. If the lymph node is suspicious for metastatic carcinoma from a breast primary and mammography and ultrasound does not demonstrate a lesion, MRI is recommended. Further systemic staging is also recommended. Patient is then managed depending on the clinical stage and tumor markers. Occult breast cancers represent less than 1% of all newly diagnosed breast cancers. These patients are managed with axillary dissection with mastectomy or whole breast radiation and systemic therapies depending on the tumor markers. Multidisciplinary decision-making is recommended in the setting of occult breast cancers.
KeywordsBreast cancer Mammography Ultrasound MRI Occult primary Metastatic breast cancer Radiation therapy
- 1.NCCN clinical practice guidelines in oncology occult primary version 2.2017 [Internet]. 2016 [cited 2017 Sep 4.]. Available from: https://www.nccn.org/professionals/physician_gls/pdf/occult.pdf.
- 5.He M, Tang L-C, Yu K-D, Cao A-Y, Shen Z-Z, Shao Z-M, et al. Treatment outcomes and unfavorable prognostic factors in patients with occult breast cancer. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol. 2012;38(11):1022–8.Google Scholar