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Radiating Internal Mammary Nodes

Posted 11/5/2013

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  First a definition: the internal mammary nodes are those under the chest wall. We also have a chain of lymph nodes called supraclavicular lymph nodes; they are above the collar bone, near the hollow of the neck. Both of these sets of lymph nodes, as well as the better known axillary nodes under our arms, are referred to as regional lymph nodes vs. a vs. breast cancer. For a long time, women with positive axillary lymph nodes or whose cancer seems to have other characteristics of higher risk, have received radiation to the underarm area.

  More recently, some women have also received radiation to the lymph nodes in their chests and necks. If you think about it, this makes some practical sense. Surgeons sample the axillary lymph nodes, but don't look at these others (for obvious reasons of ease and risk). A breast tumor may just as well spread via the internal mammary lymph nodes as by those under the arm. This is not meant to be alarming, just some background for today's blog.

  A recent European study suggests that women who have known positive axillary lymph nodes do better, have longer disease free survival and absolute survival, if these other nodes are also radiated. Here is the report from and then a link to read more:

Research Suggests Treating Neck and Chest Lymph Nodes With Radiation Improves Overall Survival in EarlyStage Disease

After surgery to remove earlystage breast cancer, many women will have radiation therapy to the breast area.
Radiation is given to reduce the risk of the cancer coming back in the breast area and nearby tissue (doctors call this locoregional recurrence).
Doctors sometimes also recommend that lymph nodes near the area where the breast cancer was removed be
included in the area that gets radiation. This is called regional lymph node radiation. Regional lymph node
radiation may include the internal mammary lymph nodes, which are the nodes underneath the chest wall.
Regional lymph node radiation also may include the supraclavicular lymph nodes, which are just above the collar
bone, near the hollow of the neck.
Regional lymph node radiation usually is recommended only for certain women diagnosed with breast cancer that already has spread to one or more nearby lymph nodes and who are considered to have a higher than average risk of the breast cancer coming back in the same area.
A European study suggests that women diagnosed with earlystage breast cancer that had spread to the lymph nodes had better overall survival when they received radiation to the internal mammary and supraclavicular lymph nodes after breast cancer surgery compared to women who didn’t get radiation to that area.


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