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Clinical evaluation

According to tumour lymphatic drainage, node extension assessment may be done (at least partly) by clinical evaluation.

An invaded node has a very typical appearance : its size is increased, its consistency is indurate without any pain, its mobility is more or less reduced relating to the adjacent tissues; usually there is no inflammatory reaction (except in inflammatory forms of breast cancer or when the node or the tumour is super infected.

With careful palpation of node areas, one can find:

• the axillary nodes of a breast carcinoma, (but of course the intern mammary nodes need a thoracic exploratory examination such as a scan),
• the cervical nodes of head and neck cancers,
• the inguinal nodes of vulvae or penis cancer, or of melanoma on the leg,
• the supraclavicular nodes from distant metastases (we are no longer speaking of regional involvement).

Paraclinical evaluation

Most nodes need paraclinical evaluation in order to be assessed:

• pelvic lymphography, usually done for lymph node diseases but still, according to certain medical teams, for cervix uteri cancers, showing node hypertrophy, the presence of lacunae and a jamming or derivation of the contrasting agent in the case of massive involvement,
• thoraco-abdomino-pelvic scan, shows an increased node size (any volume above 1 cm begins to be significant) which is not always in relation to a cancerous nodal involvement,
• abdominal ultrasonography,
• RMI,
• positron scintigraphy seems most interesting for many tumours (PET scan).

Surgical evaluation

Most clinical and paraclinical methods do not offer a definitive conclusion.

For this reason, in most cancer surgical procedures, exploratory satellite lymph node surgery is mandatory with systematic histological study of the specimens.