Pain Near the Axilla in Breast Cancer
Yes, pain near the axilla can occur with breast cancer, though it is not a typical presenting symptom of the primary tumor itself. Axillary pain is more commonly associated with lymph node involvement, post-surgical complications, or treatment-related sequelae rather than the breast cancer itself.
Primary Mechanisms of Axillary Pain in Breast Cancer Context
Lymph Node Metastases
- Axillary lymph node metastases from breast cancer can cause pain and discomfort in the armpit region. Regional lymph node status remains one of the strongest predictors of long-term prognosis in primary breast cancer 1.
- Metastatic breast cancer is the most common malignant cause when cancer is identified in axillary nodes 2.
- Patients with unexplained axillary lymph node tenderness should undergo axillary ultrasound to characterize lymph node morphology, assessing cortical thickness, uniformity, size, shape, and vascularity patterns 3.
Post-Surgical Pain and Complications
- Pain is a common long-term complication after axillary surgery, reported in 30% of patients 2-5 years post-operatively 4.
- Younger age is significantly associated with more frequent reporting of pain following axillary lymph node dissection (P=0.001) 4.
- Numbness occurs in 35% of patients long-term, with younger patients and those with smoking history experiencing higher rates 4.
Axillary Web Syndrome
- Axillary web syndrome (AWS) occurs in up to 86% of patients following breast cancer surgery with ipsilateral lymphadenectomy and presents as painful cords in the subcutaneous tissues of the axilla 5.
- AWS most frequently becomes symptomatic between 2 and 8 weeks postoperatively but can develop and recur months to years after surgery 5.
- The cords result in painful shoulder abduction and limited shoulder range of motion 5.
Diagnostic Approach for Axillary Pain
Initial Evaluation
- Perform axillary ultrasound to characterize lymph node morphology for patients with unexplained axillary tenderness 3.
- For clinically or radiographically suspicious nodes, obtain pathologic confirmation using ultrasound-guided fine needle aspiration or core biopsy before proceeding to axillary lymph node dissection 3.
Sentinel Lymph Node Biopsy
- Sentinel lymph node biopsy is the standard staging approach for clinically negative axillary lymph nodes in breast cancer patients 1, 3.
- This technique achieves high identification rates (over 97%) with acceptably low false-negative rates (5-10%) 1, 3.
- SLNB delivers significantly less morbidity compared to complete axillary lymph node dissection, including reduced shoulder stiffness, arm swelling, and pain 1.
Treatment-Related Considerations
Lymphedema Risk and Management
- Axillary clearance is associated with lymphedema in up to 25% of women following surgery 1.
- The incidence rises dramatically to 40% when axillary clearance is combined with radiotherapy to the axilla 1.
- Early detection and intervention for lymphedema is critical, as it may be reversible or more effectively managed with early physiotherapy 3.
Post-Treatment Precautions
- Women who have undergone axillary clearance should avoid cannulation, venesection, and blood pressure monitoring in the ipsilateral arm 1.
- Start antibiotic treatment promptly for potentially infected wounds on the ipsilateral arm 1.
- Radiation therapy to the axilla is associated with higher frequency of infection or inflammation in the arm and/or breast (P=0.001) 4.
Critical Clinical Pitfalls
- Do not assume all axillary pain represents malignancy—consider AWS, lymphedema, infection, and post-surgical inflammatory changes in the differential diagnosis 6, 5.
- Do not delay treatment for lymphedema, as this leads to progression and increased risk of complications 3.
- Do not advise patients to avoid all physical activity with the affected arm—supervised progressive resistance training is safe and beneficial 3, 6.
- Do not use diuretics for lymphedema management, as they are generally ineffective 3, 6.