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Internal mammary and supraclavicular nodes: when they matter
Besides the armpit, the breast drains to nodes beside the breastbone and above the collarbone. This page explains where these nodes are, when cancer is more likely to reach them, how they are found on scans, how they change the stage and why they are usually treated with radiotherapy and medicines rather than surgery.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- What are internal mammary and supraclavicular nodes, and when do they matter?
- The lymph node groups around the breast
- Situations where these nodes come into planning
- The vocabulary, in plain language
- Honest realities about these nodes
- How these nodes are usually treated
- Signs worth reporting
- What people assume about these nodes
- Common questions about internal mammary and supraclavicular nodes
The short answer
What are internal mammary and supraclavicular nodes, and when do they matter?
Most lymph fluid from the breast drains to the nodes in the armpit, which is why armpit nodes are checked in almost everyone with breast cancer. But the breast also drains to two other groups of nodes. The internal mammary nodes sit inside the chest, in a chain running down beside the breastbone behind the ribs. The supraclavicular nodes sit in the hollow just above the collarbone at the base of the neck. Cancer spreads to these nodes less often than to the armpit, but when it does, it usually means the cancer is more advanced in the region, and treatment is planned to reach them. Internal mammary nodes are more likely to be involved when the tumour is in the inner or central part of the breast, or when many armpit nodes contain cancer. Supraclavicular node involvement usually follows spread through the armpit. These nodes are rarely removed by surgery. They are usually found on scans such as ultrasound, CT, MRI or PET-CT, and a needle biopsy may confirm them. When they are affected, or when the risk is judged high, radiotherapy is often aimed at them, alongside chemotherapy, hormone therapy or targeted treatment as suited to the cancer. Finding cancer in these nodes changes the stage, often to stage three, but it does not mean the cancer has spread to distant organs, and treatment is usually still given with the aim of long-term control.
Two lesser-known node groups
One lies beside the breastbone, the other just above the collarbone.
They affect stage and planning
Involvement usually means more treatment to the region, not distant spread.
Radiotherapy is the usual tool
These nodes are treated far more often with radiotherapy than with surgery.
This page gives general information only. Your oncology team will explain what applies to you.Where they are
The lymph node groups around the breast
Doctors think of the regional nodes as a few connected groups.
Armpit nodes
The main drainage route for most of the breast. They are checked with ultrasound, needle biopsy or sentinel node biopsy.
Internal mammary nodes
Small nodes along the inside of the chest wall beside the breastbone, hidden behind the ribs.
They cannot be felt on examination.Supraclavicular nodes
Nodes in the soft hollow above the collarbone. When enlarged, they can sometimes be felt as a lump.
Infraclavicular nodes
Nodes just below the collarbone, at the top of the armpit chain.
How they are usually checked
- Ultrasound of the neck and armpit
- CT, MRI or PET-CT scans
- Needle biopsy of a suspicious node
Not sure whether this applies to you?
Ask an oncologistWhen they matter
Situations where these nodes come into planning
Situation
What it may mean
Tumour in the inner or central breast
A higher chance of drainage to the internal mammary nodes
Several armpit nodes contain cancer
Radiotherapy may be extended to cover nodes beside the breastbone and above the collarbone
Enlarged node seen beside the breastbone on a scan
The stage may rise, and radiotherapy is often planned to include it
Lump felt above the collarbone
A needle biopsy is usually done, and scans check for wider spread
No armpit nodes involved, outer tumour
These node groups are usually not treated separately
Words you may hear
The vocabulary, in plain language
- Regional nodes
- Lymph nodes near the breast, including the armpit, breastbone and collarbone groups.
- Internal mammary chain
- The line of small nodes beside the breastbone inside the chest.
- Supraclavicular fossa
- The hollow area above the collarbone.
- Regional nodal radiotherapy
- Radiotherapy that treats the nearby node areas as well as the breast or chest wall.
- Locally advanced breast cancer
- Cancer that has spread widely to nearby nodes or tissue but not to distant organs.
- Distant spread
- Cancer that has reached organs such as bone, lung, liver or brain.
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Being straight with you
Honest realities about these nodes
These nodes raise real questions, and some answers remain uncertain even for specialists.
Small deposits can be missed
Scans cannot see every tiny collection of cancer cells, so decisions often rest on risk rather than proof.
Treating them has trade-offs
Radiotherapy to nodes beside the breastbone can deliver more dose near the heart and lungs. Modern planning keeps this low, but teams weigh benefit against risk.
Practice differs between teams
Specialists do not always agree on exactly who benefits from treating these nodes.
What this page cannot tell you
It cannot tell you whether your nodes are involved or should be treated. Your scans, pathology and team discussion decide that.
Treatment
How these nodes are usually treated
Treatment is planned as a whole by your breast surgeon, medical oncologist and radiation oncologist.
Radiotherapy
The most common way to treat nodes beside the breastbone or above the collarbone is to include them in the radiotherapy field. Careful planning with breathing techniques can reduce dose to the heart.
Treatment through the bloodstream
Chemotherapy, hormone therapy or HER2-targeted treatment reach cancer cells wherever they are, and are often given before or after surgery when these nodes are involved.
Surgery
Surgery on these nodes is uncommon. Nodes above the collarbone are occasionally removed if they remain after other treatment, but this is decided case by case.
What to watch for
Signs worth reporting
Most people with involved nodes in these areas have no symptoms, and the nodes are found on scans. Even so, it helps to know what to mention.
A lump above the collarbone
A new, firm, painless lump in the hollow above your collarbone should be checked promptly.
Swelling in the arm or neck
New swelling on the same side can have many causes, including treatment effects, but tell your team.
Changes during follow-up
Report any new lump near the breastbone, chest wall or neck at your follow-up visits.
Commonly believed
What people assume about these nodes
Cancer in nodes above the collarbone means stage four.
These are regional nodes, so involvement is usually staged as stage three.
All involved nodes must be cut out.
These nodes are usually treated with radiotherapy and medicines instead.
Only armpit nodes matter in breast cancer.
The breast drains to several node groups, which are considered in planning.
Radiotherapy near the breastbone always damages the heart.
Modern planning keeps heart dose low, though some risk remains.
Questions we are asked
Common questions about internal mammary and supraclavicular nodes
Why were these nodes not removed during my surgery?
Internal mammary nodes lie behind the ribs and nodes above the collarbone sit near major vessels and nerves, so removing them is difficult and adds risk. Research suggests radiotherapy and medicines treat these areas effectively for most people, so surgeons usually leave them and plan other treatment instead.
Does cancer in these nodes mean it has spread everywhere?
No. These are regional nodes, close to the breast. Involvement means the cancer is more advanced locally, but not that it has reached distant organs. Your team will usually arrange scans to check, and treatment is normally aimed at long-term control.
How will I know if these nodes are involved?
They are usually seen on scans such as ultrasound, CT, MRI or PET-CT, which may be done for larger tumours or when armpit nodes are affected. A suspicious node above the collarbone can often be sampled with a needle. Nodes beside the breastbone are harder to sample.
Will my radiotherapy include these nodes?
It depends on your tumour position, how many armpit nodes were involved, your scans and your overall risk. Your radiation oncologist will explain which areas are included and why, and what side effects to expect from treating a larger area.
Does treating these nodes affect my heart?
Radiotherapy near the breastbone, especially on the left side, can deliver some dose to the heart. Techniques such as breath holding and careful planning keep this as low as possible. If you already have heart problems, mention them so your team can take extra care.
Can I feel these nodes myself?
Internal mammary nodes cannot be felt because they lie behind the ribs. Enlarged nodes above the collarbone can sometimes be felt as a firm lump. Many lumps in the neck are harmless, but any new lump there should be shown to your doctor.
Is surgery ever used for these nodes?
Occasionally. If a node above the collarbone remains after chemotherapy and radiotherapy, a surgeon may consider removing it. Surgery on nodes beside the breastbone is rare. These decisions are made by the whole team based on your scans and response to treatment.
What stage is breast cancer with these nodes involved?
Involvement of nodes above the collarbone, or of nodes beside the breastbone together with armpit nodes, is usually classed as stage three. The exact stage also depends on tumour size, other nodes and features such as receptor status, so ask your team to explain your full staging.
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Sources
- American Cancer Society — Breast cancer stages
- Cancer Research UK — Radiotherapy for breast cancer
- National Cancer Institute — Breast cancer treatment patient version
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.