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Lymph node body diagram: Illustration Picture of Lymphatic System

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Lymph node | anatomy | Britannica

Lymph node, any of the small, bean-shaped masses of lymphoid tissue enclosed by a capsule of connective tissue that occur in association with the lymphatic vessels. As part of the lymphatic system, lymph nodes serve as filters for the blood, providing specialized tissues where foreign antigens can be trapped and exposed to cells of the immune system for destruction. They are typically found concentrated near junctions of the major lymphatic vessels, most prominently in the neck, groin, and armpits.

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lymphatic system: Lymph nodes

The lymph nodes, or lymph glands, are small, encapsulated bean-shaped structures composed of lymphatic tissue. Thousands of lymph nodes…

Each lymph node is divided into two general regions, the capsule and the cortex. The capsule is an outer layer of connective tissue. Underlying the capsule is the cortex, a region containing mostly inactivated B and T lymphocytes plus numerous accessory cells such as dendritic cells and macrophages. The cortex is further divided into two functional areas: the outer cortex and inner cortex, or paracortex. These regions surround an inner medulla, which consists primarily of activated antibody-secreting plasma cells.

lymph node

Internal and external structures of a lymph node.

Encyclopædia Britannica, Inc.

Cells enter the lymph node through two primary routes. Lymph and its associated cells enter through the afferent lymphatic vessels, which drain into each node through its convex surface. These vessels may drain directly from the lymphatic capillaries, or they may be connected to a previous node. Lymphocytes generally enter through specialized blood vessels called high endothelial venules (HEVs). HEVs contain a single layer of large endothelial cells that possess surface receptors specific for B and T lymphocytes. As these cells pass through the HEVs, they bind to the receptors and are carried into the paracortex of the lymph node.

The structural divisions within a lymph node serve different purposes. Most of the lymphocytes within a node are “naive”—i.e., they have yet to encounter antigen—and therefore must migrate to regions where they will be most effective in recognizing foreign agents. B cells enter the paracortex through the HEVs and then migrate into the outer cortex and join specialized dendritic cells and macrophages to form follicles. Primary follicles consist of a resting B cell surrounded by a loose network of dendritic cells. After encountering a foreign antigen, the B cell becomes activated and is surrounded by a more tightly packed association of dendritic cells and macrophages, forming a germinal centre. The germinal centre in turn is enclosed by a mantle zone—a ring of resting B cells and dendritic cells. The germinal centre and mantle together compose a secondary follicle, which is the site of antigen-dependent B-cell maturation. The activated B cells then migrate through the paracortex to the medulla, where they proliferate as antibody-secreting plasma cells. T cells enter the lymph node through the HEVs and remain in the paracortex, where the cortical macrophages and dendritic cells present antigenic peptides to the naive T cells, stimulating them to become activated helper T cells or cytotoxic T lymphocytes. All activated lymphocytes migrate through the medulla and enter the lymphatic circulation through the efferent lymphatic vessel, which drains either into adjacent lymph nodes or ultimately into the thoracic duct, a major vessel of the lymphatic system.

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The central role played by lymph nodes in filtering microorganisms and other undesired substances from the blood is critical to the functioning of the immune system but also makes lymph nodes vulnerable to cancer. As cancerous cells spread by metastasis, they can become trapped and concentrated in lymph nodes, where they proliferate. Virtually all cancers have the potential of spreading to lymph nodes, a condition that greatly complicates treatment. In most cases surgery alone will not remove the cancer from the nodes, and therefore postoperative radiation or chemotherapy is required.

Lymphatic System: Parts & Common Problems

The lymphatic system is a network of tissues, vessels and organs that work together to move lymph back into your your bloodstream. The lymphatic system is part of your immune system.

What is the lymphatic system?

The lymphatic system is a network of tissues, vessels and organs that work together to move a colorless, watery fluid called lymph back into your circulatory system (your bloodstream).

Some 20 liters of plasma flow through your body’s arteries and smaller arteriole blood vessels and capillaries every day. After delivering nutrients to the body’s cells and tissues and receiving their waste products, about 17 liters are returned to the circulation by way of veins. The remaining three liters seep through the capillaries and into your body’s tissues. The lymphatic system collects this excess fluid, now called lymph, from tissues in your body and moves it along until it ultimately returns it to your bloodstream.

Your lymphatic system actually has many functions. Its key functions include:

  • Maintains fluid levels in your body: As just described, the lymphatic system collects excess fluid that drains from cells and tissue throughout the body and returns it to the bloodstream, which is then recirculated through the body.
  • Absorbs fats from the digestive tract: Lymph includes fluids from the intestines that contain fats and proteins and transports it back to the bloodstream.
  • Protects your body against foreign invaders: The lymphatic system is part of the immune system. It produces and releases lymphocytes (white blood cells) and other immune cells that monitor and then destroy the foreign invaders — such as bacteria, viruses, parasites and fungi — that enter the body.
  • Transports and removes waste products and abnormal cells from the lymph.

What are the parts of the lymphatic system?

The lymphatic system consists of many parts. These include:

  • Lymph: Lymph, also called lymphatic fluid, is a collection of the extra fluid that drains from cells and tissues (that is not reabsorbed into the capillaries) plus other substances. The other substances include proteins, minerals, fats, nutrients, damaged cells, cancer cells and foreign invaders (bacteria, viruses, etc). Lymph also transports infection-fighting white blood cells (lymphocytes).
  • Lymph nodes: Lymph nodes are bean-shaped glands that monitor and cleanse the lymph as it filters through them. The nodes filter out the damaged cells and cancer cells. These lymph nodes also produce and store lymphocytes and other immune system cells that attack and destroy bacteria and other harmful substances in the fluid. You have about 600 lymph nodes scattered throughout your body. Some exist as a single node; others are closely connected groups called chains. A few of the more familiar locations of lymph nodes are in your armpit, groin and neck. Lymph nodes are connected to others by the lymphatic vessels.·
  • Lymphatic vessels: Lymphatic vessels are the network of capillaries (microvessels) and large network of tubes located throughout the body that transport lymph away from tissues. Lymphatic vessels collect and filter lymph (at the nodes) as it continues to move toward larger vessels called collecting ducts. These vessels operate very much like your veins do: they work under very low pressure, have a series of valves in them to keep the fluid moving in one direction.
  • Collecting ducts: Lymphatic vessels empty the lymph into the right lymphatic duct and left lymphatic duct (also called the thoracic duct). These ducts connect to the subclavian vein, which returns lymph to your bloodstream. The subclavian vein runs below your collarbone. Returning lymph to the bloodstream helps to maintain normal blood volume and pressure. It also prevents the excess buildup of fluid around the tissues (called edema).

The lymphatic system collects excess fluid that drains from cells and tissue throughout the body and returns it to the bloodstream, which is then recirculated through the body.

  • Spleen: This largest lymphatic organ is located on your left side under your ribs and above your stomach. The spleen filters and stores blood and produces white blood cells that fight infection or disease.
  • Thymus: This organ is located in the upper chest beneath the breast bone. It matures a specific type of white blood cell that fights off foreign organisms.
  • Tonsils and adenoid: These lymphoid organs trap pathogens from the food you eat and air you breathe. They are your body’s first line of defense against foreign invaders.
  • Bone marrow: This is the soft, spongy tissue in the center of certain bones, such as the hip bone and breastbone. White blood cells, red blood cells, and platelets are made in the bone marrow.
  • Peyer’s patches: These are small masses of lymphatic tissue in the mucous membrane that lines your small intestine. These lymphoid cells monitor and destroy bacteria in the intestines.
  • Appendix: Your appendix contains lymphoid tissue that can destroy bacteria before it breaches the intestine wall during absorption. Scientists also believe the appendix plays a role in housing “good bacteria” and repopulating our gut with good bacteria after an infection has cleared.

What conditions affect the lymphatic system?

Many conditions can affect the vessels, glands, and organs that make up the lymphatic system.

Some happen during development before birth or during childhood. Others develop as a result of disease or injury. Some common and less common diseases and disorders of the lymphatic system include:

  • Enlarged (swollen) lymph nodes (lymphadenopathy): Enlarged lymph nodes are caused by infection, inflammation or cancer. Common infections that can cause enlarged lymph nodes include strep throat, mononucleosis, HIV infection and infected skin wounds. Lymphadenitis refers to lymphadenopathy that is caused from an infection or inflammatory condition.
  • Swelling or accumulation of fluid (lymphedema): Lymphedema can result from a blockage in the lymphatic system caused by scar tissue from damaged lymph vessels or nodes. Lymphedema is also often seen when lymph nodes are removed in persons who have had surgery and/or radiation to remove a cancer. The buildup of lymphatic fluid is most commonly seen in the arms and legs. Lymphedema can be very mild or be quite painful, disfiguring and disabling. People with lymphedema are at risk for serious and potentially life-threatening deep skin infections.
  • Cancers of the lymphatic system: Lymphoma is cancer of the lymph nodes and occurs when lymphocytes grow and multiply uncontrollably. There are several different types of lymphoma, including Hodgkin’s lymphoma and non-Hodgkin’s lymphoma. Cancerous tumors can also block lymphatic ducts or be near lymph nodes and interfere with the flow of lymph through the node.

Other disorders include:

  • Lymphangitis: This is an inflammation of the lymph vessels.
  • Lymphangioma: This is a condition that you are born with. It’s a malformation in the lymphatic system. Lymphangiomatosis is the presence of multiple or widespread lymphatic vascular malformations.
  • Intestinal lymphangiectasia: This is a condition in which loss of lymph tissue in the small intestine leads to loss of protein, gammaglobulins, albumin and lymphocytes.
  • Lymphocytosis: This is a condition in which there is a higher-than-normal amount of lymphocytes in the body.
  • Lymphatic filariasis: This is an infection caused by a parasite that causes the lymphatic system not to function correctly.
  • Castleman disease: Castleman disease involves an overgrowth of cells in the body’s lymphatic system.
  • Lymphangioleiomyomatosis: This is a rare lung disease in which abnormal muscle-like cells begin to grow out of control in the lungs, lymph nodes and kidneys.
  • Autoimmune lymphoproliferative syndrome: This is a rare genetic disorder in which there is a high number of lymphocytes in the lymph nodes, liver and spleen.
  • Mesenteric lymphadenitis: This is an inflammation of the lymph nodes in the abdomen.
  • Tonsillitis: This is an inflammation and infection of the tonsils.

How can I keep my lymphatic system healthy?

To keep your lymphatic system strong and healthy, you should:

  • Avoid exposure to toxic chemicals like those in pesticides or cleaning products. These chemicals can build up in your system and make it harder for your body to filter waste.
  • Drink plenty of water to stay hydrated so lymph can easily move throughout the body.
  • Maintain a healthy lifestyle that includes regular exercise and a healthy diet.

When should I call my doctor about an issue with my lymphatic system?

Call your doctor if you experience fatigue (extreme tiredness) or have unexplained swelling that lasts more than a few weeks or interferes with your daily activities.

How will my doctor test my lymphatic system?

To see if your lymphatic system is working as it should, your doctor may use imaging tests such as a CT scan or MRI. These tests allow your doctor to see blockages in your lymphatic system.

The Lymphatic System – Vessels – Nodes – Organs

The lymphatic system is a series of vessels and nodes that collect and filter excess tissue fluid (lymph), before returning it to the venous circulation. It forms a vital part of the body’s immune defence.

In this article, we shall look at the components of the lymphatic system, their structure and their clinical correlations.

Fig 1 – Overview of the lymphatic system. It contains lymphoid organs, vessels, nodes and lymph fluid.

Lymph Organs

There are a number of organs that contain lymphatic tissue. They are involved in blood filtering and the maturation of lymphocytes.

  • Spleen –  Functions mainly as a blood filter, removing old red blood cells. It also plays a role in the immune response.
  • Thymus – Responsible for the development and maturation of T lymphocyte cells.
  • Red bone marrow – Responsible for maturation of immature lymphocytes, much like the thymus.

In addition, some lymphatic tissue is located in the tonsils, appendix, and in the walls of the gastrointestinal tract.


Lymph Nodes

Lymph nodes are kidney shaped structures which act to filter foreign particles from the blood, and play an important role in the immune response to infection.  On average, an adult has around 400 to 450 different lymph nodes spread throughout the body – with the majority located within the abdomen.

Each node contains T lymphocytes, B lymphocytes, and other immune cells. They are exposed to the fluid as it passes through the node, and can mount an immune response if they detect the presence of a pathogen. This immune response often recruits more inflammatory cells into the node – which is why lymph nodes are palpable during infection.

Lymph fluid enters the node through afferent lymphatic channels and leaves the node via efferent channels. Macrophages located within the sinuses of the lymph node act to filter foreign particles out of the fluid as it travels through.

Fig 2 – Structure of a lymph node.

Lymph Vessels

The lymphatic vessels transport lymph fluid around the body. There are two main systems of lymph vessels – superficial and deep:

  • Superficial vessels – arise in the subcutaneous tissue, and tends to accompany venous flow. They eventually drain into deep vessels.
  • Deep vessels – drain the deeper structures of the body, such as the internal organs. They tend to accompany deep arteries.

The drainage of lymph begins in lymph channels, which start as blind ended capillaries and gradually develop into vessels. These vessels travel proximally, draining through several lymph nodes.

Eventually the vessels empty into lymphatic trunks (also known as collecting vessels) – and these eventually converge to form the right lymphatic duct and the thoracic duct.

The right lymphatic duct is responsible for draining the lymph from the upper right quadrant of the body. This includes the right side of the head and neck, the right side of the thorax and the right upper limb. The thoracic duct is much larger and drains lymph from the rest of the body. These two ducts then empty into the venous circulation at the subclavian veins, via the right and left venous angles.

Fig 3 – The left and right lymphatic ducts.

Lymph Fluid

Lymph is a transudative fluid that is transparent and yellow. It is formed when fluid leaves the capillary bed in tissues due to hydrostatic pressure. Roughly 10% of blood volume becomes lymph.

The composition of lymph is fairly similar to that of blood plasma, with the majority of the volume (around 95%) comprised of water. The remaining 5% is composed of proteins, lipids, carbohydrates (mainly glucose), various ions and some cells (mainly lymphocytes), although this can vary depending on where in the body the lymph is produced. For example, chyle (lymph that is produced in the gastrointestinal system) is particularly rich in fats.

The average adult produces between 3-4 litres of lymphatic fluid each day, although this can vary in illness.

[start-clinical]

Clinical Relevance – Lymphoma

A lymphoma is one of a group of tumours developing from lymphatic cells. They make up around 3-4% of all cancers worldwide and typically have a 5-year survival rate of 70-85%, depending on the subtype. The two main subtypes are Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL), with roughly 90% of lymphomas being NHLs. Risk factors for these lymphomas include:

  • Infection with Epstein-Barr virus (HL)
  • Autoimmune diseases (NHL)
  • HIV/AIDs (NHL)
  • Eating a large amount of meat and fat (NHL)
Fig 4 – A follicular lymphoma.

A diagnosis is reached following a lymph node biopsy, if histological features of lymphoma are found, further tests such as immunophenotyping can be carried out to determine the subtype.

Symptoms of lymphoma often include:

  • Lymphadenopathy – swelling of lymph nodes
  • Fever
  • Night sweats
  • Weight loss
  • Loss of appetite
  • Itching
  • Fatigue

[end-clinical]

Lymphatic System and Immune System

Medical Terminology for Cancer

© Copyright 1996-2013

9: The Lymphatic and Immune Systems


Contents

Functions of the lymphatic system
Components of the lymphatic system
Circulation of tissue fluids
The Immune System
Cancer Focus
Roots, suffixes, and prefixes
Related Abbreviations and Acronyms
Further Resources

Functions of the lymphatic system

The key functions of the lymphatic system:

  • Drains excess fluids and proteins from tissues all around the body and returns them back into the bloodstream.
  • Removes waste products produced by cells.
  • Fights infections.
  • Absorbs fats and fat-soluble vitamins from the digestive system and transports these into the bloodstream.

Components of the lymphatic system




Immage source: Wikimedia License: CC-BY-3.0

Lymph

Lymph is a fluid that circulates throughout the body in the lymphatic system. It forms when tissue fluids/blood plasma (mostly water, with proteins and other dissolved substances) drain into the lymphatic system. It contains a high number of lymphocytes (white cells that fight infection). Lymph that forms in the digestive system called chyle, this contains higher levels of fats, and looks milky white.



Lymph vessels

Walled, valved structures that carry lymph around the body


Lymph nodes

Small bean-shaped glands that produce lymphocytes, filter harmful substances from the tissues, and contain macrophages, which are cells that digest cellular debris, pathogens and other foreign substances. Major groups of lymph nodes are located in the tonsils, adenoids, armpits, neck, groin and mediastinum.


Thymus

The thymus is a specialized organ of the immune system, located between the breast bone and heart. It produces lymphocytes, is important for T cell maturation (T for thymus-derived).


Spleen

The spleen is an organ in the upper left abdomen, which filters blood, disposes of worn-out red blood cells, and provides a ‘reserve supply’ of blood. It contains both red tissue, and white lymphatic tissue. Different parts of the the spleen specialize in different kinds of immune cells.

The major (encapsulated) lymphatic organs are the lymph nodes, thymus and spleen. In addition the lymphoid tissues include:

Mucosa-associated lymphoid tissue (MALT)

These are bundles of lymphatic cells, called lymphatic nodules, located within the mucus membranes that line the gastrointestinal, respiratory, reproductive, and urinary tracts. These nodules contain lymphocytes and macrophages which defend against invading bacteria and other pathogens that enter these passages along with food, air, or urine. These nodules can be solitary or grouped together in clusters.

Major clusters of lymphatic nodules include:

  • Tonsils: these are clusters of lymphatic tissue under the mucous membrane lining of the nose, mouth, and throat. Lymphocytes and macrophages in the tonsils provide protection against foreign substances and pathogens that enter the body through the nose or mouth.
  • Adenoids: A cluster of lymphatic tissue that hangs from the upper part of the back of the nasal cavity. Adenoids get bigger after birth but usually stop growing by the age of 7. Like the Tonsils, they can be removed without significantly increased risk of infections.
  • Peyer’s patches: these are clusters of lymphatic nodules in the mucosa that lines the ileum of the small intestine. They play an important role in defending against the large number of pathogens that enter the gastrointestinal system.

Circulation of tissue fluids

Fluid in the spaces between tissues is called interstitial fluid, or ’tissue fluid’. This provides the cells of the body with nutrients (via the blood supply) and a means of waste removal. Lymph is formed when the interstitial fluid is collected through tiny lymph capillaries (see diagram), which are located throughout the body. It is then transported through lymph vessels to lymph nodes, which clean and filter it. Lymph then flows on to the lymphatic ducts, before emptying into the right or the left subclavian vein, where it mixes back with blood.

Blood is enriched with oxygen (by the respiratory system) and nutrients (by the digestive system), which are circulated all around the body (by the cardiovascular system). Some fluid (blood plasma) leaks out into the tissues via tiny capillaries, contributing to interstitial fluid, which eventually drains back into the lymphatic system.

The Immune System

The immune system includes a variety of defenses against viruses, bacteria, fungal infections, and parasites (such as thread worms). The lympatic system is part of the broader Immune System.

Innate immune system


This are the non-specific, unchanging lines of defenses which include:

  • Physical and chemical barriers to pathogens.
  • Producing cytokines and other chemical factors to recruit immune cells to sites of infection.
  • Activates the complement cascade to identify bacteria, activate cells and to promote clearance of dead cells or antibody complexes.
  • Identifies and removes foreign substances present in organs, tissues, the blood and lymph, by specialised white blood cells.
  • Activation of the adaptive immune system, through a process known as antigen presentation.




Adaptive immune system

Adaptive (or acquired) immunity is where immunological memory is made after an initial response to a new pathogen, leading to an enhanced response to future exposure to that same pathogen. This process of acquired immunity is the basis of vaccination. This is essential because bacteria and viruses are continually adapting and evolving in an ‘arms race’ with our immune systems. Features of the adaptive immune system include:

  • Recognition of specific “non-self” antigens, during the process of antigen presentation.
  • The generation of responses tailored to destroy specific pathogens or pathogen-infected cells.
  • Development of immunological memory, in which each pathogen is “remembered” by signature antibodies or T cell receptors. These memory cells can be called upon to quickly eliminate a pathogen should subsequent infections occur.


Cells of the Immune System

There are many different cell types and sub-types involved in the immune system. Some of the main types include:

  • Lymphocytes: are white cells which circulate between blood and lymph. They play an important role in fighting infection. There are many kinds of lymphocytes; the main types are T cells, B cells and natural killer cells. Lymphocytes initially develop in the bone marrow. Some migrate to the thymus, where they mature into T cells ; others mature in the bone marrow as B cells.
  • Neutrophils: are the most abundant type of white blood cells and are an important part of the innate immune system. Neutrophils are a type of phagocyte (cells which engulf and then digest, cellular debris and pathogens). They are normally found in the blood stream, but are quickly recruited to the site of injury or infection following chemical signals such as Interleukin-8.
  • Macrophages: are another type of phagocyte and have a role in both the innate and adaptive immune systems. They attack foreign substances, infectious microbes and cancer cells. Macrophages also stimulate lymphocytes and other immune cells to respond to pathogens.
  • Dendritic cells: are antigen-presenting cells which act as messengers between the innate and adaptive immune systems. They are usually located in tissues in contact with the external environment such as the skin, linings of the nose, lungs, stomach and intestines. In response to pathogens they migrate to the lymph nodes where they interact with T cells and B cells to initiate the adaptive immune response.


Antigens and Antibodies

Antibodies (also known as an immunoglobulins) are Y-shaped proteins produced by B-cells,that bind to specific antigens on the surface of foreign objects such as bacteria and viruses. This identifies and ‘tags’ the foreign object as ‘non-self’, signalling other immune cells to attack them.



Hormones and the Immune System


There are several hormones generated by the immune system. These hormones are generally known as lymphokines. Steroids and corticosteroids (components of adrenaline) suppress the immune system.


Cancer Focus

Metastatic spread of cancer via the lymph nodes

Lymph nodes close to the primary tumor are often the first site of metastases (spread of cancer). Lymph node metastases are rarely life threatening, but their detection is a prognostic factor for many types of cancer as it shows the tumor has developed the ability to spread. Tumor cells may travel via the lymphatic system and spread to to lymph nodes and distant organs.


Sentinel Lymph Node Biopsy


A dye is injected near the primary tumor to identify the position of the sentinel lymph node (the first lymph node to which cancer cells are most likely to spread as the lympatic system drains fluid away from the tumor). The sentinel node is surgically removed and a pathologist checks for the presence of cancer cells. SLNB is most frequently used to help stage breast cancer and melanoma. It is a less extensive operation compared to standard lymph node surgery.


Immunosuppression

This is reduced activity or efficiency of the immune system and its ability to fight infections and other diseases. Certain diseases such as AIDS or lymphoma can cause immunosuppression. It is also a common side-effect of anticancer chemotherapy, leading to cancer patients having an increased risk of infections during treatment.


Lymphoma

A general term form for malignant disease of the lymphatic tissue characterized by abnormal, uncontrolled cell growth. There are a number of types of lymphoma, including Hodgkin Lymphoma, with most other types classed together as Non-Hodgkin Lymphoma.


Hodgkin Lymphoma

A malignancy of the lymphatic tissue that occurs most often in males, and the peak incidence is between ages 15 and 35. It is characterised by progressive, painless enlargement of the lymph nodes, spleen, and general lymph tissue. In Hodgkin Lymphoma Reed-Sternberg cells (a specific type of lymphocyte) become abnormal and grow in an uncontrolled way.

Internet Resources for Hodgkin Lymphoma


Non Hodgkin Lymphoma (NHL)

NHL is cancer of the lymphatic tissue, that does not involve abnormal Reed-Sternberg cells (a specific type of lymphocyte). There are many different types of NHL. Some grow very slowly, whilst others grow quickly and need aggressive treatment.

Internet Resources for NHL


AIDS related lymphoma

Incidence of non-Hodgkin’s lymphoma has increased in parallel with the AIDS epidemic. Lymphomas affecting HIV infected people are mostly of the aggressive B-cell types (diffuse large cell, B-immunoblastic, or small non-cleaved Burkitt’s / Burkitt’s like lymphoma) which are less common in non-HIV infected lymphoma patients. The HIV virus is not thought to a direct cause of lymphoma, rather it weakens the body’s defences and may increase susceptibility to other infections such as the Epstein-Barr and HHV-8 viruses which are associated with these types of lymphomas.

Internet Resources for AIDS related Lymphoma


Waldenstrom’s Macroglobulinemia


This is a rare malignant condition, involving an excess of beta-lymphocytes (a type of cell in the immune system) which secrete immunoglobulins (a type of antibody). WM usually occurs in people over sixty, but has been detected in younger adults.

Internet Resources for Waldenstrom’s Macroglobulinemia


Cancer Immunotherapy

This is treatment to stimulate the patient’s own immune system to attack the cancer cells. Different approaches include: 1) cancer vaccination to train the immune system to recognise the cancer cells as targets to be destroyed, 2) giving therapeutic antibodies to recruit immune system cells to destroy tumor cells, and 3) cell based immunotherapy which is either transfusing immune cells (such as Natural killer Cells) or by administering cytokines (such as Interleukins) which activate the immune cells.


HPV Vaccination and Cervical Cancer


Human papillomavirus (HPV) is a common cause of infection. There are over 100 different sub-types of HPV. HPV types 16 and 18 cause 70% of cervical cancers and are also linked to cancers of the anus, vulva, vagina, penis, as well as the mouth and throat. Over time these can cause cells in the cervix to change, leading to precancerous conditions – cervical intraepithelial neoplasia (CIN), with a higher risk of developing cancer. Vaccination against HPV 16, 18 and other ‘high risk’ types of HPV reduces the risk of developing cervical and other HPV-related cancers.

Internet Resources for HPV Vaccination and Cervical Cancer


Lymphedema

Lymphedma is an abnormal build up of interstitial fluid due to problems in the lymphatic system. It can have many causes. In the context of cancer it is often a result of obstruction by a tumor or enlarged lymph nodes. It can also be a side effect of radiotherapy or surgery, which has damaged the lymph vessels.


Roots, suffixes, and prefixes

Most medical terms are comprised of a root word plus a suffix (word ending) and/or a prefix (beginning of the word). Here are some examples related to the Lymphatic and Immune systems. For more details see Chapter 4: Understanding the Components of Medical Terminology

componentmeaningexample
aden(o)-glandLymphadenopathy – disease of, or swelling/enlarged lymph nodes
immun(o)-ImmunityImmunosuppression = reduced activation or efficacy of the immune system
lymph(o)-LymphLymphoma = tumour of lymphoid cells
lymphaden(o)-lymph nodeLymphadenectomy = surgical removal of lymph node(s)
lymphangi(o)-lymphatic vesselsLymphangitis = inflammation or infection of the lymphatic vessels
splen(o)-spleenSplenomegaly = enlargement of the spleen
thym(o)-thymusThymectomy = surgical removal of the thymus
tox(o)-poisonImmunotoxicity = adverse effects on immune system function resulting from exposure to chemical substances.

Related Abbreviations and Acronyms

AIDSAcquired Immunodeficiency Syndrome
EBVEpstein-Barr virus
HDHodgkin’s Disease (now known as Hodgkin Lymphoma)
HIVHuman Immunodeficiency Virus
HPVHumapapillomavirus
HSVHerpes Simplex Virus
IgAImmunoglobulin A
IgDImmunoglobulin D
IgEImmunoglobulin E
IgGImmunoglobulin G
IgMImmunoglobulin M
MALTMucosa-associated lymphoid tissue
NHLNon Hodgkin’s Lymphoma
NKTNatural killer T cell
SLNBSentinel Lymph Node Biopsy

Further Resources (9 links)

     Immune System

    National Cancer Institute
    Detailed presentation and notes.

     Introduction to the Lymphatic System

    SEER, National Cancer Institute
    Part of a SEER training module for cancer registry staff.

     Lymphatic System – Self Test questions

    WebAnatomy, University of Minnesota
    Test your anatomy knowledge with these interactive questions. Includes different question types and answers.

     Mechanism of lymph node metastasis in prostate cancer

    Future Oncol. 2010 May;6(5):823-36
    Datta K, Muders M, Zhang H, Tindall DJ. Mechanism of lymph node metastasis in prostate cancer. Future Oncol. 2010 May; 6(5): 823-836. (full article available free on PubMed Central)

     Sentinel Lymph Node Biopsy

    National Cancer Institute
    Factsheet in the form of questions and answers, with references.

     The components of the immune system

    National Library of Medicine
    A section, with diagrams from: Janeway CA Jr, Travers P, Walport M, et al. Immunobiology: The Immune System in Health and Disease. 5th edition. New York: Garland Science; 2001.

      The Immune System

    Paul Andersen
    Paul Andersen explains how your body protects itself from invading viruses and bacteria. He starts by describing the nonspecific immune responses of skin and inflammation. He then explains how we use antibodies to disrupt the function of antigens and mark them for destruction. He then explains both the homoral and cell-mediated immune response highlighting the importance of B and T lymphocytes. He finally describes the process of long term immunity.

     The Lymphatic System

    Cancer Research UK
    Short overview, with diagrams.

      Your Immune System 101: Introduction to Clinical Immunology

    UCSF
    Dr. Katherine Gundling, Professor, Division of Allergy and Immunology at UCSF presents an overview of the immune system, how it functions and what can go wrong.


This guide by Simon Cotterill

First created 4th March 1996
Last modified: 1st February 2014

Lymphatic Vessels | Boundless Anatomy and Physiology

Lymphatic Vessel Structure

The lymphatic structure is based on that of blood vessels.

Learning Objectives

Describe lymphatic circulation and the structure of lymphatic vessels

Key Takeaways

Key Points
  • Lymph (or lymphatic ) vessels are thin-walled valved structures that carry lymph.
  • Lymph vessels are lined by endothelial cells and have a thin layer of smooth muscles and adventitia that bind the lymph vessels to the surrounding tissue.
  • Lymph movement occurs despite low pressure due to smooth muscle action, valves, and compression during contraction of adjacent skeletal muscle and arterial pulsation.
  • When the pressure inside a lymphangion becomes high enough, lymph fluid will push through the semilunar valve into the next lymphangion, while the valve then closes.
  • Lymph vessels are structurally very similar to blood vessels.
  • Valves prevent backwards flow of lymph fluid, which allows the lymphatic system to function without a central pump.
Key Terms
  • lymphagion: The space between two semilunar valves of the lymphatic vessels that forms a distinct functional unit for the forward flow of lymph.
  • adventitia: The outermost layer of connective tissue encasing a visceral organ or vessel.
  • ISF: Interstitial (or tissue) fluid, a solution that bathes and surrounds the cells of multicellular animals. It is the main component of extracellular fluid, which also includes plasma and transcellular fluid.
  • endothelial cells: A thin layer of cells that lines the interior surface of blood and lymphatic vessels, forming an interface between circulating blood or lymph in the lumen and the rest of the vessel wall.

The general structure of lymphatic vessels is similar to that of blood vessels since these are the only two types of vessels in the body. While blood and lymph fluid are two separate substances, both are composed of the same water (plasma or fluid) found elsewhere in the body.

Layers of Lymph Vessels

The endothelium, a general term for the inner layer of a vessel, is composed of an inner lining of single, flattened epithelial cells (simple squamous epithelium). This layer mechanically transports fluid. It sits on a highly permeable basement membrane made out of extracellular matrix that separates the endothelium from the other layers. The endothelium is designed with junctions between cells that allow interstitial fluid to flow into the lumen when pressure becomes high enough (such as from blood capillary hydrostatic pressure), but does not normally allow lymph fluid to leak back out into the interstitial space.

The next layer is smooth muscles arranged in a circular fashion around the endothelium that alters the pressure inside the lumen (space) inside the vessel by contracting and relaxing. The activity of smooth muscles allows lymph vessels to slowly pump lymph fluid through the body without a central pump or heart. By contrast, the smooth muscles in blood vessels are involved in vasoconstriction and vasodilation instead of fluid pumping.

The outermost layer is the adventitia, consisting of fibrous tissue. It is made primarily out of collagen and serves to anchor the lymph vessels to structures within the body for stability. Larger lymph vessels have many more layers of adventitia than do smaller lymph vessels. The smallest vessels, such as the lymphatic capillaries, may have no outer adventitia. As they proceed forward and integrate into the larger lymph vessels, they develop  adventitia and smooth muscle. Blood vessels also have adventitia, sometimes referred to as tunica.

Lymphatic Valves

One of the main structural features of lymph vessels is their valves, which are semilunar structures attached to opposite sides of the lymphatic endothelium. Valves are found in larger lymph vessels and collecting vessels and are absent in the lymphatic capillaries. The valves is to prevent backflow of fluid, so that lymph eventually flows forward instead of falling backwards. When the pressure of lymph fluid increase to a certain point due to filling with more lymph fluid or from smooth muscle contraction, the fluid will be pushed through the valve (opening it) into the next chamber of the vessel (called a lymphangion). As the pressure falls, the open valve then closes so that the lymph fluid cannot flow backwards.

Lymph Vessel: Diagram representing propulsion of lymph through a lymph vessel.

A lymphangion is the term for the space between two semilunar valves in a lymphatic vessel, functional unit of the lymphatic system. Lymph fluid can only flow forward through lymphangions due to the closing of valves after fluid is pushed through by fluid accumulation, smooth muscle contraction, or skeletal muscle contraction.

Without valves, the lymphatic system would be unable to function without a central pump. Smooth muscle contractions only cause small changes in pressure and volume within the lumen of the lymph vessels, so the fluid would just move backwards when the pressure dropped. Blood vessels also have valves, but only in low pressure venous circulation. They function similarly to lymphatic valves, though are comparatively more dependent on skeletal muscle contractions.

Distribution of Lymphatic Vessels

The lymphatic system comprises a network of conduits called lymphatic vessels that carry lymph unidirectionally towards the heart.

Learning Objectives

Describe the structure of the lymphatic system and its role in the immune system and blood circulation

Key Takeaways

Key Points
  • The lymph system is not a closed system. Lymph flows in one direction toward the heart.
  • Lymph nodes are most densely distributed toward the center of the body, particularly around the neck, intestines, and armpits.
  • Lymph vessels and nodes are not found within bone or nervous system tissue.
  • Afferent lymph vessels flow into lymph nodes, while efferent lymph vessels flow out of them.
  • Lymphatic capillaries are the sites of lymph fluid collection, and are distributed throughout most tissues of the body, particularly connective tissue.
Key Terms
  • lymph: A colorless, watery, bodily fluid carried by the lymphatic system, consisting mainly of white blood cells.
  • plasma: The straw-colored/pale-yellow liquid component of blood that normally holds the blood cells of whole blood in suspension.
  • Efferent: A type of vessel that flows out of a structure, such as lymph vessels that leave the spleen or lymph nodes and arterioles that leave the kidney.

The lymphatic system is a circulatory system for lymphatic fluid, comprising a network of conduits called lymphatic vessels that carry the fluid in one direction toward the heart. Its functions include providing sites for certain immune system functions and facilitating plasma circulation in the cardiovascular system. The lymphatic system is composed of many different types of lymph vessels over a wide distribution throughout the body.

Lymph Node Distribution

Lymphatic System: The lymph nodes and lymph vessels in human beings.

Lymphatic vessels are most densely distributed near lymph nodes: bundles of lymphoid tissue that filter the lymph fluid of pathogens and abnormal molecules. Adaptive immune responses usually develop within lymphatic vessels. Large lymphatic vessels can be broadly characterized into two categories based on lymph node distribution.

  • Afferent lymphatic vessels flow into a lymph node and carry unfiltered lymph fluid.
  • Efferent lymphatic vessels flow out of a lymph node and carry filtered lymph fluid. Lymph vessels that leave the thymus or spleen (which lack afferent vessels) also fall into this category.

Lymph nodes are most densely distributed around the pharynx and neck, chest, armpits, groin, and around the intestines. Afferent and efferent lymph vessels are also most concentrated in these areas so they can filter lymph fluid close to the end of the lymphatic system, where fluid is returned into the cardiovascular system. Conversely, lymph nodes are not found in the areas of the upper central nervous system, where tissue drains into cerebrospinal fluid instead of lymph, though there are some lymph vessels in the meninges. There are few lymph nodes at the ends of the limbs. The efferent lymph vessels in the left and lower side of the body drain into the left subclavian vein through the thoracic duct, while the efferent lymph vessels of the right side of the body drain into the right subclavian vein through the right lymphatic duct.

Flow Through Lymph Vessels

The lymphatic vessels start with the collection of lymph fluid from the interstitial fluid. This fluid is mainly water from plasma that leaks into the intersitial space in the tissues due to pressure forces exerted by capillaries (hydrostatic pressure) or through osmotic forces from proteins (osmotic pressure). When the pressure for interstitial fluid in the interstitial space becomes large enough it leaks into lymph capillaries, which are the site for lymph fluid collection.

Like cardiovascular capillaries, lymph capillaries are well distributed throughout most of the body’s tissues, though they are mostly absent in bone or nervous system tissue. In comparison to cardiovascular capillaries, lymphatic capillaries are larger, distributed throughout connective tissues, and have a dead end that completely prevents backflow of lymph. That means the lymphatic system is an open system with linear flow, while the cardiovascular system is a closed system with true circular flow.

Lymph flows in one direction toward the heart. Lymph vessels become larger, with better developed smooth muscle and valves to keep lymph moving forward despite the low pressure and adventia to support the lymph vessels. As the lymph vessels become larger, their function changes from collecting fluid from the tissues to propelling fluid forward. Lymph nodes found closer to the heart filter lymph fluid before it is returned to venous circulation through one of the two lymph ducts.

Lymph Transport

Lymph circulates to the lymph node via afferent lymphatic vessels and drains into the lymph node in the subcapsular sinus.

Learning Objectives

Describe the location of B cells and T cells in lymph nodes and the path of lymph circulation

Key Takeaways

Key Points
  • The sinus space is crisscrossed by the pseudopods of macrophages, which act to trap foreign particles and filter the lymph.
  • Lymph then leaves the lymph node via the efferent lymphatic vessel towards either a more central lymph node or for drainage into a central venous subclavian blood vessel.
  • Lymphatic transport begins in the lymphatic capillaries, which converge into collecting vessels that flow into afferent vessels, then into lymph nodes.
  • The lymph fluid leaves the node through efferent lymph vessels, which converge into lymphatic trunks, which in turn converge into one of the lymphatic ducts that flow lymph back into venous circulation.
  • B and T lymphocytes must be transported to different sites within lymph nodes during an adaptive immune response.
Key Terms
  • afferent lymphatic vessels: These vessels enter into the lymph nodes, flowing into the sinus space below the capsule of the node.
  • lymph: A colorless, watery bodily fluid carried by the lymphatic system, consisting mainly of white blood cells.
  • germinal centers: Places within secondary lymph nodes to which B cells migrate to proliferate and differentiate based on an antigen response.

Lymph transport refers to the transport of lymph fluid from the interstitial space inside the tissues of the body, through the lymph nodes, and into lymph ducts that return the fluid to venous circulation.

Transport in the Lymph Capillaries and Vessels

Lymphatic capillaries are the site of lymph fluid collection from the tissues. The fluid accumulates in the interstitial space inside tissues after leaking out through the cardiovascular capillaries. The fluid enters the lymphatic capillaries by leaking through the minivalves located in the junctions of the endothelium. Under ordinary conditions these minivalves prevent the lymph from flowing back into the tissues. In addition to interstitial fluid, pathogens, proteins, and tumor cells may also leak into the lymph capillaries and be transported through lymph.

The lymph capillaries feed into larger lymph vessels. The lymph vessels that receive lymph fluid from many capillaries are called collecting vessels. Semilunar valves work together with smooth muscle contractions and skeletal muscle pressure to slowly push the lymph fluid forward while the valves prevent backflow. The collecting vessels typically transport lymph fluid either into lymph nodes or lymph trunks.

Transport Within Lymph Nodes

Lymph circulates to the lymph node via afferent lymphatic vessels. The lymph fluid drains into the node just beneath the capsule of the node into its various sinus spaces. These spaces are loosely separated by walls, so lymph fluid flows around them throughout the lymph node.

The sinus space is filled with macrophages that engulf foreign particles and pathogens and filter the lymph. The sinuses converge at the hilum of the node, where lymph then leaves the node via an efferent lymphatic vessel toward either a more central lymph node or a lymph duct for drainage into one of the subclavian veins.

The lymph nodes contain a large number of B and T lymphocytes, which are transported throughout the node during many components of the adaptive immune response. When a lymphocyte is presented with an antigen (such as by an activated helper T cell), B cells become activated and migrate to the germinal centers of the node, where they proliferate and differentiate to be specific to that antigen. When antibody-producing B cells are formed, they migrate to the medullary (central) cords of the node. Stimulation of the lymphocytes by antigens can accelerate the migration process to about ten times normal, resulting in the characteristic swelling of the lymph nodes that is a common symptom of many infections. The lymphocytes are transported through lymph fluid and leave the node through the efferent vessels to travel to other parts of the body to perform adaptive immune response functions.

Flow of Lymph : The lymph flows from the afferent vessels into the sinuses of the lymph node, and then out of the node through the efferent vessels.

The End of Lymphatic Transport

After leaving the lymph node through efferent vessels, lymph travels either to another node further into the body or to a lymph trunk, the larger vessel where many efferent vessels converge. Four pairs of lymph trunks are distributed laterally around the center of the body, along with an unpaired intestinal trunk.

The lymph trunks then converge into the two lymph ducts, the right lymph duct and the thoracic duct. These ducts take the lymph into the right and left subclavian veins, which flow into the vena cava. This is where lymph fluid reaches the end of its journey from the interstitial space of tissues back into blood circulation.

Lymphatic Capillaries

Lymph capillaries are tiny, thin-walled vessels, closed at one end and located in the spaces between cells throughout the body.

Learning Objectives

Describe the location, structure, and role of lymphatic capillaries in maintaining the pressure of the interstitial fluid

Key Takeaways

Key Points
  • Lymph or lymphatic capillaries are tiny thin-walled vessels,  closed at one end and located in the spaces between cells throughout the body, except in the central nervous system and non-vascular tissues.
  • Lymphatic capillaries are slightly larger in diameter and have greater oncotic pressure than blood capillaries.
  • When pressure is greater in the interstitial fluid than in lymph, the minivalve cells separate slightly and interstitial fluid enters the lymphatic capillary. When pressure is greater inside the lymphatic capillary, the cells of the minivalves adhere more closely, and lymph cannot flow back into interstitial fluid.
  • Anchoring filaments attach to the minivalves to anchor the capillary to connective tissue, and also pull the capillary open to increase lymph collection when the tissue is swollen.
  • Because lymph capillaries have a closed end, lymph is pushed forward into larger vessels as the pressure inside the capillary increases as lymph accumulates from fluid collection.
  • Edema can occur when interstitial fluid accumulation in tissues is greater than fluid removal (acute inflammation ) or when the lymph vessels are obstructed in some way (elephantiasis).
Key Terms
  • interstitial fluid: Also called tissue fluid, a solution that bathes and surrounds the cells of multicellular animals.
  • lymph capillaries: Tiny thin-walled vessels, closed at one end and located in the spaces between cells throughout the body, collect fluid from the tissues.

Lymphatic circulation begins in the smallest type of lymph vessels, the lymph capillaries. These regulate the pressure of interstitial fluid by draining lymph from the tissues.

Structure of Lymphatic Capillaries

Lymph or lymphatic capillaries are tiny thin-walled vessels, closed at one end and located in the spaces between cells throughout the body. These are  particularly dense within connective tissue. Lymphatic capillaries are slightly larger in diameter than blood capillaries and contain flap-like “minivalves” that permit interstitial fluid to flow into them but not out, under normal conditions.

Lymphatic capillaries are primarily made out of an endothelium layer that sits on a permeable basement membrane. The flap-like minivalves, located at gap-like junctions in the endothelium, are formed from the overlap of endothelial cells and are normally closed. Attached to the outer opening of the minivalves are anchoring filaments containing elastic fibers. They extend out from the lymphatic capillary, attaching the endothelium to fibroblast cells in the connective tissue. Unlike larger lymphatic vessels, lymphatic capillaries do not contain smooth muscle nor do they have a well developed adventitia, only small elastic filaments that perform a similar function.

Function of Lymphatic Capillaries

The lymph capillaries serve a variety of important functions.

Fluid Pressure Regulation

Lymphatic capillaries collect lymph fluid from the tissues, which allows them to regulate the pressure of interstitial fluid. This fluid is essentially plasma that leaks out of cardiovascular capillaries into the tissues due to the forces of hydrostatic or oncotic pressure. When pressure is greater in the interstitial fluid than in lymph due to accumulation of interstitial fluid, the minivalves separate slightly like the opening of a one-way swinging door so that fluid can enter the lymphatic capillary. When pressure is greater inside the lymphatic capillary, the cells adhere more closely to each other to prevent lymph backflow. The anchoring filaments are also pulled when the tissues are swollen. This opens the lymph capillaries more, increasing their volume and reducing their pressure to further facilitate fluid flow into the capillaries.

Lymph capillaries have a greater oncotic pressure (a pulling pressure exerted by proteins in solution) than blood plasma due to the greater concentration of plasma proteins in lymph. Additionally, the greater size of lymphatic capillaries compared to cardiovascular capillaries allows them to take more fluid proteins into lymph compared to plasma, which is the other reason for their greater levels of oncotic pressure. This also explains why lymph flows into the lymph capillaries easily, since fluid follows proteins that exert oncotic pressure.

Edema Prevention

Under normal conditions, lymph capillaries prevent the accumulation of edema (abnormal swelling) in the tissues. However, edema will still occur during acute inflammation or diseases in which lymph vessels are obstructed. During inflammation, fluid leaks into the tissues at a rate faster than it can be removed by the lymph capillaries due to the increased permeability of cardiovascular capillaries. During lymph vessel obstruction (such as through elephantiasis infection), lymph will be unable to progress normally through the lymphatic system, and pressure within the blocked off lymph capillaries increases to the point where backflow into tissues may occur, while the pressure of interstitial fluid gradually rises.

Drive Lymph Through Lymphatic Vessels

Lymph Capillary: Diagram showing the formation of lymph from interstitial fluid (labeled here as “tissue fluid”). Note: how the tissue fluid is entering the blind ends of lymph capillaries (indicated by deep green arrows).

The lymphatic capillaries bring lymph further into the lymphatic vessels. The capillaries have external valves but no internal valves or smooth muscle, so the pressure of lymph accumulation itself must propel the fluid forward into the larger vessels. Because lymphatic capillaries have a closed end and minivalves normally prevent backflow into tissues, the pressure of lymph becomes higher as more lymph is collected from the tissues, which sends the lymph fluid forward. Multiple capillaries converge in collecting vessels, where the internal valves and smooth muscle start to appear. This moves lymph further along the system despite the fall in pressure that occurs when moving from the higher-pressure capillaries to the lower-pressure collecting vessels.

Lymph Trunks and Ducts

The lymph trunks drain into the lymph ducts, which in turn return lymph to the blood by emptying into the respective subclavian veins.

Learning Objectives

Describe the types of lymph vessels and lymph trunks and their roles

Key Takeaways

Key Points
  • The lymph trunks drain into the lymph ducts, which in turn return lymph to the blood by emptying into the respective subclavian veins.
  • There are two lymph ducts in the body: the right lymph duct and the thoracic duct.
  • There are four pairs of lymph trunks: jugular lymph trunks, subclavian lymph trunks, bronchomediastinal lymph trunks, and lumbar lymph trunks. In addition, the intestinal lymph trunk is unpaired.
  • The intestinal lymph trunk and the thoracic lymph duct contain chyle, a mixture of emulsified fats from the intestines and lymph fluid.
Key Terms
  • thoracic duct: The lymph duct that drains lymph and chyle from the lower and left halves of the body.
  • subclavian vein: Two large veins, one on either side of the body, with a diameter similar to that of the smallest finger.
  • lymph: A colorless, watery body fluid carried by the lymphatic system, consisting mainly of white blood cells.

After filtration by the lymph nodes, efferent lymphatic vessels take lymph to the end of the lymphatic system. The final goal of the lymphatic system is to recirculate lymph back into the plasma of the bloodstream. There are two specialized lymphatic structures at the end of the lymphatic system, called the lymph trunks and ducts.

Lymphatic Trunks

Lymphatic Ducts: The thoracic duct and right lymphatic duct.

A lymphatic trunk is any large lymph vessel that forms from the convergence of many efferent lymph vessels. There are four sets of of lymph trunks that are paired with a right and left half, and one unpaired trunk:

  • Jugular lymph trunks, located in the neck, drain lymph fluid from the cervical lymph nodes of the neck.
  • Subclavian lymph trunks, located beneath the clavicle, drain lymph fluid from the apical lymph nodes around the armpit, which carry lymph from the arms.
  • Bronchomediastinal lymph trunks, located in the chest, drain lymph fluid from the lungs, heart, trachea, mediastinal, and mammary glands.
  • Lumbar lymph trunks are the lower pair of lymph trunks that drain lymph fluid from the legs, pelvic region, and kidneys.
  • Intestinal lymph trunk is the unpaired lymph trunk that receives chyle (lymph mixed with fats) from the intestines. Chyle typically has a high fatty acid content.

Lymphatic trunks then drain lymph fluid into the lymph ducts, the final part of the lymphatic system.

Lymph Ducts

Two lymph ducts receive lymph from the lymph trunks. These are the largest lymph vessels and contain three layers, similar to those of great veins.

  • The thoracic lymph duct, the largest lymph vessel in the body, takes lymph from the lower and left halves of the body. Because the thoracic lymph duct drains the intestinal lymph trunks, it carries a mixture of lymph and emulsified fatty acids called chyle back to the bloodstream.
  • The right lymphatic duct receives lymph from the right and upper halves of the body, including the right sides of the jugular, bronchomediastinal, and subclavian lymph trunks.

The thoracic duct drains into to the left subclavian vein while the right duct drains into the right subclavian vein, both at the junction between the respective vein and the jugular vein. The two subclavian veins then merge into the vena cava,  the large vein that brings deoxygenated blood to the heart. The lymph ducts each have internal valves at their junction with the subclavian vein. These function similarly to other lymphatic valves and prevent venous blood from flowing into the lymph duct. This point marks the end of lymph fluid’s journey through the lymphatic system.

Lymphatic System Structure and Function

Structure of the Lymphatic System

The lymphatic system consists of lymphatic vessels and associated lymphoid organs.

Learning Objectives

Describe the structure and function of the lymphatic system 

Key Takeaways

Key Points
  • The lymphatic system is a circulatory system that drains fluid from the blood vessels.
  • Lymph vessels are the site of fluid drainage and pump lymph fluid using smooth muscle and skeletal muscle action. The larger vessels contain valves to prevent backflow and pump towards the heart to return lymph fluid to the bloodstream by the subclavian veins.
  • A lymph node is an organized collection of lymphoid tissue through which the lymph passes on its way to returning to the blood. Lymph nodes are located at intervals along the lymphatic system.
  • Lymphoid tissue contains lymphocytes and other specialized cells and tissues that have immune system functions.
Key Terms
  • lymph node: Small oval bodies of the lymphatic system, distributed along the lymphatic vessels clustered in the armpits, groin, neck, chest, and abdomen. They filter through lymph fluid.
  • lymph: A colorless, watery, bodily fluid carried by the lymphatic system, consisting mainly of white blood cells.

The lymphatic system is a collection of structures and vessels that drains lymph from blood and has several other functions. It is a circulatory system for lymph fluid and the site of many key immune system functions. 

Lymphatic Vessels

The lymphatic vessels are the lymphatic system equivalent of the blood vessels of the circulatory system and drain fluid from the circulatory system. The network of lymph vessels consists of the initial collectors of lymph fluid, which are small, valveless vessels, and goes on to form the precollector vessels, which have rudimentary valves that are not fully functional. These structures then form increasingly larger lymphatic vessels which form colaterals and have lymph-angions (lymph hearts).  The larger lymph vessels contain valves that prevent the backflow of lymph. 

The lymphatic system is an active pumping system driven by segments that have a function similar to peristalsis. They lack a central pump (like the heart in the cardio vascular system), so smooth muscle tissue contracts to move lymph along through the vessels. Skeletal muscle contractions also move lymph through the vessels. The lymphatic vessels make their way to the lymph nodes, and from there the vessels form into trunks. In general, the lymph vessels bring lymph fluid toward the heart and above it to the subclavian veins, which enable lymph fluid to re-enter the circulatory system through the vena cava.

The lymphatic system: This diagram shows the network of lymph nodes and connecting lymphatic vessels in the human body.

Lymphatic Tissues and Organs

Lymphoid tissue is found in many organs including the lymph nodes, as well as in the lymphoid follicles in the pharynx such as the tonsils. Lymph nodes are found primarily in the armpits, groin, chest, neck, and abdomen. Lymphoid tissues contain lymphocytes (a type of highly differentiated white blood cell), but they also contain other types of cells for structural and functional support, such as the dendritic cells, which play a key role in the immune system. The system also includes all the structures dedicated to the circulation and production of lymphocytes, including the spleen, thymus, and bone marrow.

Functions of the Lymphatic System

The lymphatic system plays a prominent role in immune function, fatty acid absorption, and removal of interstitial fluid from tissues.

Learning Objectives

Describe the roles of the lymphatic system

Key Takeaways

Key Points
  • The lymphatic system is a linear network of lymphatic vessels and secondary lymphoid organs. It is the site of many immune system functions as well as its own functions.
  • It is responsible for the removal of interstitial fluid from tissues into lymph fluid, which is filtered and brought back into the bloodstream through the subclavian veins near the heart. 
  • Edema accumulates in tissues during inflammation or when lymph drainage is impaired.
  • It absorbs and transports fatty acids and fats as chylomicrons from the digestive system.
  • It transports white blood cells and dendritic cells to lymph nodes where adaptive immune responses are often triggered.
  • Tumors can spread through lymphatic transport.
Key Terms
  • lacteal: A lymphatic capillary that absorbs dietary fats in the villi of the small intestine.
  • interstitial fluid: Also called tissue fluid, a solution that bathes and surrounds the cells of multicellular animals.
  • white blood cell: A type of blood cell involved with an immune response. Many white blood cells (primarily lymphocytes) are transported by the lymphatic system.

The lymphatic system is the site of many key immune system functions. It is important to distinguish that immune system functions can happen almost anywhere in the body, while the lymphatic system is its own system where many immune system functions take place. Besides immune system function, the lymphatic system has many functions of its own. It is responsible for the removal and filtration of interstitial fluid from tissues, absorbs and transports fatty acids and fats as chyle from the digestive system, and transports many of the cells involved in immune system function via lymph.

Removal of Fluid

Interstitial fluid accumulates in the tissues, generally as a result of the pressure exerted from capillaries (hydrostatic and osmotic pressure) or from protein leakage into the tissues (which occurs during inflammation). These conditions force fluid from the capillaries into the tissues. One of the main functions of the lymphatic system is to drain the excess interstitial fluid that accumulates.

The lymphatic system is a blunt-ended linear flow system, in which tissue fluids, cells, and large extracellular molecules, collectively called lymph, are drained into the initial lymphatic capillary vessels that begin at the interstitial spaces of tissues and organs. They are then transported to thicker collecting lymphatics, which are embedded with multiple lymph nodes, and are eventually returned to the blood circulation through the left and right subclavian veins and into the vena cava. They drain into venous circulation because there is lower blood pressure in veins, which minimizes the impact of lymph cycling on blood pressure. Lymph nodes located at junctions between the lymph vessels also filter the lymph fluid to remove pathogens and other abnormalities.

Fluid removal from tissues prevents the development of edema. Edema is any type of tissue swelling from increased flow of interstitial fluid into tissues relative to fluid drainage. While edema is a normal component of the inflammation process, in some cases it can be very harmful. Cerebral and pulmonary edema are especially problematic, which is why lymph drainage is so important. Abnormal edema can still occur if the drainage components of the lymph vessels are obstructed.

The lymphatic system: A diagram of fluid movement in the lymphatic system.

Fatty Acid Transport

The lymphatic system also facilitates fatty acid absorption from the digestive system. During fat digestion, fatty acids are digested, emulsified, and converted within intestinal cells into a lipoprotein called chylomicrons. Lymph drainage vessels that line the intestine, called lacteals, absorb the chylomicrons into lymph fluid. The lymph vessels then take the chylomicrons into blood circulation, where they react with HDL cholesterols and are then broken down in the liver.

Immune Cell Transport

In addition to tissue fluid homeostasis, the lymphatic system serves as a conduit for transport of cells involved in immune system function. Most notably, highly-specialized white blood cells called lymphocytes and antigen -presenting cells are transported to regional lymph nodes, where the immune system encounters pathogens, microbes, and other immune elicitors that are filtered from the lymph fluid. Much of the adaptive immune system response, which is mediated by dendritic cells, takes place in the lymph nodes. Lymphatic vessels, which uptake various antigens from peripheral tissues, are positively regulated by chemokines/cytokines secreted by various immune cells during inflammation. This allows antigens to enter lymph nodes, where dendritic cells can present them to lymphocytes to trigger an adaptive immune response.

While the lymphatic system is important for transporting immune cells, its transport capabilities can also provide a pathway for the spread of cancer. Lymph circulation is one of the main ways that tumors can spread to distant parts of the body, which is difficult to prevent.

The lymphatic system and cancer

This page tells you about the lymphatic system and how cancer may affect it. There is information about

 

What the lymphatic system is

The lymphatic system is a system of thin tubes and lymph nodes that run throughout the body. These tubes are called lymph vessels or lymphatic vessels. The lymph system is an important part of our immune system. It plays a role in:

  • fighting bacteria and other infections
  • destroying old or abnormal cells, such as cancer cells

This video is about the lymphatic system, it lasts for 1 minute and 59 seconds.

Read a transcript of this video.

You can read detailed information about the immune system and cancer.

The lymphatic system

The diagram shows the lymph vessels, lymph nodes and the other organs that make up the lymphatic system.

How it works

The lymphatic system is similar to the blood circulation. The lymph vessels branch through all parts of the body like the arteries and veins that carry blood. But the lymphatic system tubes are much finer and carry a colourless liquid called lymph.

The lymph contains a high number of a type of white blood cells called lymphocytes. These cells fight infection and destroy damaged or abnormal cells.

As the blood circulates around the body, fluid leaks out from the blood vessels into the body tissues. This fluid carries food to the cells and bathes the body tissues to form tissue fluid. The fluid then collects waste products, bacteria, and damaged cells. It also collects any cancer cells if these are present. This fluid then drains into the lymph vessels.

The lymph then flows through the lymph vessels into the lymph glands, which filter out any bacteria and damaged cells.

From the lymph glands, the lymph moves into larger lymphatic vessels that join up. These eventually reach a very large lymph vessel at the base of the neck called the thoracic duct. The thoracic duct then empties the lymph back into the blood circulation.

Lymph nodes (lymph glands)

The lymph glands are small bean shaped structures, also called lymph nodes.

There are lymph nodes in many parts of the body including:

  • under your arms, in your armpits
  • in each groin (at the top of your legs)
  • in your neck
  • in your tummy (abdomen), pelvis and chest

You may be able to feel some of them, such as the lymph nodes in your neck.

The lymph nodes filter the lymph fluid as it passes through them. White blood cells, such as B cells and T cells, attack any bacteria or viruses they find in the lymph.

When cancer cells break away from a tumour, they may become stuck in one or more of the nearest lymph nodes. So doctors check the lymph nodes first when they are working out how far a cancer has grown or spread.

When the lymph nodes are swollen, doctors call it lymphadenopathy. The most common cause is infection but lymph nodes can also become swollen because of cancer.

Other lymphatic system organs

The lymphatic system includes other organs, such as the spleen, thymus, tonsils and adenoids.

The spleen

The spleen is under your ribs, on the left side of your body. It has 2 main different types of tissue, red pulp and white pulp.

The red pulp filters worn out and damaged red blood cells from the blood and recycles them.

The white pulp contains many B lymphocytes and T lymphocytes. These are white blood cells that are very important for fighting infection. As blood passes through the spleen, these blood cells pick up on any sign of infection or illness and begin to fight it.

The thymus

The thymus is a small gland under your breast bone. It helps to produce white blood cells to fight infection. It is usually most active in teenagers and shrinks in adulthood.

The tonsils and adenoids

The tonsils are 2 glands in the back of your throat.

The adenoids are glands at the back of your nose, where it meets the back of your throat. The adenoids are also called the nasopharyngeal tonsils.

The tonsils and adenoids help to protect the entrance to the digestive system and the lungs from bacteria and viruses.

Related information

You might like to read our information about how cancer starts. We also have information about how cancer can spread.  

For information about how cancer can affect the immune system, look at our page about the immune system and cancer.

90,000 Biopsy of sentinel lymph nodes for skin melanoma in Israel

How does the lymphatic system work?

Lymph nodes are small, rounded formations that are part of the lymphatic system. They are widespread throughout the body and are connected to each other by a network of lymphatic vessels.

Group clusters of lymph nodes are localized in the neck, armpits, chest, abdomen and groin.The clear fluid that circulates through the lymphatic vessels and lymph nodes is called lymph. It is formed from intercellular fluid that “seeps” through small blood vessels called capillaries. This liquid has a complex composition and consists of blood plasma, proteins, glucose and oxygen. It washes most of the cells in the body, providing them with oxygen and nutrients necessary for their growth and functioning. The intercellular fluid utilizes toxins from the cells, and also participates in the neutralization and elimination of bacteria and viruses from the body.Interstitial fluid eventually accumulates in the lymphatic vessels, where it becomes known as lymph. Lymph flows through the body’s lymphatic vessels to reach two large ducts at the base of the neck, where it is emptied into the systemic circulation.

Lymph nodes are important components of the immune system. They contain T- and B-lymphocytes, as well as other types of cells of the immune system. These elements monitor the lymph for the presence of such “foreign” substances as bacteria and viruses.If a foreign substance is detected in the body, some of the cells are activated and an immune response occurs.

Lymph nodes also play an important role in diagnosis. Lymph node examinations help answer the question of whether cancer cells have spread to other parts of the body. Cancer cells in some tumors spread throughout the body through the lymphatic system, and one of the earliest sites for these tumors to spread is in nearby lymph nodes.

What is a sentinel lymph node?

The sentinel lymph node is the first watchful lymph node in which cancer cells are most likely to be expected from the primary tumor.There can be several such nodes.

Prices

$ 90,025 $ 11850 90,026

# Procedure name Price
1 Sentinel Biopsy, without enlargement of the primary site of removal – middle and lower parts of the body (including 1 day of hospitalization)
2 Sentinel Biopsy, with expansion of the primary site of removal – middle and lower parts of the body (including 1 day of hospitalization) $ 13500

What is a sentinel lymph node biopsy?

Sentinel Lymph Node Biopsy – Sentinel Lymph Node Biopsy (SLNB) – a procedure in which a sentinel lymph node is identified and removed for subsequent detection of cancer cells.Sentinel lymph node biopsy is a surgical procedure that is performed with the lymphogenous spread of the tumor process outside the primary tumor, while a biopsy of the lymph node adjacent to the tumor is performed. This manipulation is most often used to determine the prevalence of breast cancer and melanoma.

A negative SLNB result suggests that the cancer has not spread to nearby lymph nodes or other organs. A positive SLNB result indicates that cancer cells are present in the sentinel lymph node and may be in other nearby, so-called regional lymph nodes, and possibly other organs.This information can help the doctor determine the stage of the cancer (the extent of the disease and its prevalence in the body) and develop an optimal treatment plan.

How is SLNB conducted?

The surgeon injects a radioactive substance, a special blue dye, near the tumor to locate the sentinel lymph node. Then, to search for the sentinel lymph node, a device is used that detects the activity of the nodes that have absorbed the radioactive dye. After the sentinel lymph node is located, the surgeon makes a small incision (about 1/2 inch) of the skin in the projection of the lymph node and removes it.

Sentinel Lymph Node Biopsy (SLNB) is a procedure in which a sentinel lymph node is identified and removed for subsequent detection of cancer cells.

Then a histopathological examination of the sentinel node for the presence of cancer cells is carried out. If cancer is found, the surgeon may remove additional lymph nodes. This is done either during one procedure or on subsequent biopsies. SLNB is more often performed on an outpatient basis, sometimes requiring a short inpatient stay.

SLNB is usually performed concurrently with removal of the primary tumor. However, this procedure can also be performed before or after removal of the tumor.

What are the benefits of SLNB?

The technique allows you to determine the stage of cancer and assess the risks of the spread of the tumor process to other parts of the body. SLNB may help some patients avoid extensive lymph node removal.Removal of additional nearby lymph nodes may not be necessary if the sentinel lymph node does not contain cancer cells. Currently, the SLNB technique is the gold standard in breast cancer and melanoma surgery. It allows you to minimize the risks of recurrence and spread of the tumor process, as well as to avoid extensive traumatic interventions on the lymphatic system.

Targeted removal of lymph nodes – prevention of complications

Any, especially voluminous, surgical interventions on the lymph nodes can have adverse consequences, while the fewer lymph nodes are removed, the less severity of complications will be.

Potential side effects of lymphatic surgery

  • Lymphostasis (lymphedema) – tissue edema. Sentinel lymph node biopsy or more extensive surgery on lymph nodes and lymph vessels extending towards and away from the sentinel lymph node disrupts normal lymph drainage through the affected area, accompanied by abnormal lymphatic fluid accumulation and edema. Also, patients with lymphostasis may experience pain and discomfort in the affected area.In the case of major operations on the lymph nodes in the axillary and groin areas, the edema can spread to the entire limb. In addition, the increased content of lymph in the limb can potentiate the development of infectious complications. Very rarely, chronic lymphedema due to extensive removal of the lymph nodes is complicated by cancer of the lymphatic vessels, the so-called. lymphangiosarcoma.
  • Seroma – accumulation of lymphatic fluid at the site of surgery.
  • Numbness, soreness at the site of surgery.
  • Dysfunction of the affected limb or body part.

Does sentinel have other side effects?

  • Like any other surgical procedure, a Sentinel biopsy can be accompanied by short-term pain, edema and hemorrhage at the site of surgery, as well as the risk of tissue infection.
  • Some patients may have an allergic reaction to the blue dye used in sentinel lymph node biopsies.
  • False negative biopsies are situations where cancer cells are not found in sentinel lymph nodes while they are present and may have already spread to other regional lymph nodes or other organs. In such cases, erroneous negative biopsy results give the patient and the doctor a false sense of security about the extent of cancer in the patient’s body.

Is sentinel lymph node biopsy used to treat other cancers?

Sentinel biopsy is used primarily in the treatment of breast cancer and melanoma.However, the method is currently being explored to detect other cancers, including colorectal cancer, stomach cancer, head and neck cancer, thyroid cancer, and non-small cell lung cancer.

Sentinel lymph node biopsy for melanoma

A meta-analysis of 71 studies involving 25,240 patients was to answer the question of whether patients with melanoma who received a negative sentinel lymph node biopsy, in the absence of clinical signs of other lymph node involvement, avoid major traumatic lymph node surgery during primary removal of the tumor.The results of the study show that this question can be answered in the affirmative: the risk of cancer recurrence in regional lymph nodes in patients with negative SLNB was less than 5%.

Sentinel lymph node biopsy allows you to determine the stage of cancer and assess the risks of the spread of the tumor process to other parts of the body

Currently, the National Institutes of Health and the John Wayne Cancer Institute (USA) are conducting a large-scale Selective Lymphadenectomy Study II (MSLT-II), the purpose of which is to answer the question of whether the removal of the remaining regional lymph nodes is clinically significant for survival in the presence of tumor cells in the sentinel lymph node.The study is designed for 10 years, more than 1900 patients are taking part in it.

Biopsy of sentinel lymph nodes in melanoma can be performed as an independent diagnostic manipulation, as well as during primary surgery to remove the tumor. The cost of a lymph node biopsy is variable and depends on the scope of the planned diagnostics or surgical measures. The complexity of the manipulation of the lymph node biopsy, the price, the degree of preparation of the patient and the time spent in the hospital are set individually, after prior consultation with a specialist.

Why sentinel lymph node biopsy is not performed in Russia and other CIS countries

  1. Necessary elements for biopsy of a sentinel lymph node – a radioactive element and a dye are not certified in Russia today. This makes it impossible and illegal to conduct an operation on the territory of the Russian Federation.
  2. Lack of required equipment
  3. Lack of experience of doctors in carrying out this operation.

Due to the above factors, the number of patients from Russia with a diagnosis of melanoma seeking treatment at the Melanoma Unit oncodermatology clinic is growing every year.

Sources

90,000 ultrasound of lymph nodes in Tyumen

The Alfa-Health Center clinic has digital ultrasound diagnostic devices. An ultrasound examination allows you to detect diseases at an early stage. The doctors of the clinic will offer treatment and help you stay healthy.

Lymph nodes in the body perform an important function of protection from external agents: viruses, bacteria, fungi, poisons, etc. Through them, the blood passes and is purified.There are hundreds of nodes in the human body, and each has its own role.

Changes in the structure of the lymph node do not always indicate a disease of the lymphatic system. Organs are sensitive to pathological processes throughout the body. The system is hidden in the layers of surrounding tissues, therefore, ultrasound is prescribed to diagnose any disease. An ultrasound scan of the lymph nodes gives the doctor the information he needs.

Indications for ultrasound of lymph nodes

The procedure is prescribed for the following symptoms:

  • The presence of purulent processes.
  • Swollen lymph nodes, pain on palpation.
  • Swelling and flushing of the skin.
  • Oncological diseases of the circulatory and lymphatic system.
  • Tumors, cysts in the immediate vicinity of the nodes.
  • Suspected metastases.
  • Asymmetric and mobile lymph nodes.

What the ultrasound shows

The diagnosis depends on the location of the altered node:

  • Ultrasound of the lymph nodes of the neck is prescribed for cancer, actinomycosis, tuberculosis.The study is also necessary in the absence of positive dynamics after treatment of the underlying pathology. Cervical lymph nodes help diagnose infections. For example, non-suppurative lymphadenitis does not damage tissue. The knots on the neck remain straight and well-defined. Only magnification is determined.
  • Ultrasound of the lymph nodes of the armpits is performed for mastitis, fibrosis, breast cancer, after removal of the breast. The examination is carried out as planned or as directed by a doctor if metastasis is suspected.Ultrasound of the axillary lymph nodes is also needed after toxoplasmosis has been treated and HIV-positive has been established. Viruses often persist in these structures.
  • Ultrasound of the inguinal lymph nodes helps in the diagnosis of infectious diseases, inflammatory processes in the small pelvis. Puffiness may indicate the presence of syphilis, HIV. The inguinal structures as regional can be involved in the malignant process – this is evident from the high echogenicity. A patient with such indications is referred to an oncologist’s consultation, it is possible to prescribe an additional ultrasound of the peripheral lymph nodes.

Sign up for an ultrasound of the lymph nodes of the neck and other parts of the body in Tyumen

We conduct a study of the cervical, inguinal, peripheral lymph nodes, scan the armpits. The ultrasound protocol is handed over to the patient. If necessary, in the clinic “Alfa-Health Center” you can do an ultrasound of regional lymph nodes, take tests, make an appointment for a consultation with a narrow specialist. The phone number is listed on the website.

synlab: lymph nodes

What is the lymphatic system?
The human lymphatic system is a huge network of tiny vessels that combine into larger ones and go to the lymph nodes.Lymphatic capillaries penetrate all human tissues, as well as blood vessels. Connecting with each other, the capillaries form the smallest network. Through it, fluid, protein substances, metabolic products, microbes, as well as foreign substances and toxins are removed from the tissues.
The lymph that fills the lymphatic system contains cells that protect the body from invading microbes and foreign substances. Combining, the capillaries form vessels of various diameters. The largest lymphatic duct flows into the bloodstream.

What are lymph nodes and why are they needed?
Lymph nodes are round or oval formations ranging in size from 1 millimeter to 2 centimeters. The lymph node is a barrier to the spread of both infection and cancer cells. It forms lymphocytes – protective cells that are actively involved in the destruction of foreign substances and cells.
There are several groups of lymph nodes. These groups are located in such a way as to become an obstacle to infection and cancer.So, the lymph nodes are located in the elbow bend, armpit, in the knee bend, and also in the groin area. The lymph nodes in the neck provide protection against infections and tumors in the head and organs in the neck.
A huge number of lymph nodes are found in the abdominal and chest cavity. Lymphocapillaries penetrate organs as well as superficial tissues. The lymph nodes along the blood vessels perform the same functions.

An increase in lymph nodes indicates a problem in the area that the node “serves”.Most often, an increase in the lymph node is associated with an infection, less often it is a consequence of a tumor lesion.
With purulent processes, as a rule, acute lymphadenitis occurs – inflammation of the lymph node. An inflammatory process occurs due to the ingress of microbes from wounds located in the “service area” of the lymph node. The main manifestation is an increase in the lymph node, the appearance of pain when it is felt. If a purulent process occurs over the lymph node, the skin may turn red.If at this moment the resulting cavity is not opened, the lymph node membrane ruptures and pus penetrates into the surrounding tissues. There is a severe complication of lymphadenitis – phlegmon.

IMPORTANT! Ultrasound has limited capabilities, and its data without additional research cannot be the basis for a diagnosis.

How is the examination of the lymph nodes done. Lymph node ultrasound does not require special training and is extremely simple.The sensor of the apparatus is lubricated with a gel-like substance and tightly pressed against the area of ​​the body not covered by clothing. An image is projected on the monitor of the ultrasound unit, which is formed by sound waves sent into the body and reflected back. An exception is the procedure for ultrasound of the lymph nodes in the groin. Since the changes in the lymph nodes in this area are predominantly of a venereal nature, it is necessary to undergo an examination by a venereologist before conducting.

Cancer of the lymph nodes: causes, treatment and specialists

What is lymphoma?

The term lymphoma refers to an enlarged lymph node as well as its tumor, which can be either benign or malignant.At the heart of malignant lymphoma is a strong proliferation of pathologically altered lymphocytes. These can be B- or T-lymphocytes, as well as their precursors.

Lymphomas are divided into two groups: Hodgkin’s lymphomas and non-Hodgkin’s lymphomas. In Germany, about 13 out of 100,000 people develop lymphoma every year. Both young (10–20 years old) and elderly people (over 60 years old) are affected.

What are the causes of lymph node cancer

In Hodgkin’s lymphoma, the mutated B-lymphocyte multiplies in the area of ​​the lymph node.Non-Hodgkin’s lymphoma can develop from B and T lymphocytes and their precursors. Lymphoma can occur in the lymph node, bone marrow, and blood (leukemia).

The causes of Hodgkin’s lymphoma are unknown, but HIV and EBV infections can increase the risk, as do immunosuppressive therapies and toxic substances such as wood preservatives.

Non-Hodgkin’s lymphomas occur when some genes are in the wrong place, such as on the wrong chromosome.This can be caused by congenital and acquired immunodeficiencies, immunosuppressants and radiation, as well as radioactive substances. In addition, infections such as human T-lymphotropic virus, HIV, EBV, and Helicobacter pylori can cause non-Hodgkin’s lymphoma. For people with AIDS, the risk is 1,000 times higher.

What are the symptoms of lymphomas?

Hodgkin’s lymphoma manifests itself, in particular, through enlarged lymph nodes in the head, neck and chest. Later, malignant cells can spread throughout the lymphatic system, and then the circulatory system.Lymphomas interfere with the formation of healthy protective cells, which can lead to a weakened immune system, especially in relation to tuberculosis, fungal diseases and viruses.

Symptoms B are also typical:

  • fever,
  • night sweats
  • weight loss.

This can cause itching, neurological disorders and hormonal imbalances. In rare cases, drinking alcohol can cause painful lymph nodes.Typically, the lymph nodes are painless and tightly fused, in contrast to the painful and movable lymph nodes during inflammation.

In non-Hodgkin lymphoma, there is an enlarged spleen (destruction of old blood cells) and increased bleeding (suppression of new hematopoiesis due to too many lymphocytes in the bone marrow)

How is lymph node cancer diagnosed?

The first guesses come from the patient’s conversation and the subsequent physical examination.In a blood picture, a hemato-oncologist (an internal medicine specialist who specializes in hematological and oncological diseases) can detect various specific changes. The diagnosis is confirmed by removal and examination of the lymph node tissue.

If non-Hodgkin’s lymphoma is suspected, additional gene analysis is done. Once the diagnosis is made, the entire body is scanned for lymphomas. For this, an ultrasound of the abdominal cavity, chest x-ray, computed tomography of the neck, chest and abdomen, as well as bone marrow examination are performed.

How is lymphoma treated?

Lymphomas are usually treated with chemotherapy and radiation therapy. If there is a desire to have children in the future, preservation of sperm may be considered before starting treatment.

Several chemotherapy regimens are available, depending on the extent of the lymphoma. In this case, the oncologist-hematologist administers various chemotherapy drugs at regular intervals and in a special order. In the case of minor damage, radiation therapy can be canceled after a certain time to minimize subsequent damage.

According to the many different subtypes of non-Hodgkin’s lymphoma, there are different treatment regimens that also include chemotherapy and radiation, as well as stem cell therapy (bone marrow transplant) in some cases.

Recovery Chances and Life Expectancy for Malignant Lymphomas

10% of treated patients with Hodgkin’s lymphoma do not respond to therapy. Similarly, 15% of cases have early relapse (reappearance of lymphoma within one year), while another 15% have late relapse (after more than one year).

The first two options are associated with a significantly worse prognosis and require intensive follow-up treatment (high-dose chemotherapy and stem cell transplantation). The probability of recovery with a late relapse is 50%, with an early relapse – from 20 to 30%.

Therefore, regular and detailed follow-up examinations with a hematonocologist are extremely important. In particular, because strong chemotherapy and radiation therapy can cause new lymphoma over time. Therefore, accurate, patient-specific treatment is very important to use as much as necessary, but with as little potentially harmful radiation and chemotherapy as possible.Different groups of non-Hodgkin lymphomas have different prognosis, ranging from poor to very good.


Sources:

  • Gerold, Gerd: Internal Medicine. Cologne, self-published, 2012 (Herold, Gerd: Innere Medizin. Köln, Eigenverlag 2012.)
  • Arastekh, K .; Benkler, H.-W. ; Bieber, S .; and others: Internal medicine. Stuttgart, Georg Thieme Verlag KG 2009. (Arasteh, K.; Baenkler, H.-W.; Bieber, C.; et al .: Innere Medizin. Stuttgart, Georg Thieme Verlag KG 2009.)

During the incubation period, the following processes occur in the body

The immune system is faced with an infection unknown to it until now and cannot immediately begin to fight it, the virus begins to actively multiply, its amount in the body is growing rapidly. Different organisms take different times to identify the virus and start producing the desired antibodies, but in most cases, HIV antibodies begin to actively develop 10-12 days after infection, which leads to the destruction of a large number of viruses.First of all, viruses that “float” in the blood and have not had time to penetrate into cells are destroyed. As a result, the amount of virus in the body is significantly reduced. It is with these processes that the appearance and unexpected disappearance of symptoms similar to an acute respiratory infection is associated.

After being infected with HIV, a person can feel completely healthy for a long time – from 2 to 10-12 years. During this time, an HIV-infected person will look normal and remain physically fully functional.The period when a person is already infected with HIV but does not have any significant symptoms is called latent or “asymptomatic”. At this stage, the only sign of HIV infection is widespread lymphadenopathy – an increase in 2-3 lymph nodes in various places on the body of an HIV-positive person (usually, the cervical, supraclavicular, subclavian and axillary lymph nodes swell and palpate). Such lymphadenopathy is due to the fact that over time, the amount of the virus in the body slowly increases.The constant presence of the virus keeps the immune system in constant tension. The virus infects more and more CD4 + cells and disrupts the membranes of other cells in the body. The more viruses become, the more CD4 + cells are affected, the more the body spends on fighting the infection.
Each organism has its own resources and potential, they are not endless. After a while, the body runs out of resources, and the virus encounters less and less resistance. The number of new CD4 + cells produced decreases, and with them the number of antibodies to HIV decreases.As a result, the “killer” cells have less and less opportunity to destroy the virus. Since CD 4 cells are needed to fight all infections, the body’s ability to resist diseases decreases, immunodeficiency begins to develop, which leads to the stage of a secondary disease with the following symptoms (a symptom is any separate sign (manifestation) of the disease.

B in the terminal stage of HIV infection or in the stage of AIDS, a person becomes defenseless not only against common infections such as influenza or dysentery, but also against bacteria and viruses that previously could not cause illness, since the immune system did not allow them to multiply in large numbers.Infections that, with a healthy immune system, did not harm the body, against the background of immunodeficiency, cause serious diseases that are called opportunistic (translated from the Latin language “opportunistic” means “using the case”).

Most common opportunistic infections and illnesses:

  • Carini pneumocystis – causes severe pneumonia;
  • cytomegolovirus (CMV) – causes damage to the eyes, mucous membranes and nerve cells, which leads to loss of vision, ulcers of internal organs and impaired brain activity;
  • herpes infection – affects the mucous membranes and skin, leads to significant ulceration on the internal organs and skin;

  • tuberculosis – developing most often in the lungs, with immunodeficiency it can penetrate into various tissues and organs and cause significant damage there;

  • various fungi – infect the skin and mucous membranes, lead to significant ulceration of internal organs and skin, especially significant lesions can be in the mouth and gastrointestinal tract;

  • Kaposi’s sarcoma – cancer of the walls of blood vessels (also called skin cancer, which is not true).This tumor can develop in any part of the body, but most importantly, it can cause significant physical deformities to a person. It often manifests itself as large dark cherry or brown plaques on the skin, which eventually develop into deep ulcers.

90,000 PET CT lymphoma diagnostics in the network of nuclear centers PET-Technology

Lymphomas are malignant neoplasms emanating from the elements of the lymph nodes (nodular form) or lymphatic tissue outside them.They make up 5% of all oncological pathologies. Timely diagnosis of lymphomas is very important not only due to the high prevalence – the disease often occurs in children and adults from 3 to 40 years old, for a long time it proceeds without pronounced symptoms.

Types, symptoms and localization of lymphomas

Lymphomas are divided into two large groups: Hodgkin’s lymphoma (about 60% of all cases) and non-Hodgkin’s lymphomas, which are more aggressive and have a worse prognosis. According to the degree of malignancy, non-Hodgkin’s lymphomas are divided into low, medium and high.One of the most malignant types of the disease is Burkitt’s lymphoma, originating from B-lymphocytes.

The disease can develop in any organ or tissue where there are lymphoid cells. Normally, they are found in the lymph nodes, tonsils, thymus gland, spleen, follicles of the small intestine, as well as in extra-lymphatic organs that are not related to the lymphatic system: the brain, spinal and bone marrow, lungs, uterus, ovaries and testes, kidneys, liver, stomach , colon, skin and bones.

PET / CT scan results. Left: non-Hodgkin’s lymphoma (affection of the left palatine tonsil and spleen, affection of the lymph nodes above the diaphragm. Right: Hodgkin’s lymphoma (affection of the lymph nodes on both sides of the diaphragm, with a tendency to merge into massive conglomerates, the largest in the axillary region on the left and in the lymph nodes of the mediastinum on the right. III stage)

At the first or second stage of the disease, there is a limited lesion of the lymph nodes or one extra-lymphatic organ on one side of the diaphragm – the muscular septum between the abdominal and chest cavities.Typically, the very first symptom of lymphoma is swollen lymph nodes. A biopsy of the affected lymph node and analysis for histology make it possible to establish the correct diagnosis.

At the third-fourth stage, the defeat of the lymph nodes on both sides of the diaphragm and / or several extra-lymphatic organs is detected. The patient complains of symptoms typical for most cancers: apathy, fatigue, weight loss, as well as symptoms associated with damage to a specific organ.

To select adequate therapy for lymphomas, it is important:

  • comprehensive examination before starting therapy: determining the type, degree of malignancy and stage of the disease in the patient with the diagnosis;
  • timely monitor the effectiveness of therapy: at intermediate stages between courses to determine the effectiveness of the selected regimen and timely adjust the treatment plan, as well as after a full course to determine the risk of relapse or confirm remission of the disease.

The most informative method for determining the stage and aggressiveness of the disease is PET / CT. CT and MRI are also used for diagnosis, but with their help it is difficult to distinguish a malignant process from benign changes, and the assessment of the prevalence of the process takes longer than with PET / CT.

Positron emission tomography allows you to analyze metabolic processes in cells. Malignant tumors absorb nutrients more intensively than usual, which means that they accumulate more radiopharmaceuticals and are clearly visible in the images as areas of bright glow.CT and MRI show only structural changes in organs; it is impossible to objectively assess the functional state of cells with these methods.

Whole body PET / CT in patients with lymphomas

Whole body PET / CT with 18F-fluorodeoxyglucose is used to evaluate patients with lymphomas. This radioactive drug is distributed to all organs and tissues. In one study, the doctor receives an image of all anatomical areas. To achieve this coverage with diagnostic CT, a series of examinations of different areas of the body must be analyzed, which increases the patient’s radiation exposure.

PET / CT for lymphomas is used in the following cases:

  • determination of the stage of the tumor process and the degree of its prevalence;
  • analysis of the effectiveness of treatment, including in the early stages;
  • clarification of the prognosis of the disease;
  • radiation therapy planning;
  • determination of the best site for biopsy;
  • Diagnosis of disease relapses.

According to various data, the sensitivity of PET / CT diagnostics can reach 100% in diffuse large B-cell lymphoma, 98% in Hodgkin’s lymphoma and follicular lymphoma, 67% in forms affecting the mantle zone, 95% in myeloma.The examination is most effective in cases where lymphoma cells are characterized by increased activity, that is, with Hodgkin’s disease and non-Hodgkin’s lymphomas of a high degree of malignancy.

You can ask a question about the use of PET / CT diagnostics
for lymphoma to our leading specialists:

Abashin Sergey Yurievich, MD, DSc, Professor, Oncologist, Chemotherapist, Moscow

Natalya Aleksandrovna Rucheva, Ph.D., Head. Department of Radionuclide Diagnostics, Radiologist-Radiologist, St.Moscow

Ivannikov Vitaly Valerievich, head of the direction “Radiation diagnostics”, radiologist-radiologist, Moscow

Primary diagnosis and staging of lymphomas

Currently, lymphomas, especially Hodgkin’s lymphoma, are classified as malignant diseases with a good prognosis. After histological verification of the diagnosis, it is necessary to accurately determine the stage and degree of malignancy of the disease. To choose the right chemotherapy regimen, you need to know how much the tumor has spread throughout the body and lymph nodes, and the exact location of the tumor is important for the appointment of radiotherapy.

PET / CT can detect malignant tumors from 6 mm in diameter and accurately measure the metabolic size of the lesion.

Often, primary diagnosis is carried out using X-ray, ultrasound, CT, MRI, and the treatment regimen is selected based on the number and size of the identified foci. Connective tissue is often formed around malignant tumors as treatment responds, or necrosis of tumor tissues occurs due to circulatory disorders. Such processes cause errors when analyzing the size of the focus – it seems larger than it actually is.Also, CT and MRI can miss neoplasms in cases when the pathological process occurs at the cellular level, and the structure of the organ or lymph node does not visually change.

PET / CT can detect malignant tumors from 6 mm in diameter and accurately measure the metabolic size of the lesion. The picture shows active malignant cells, and the connective tissue is almost indistinguishable from healthy areas, since it does not absorb the radiopharmaceutical.

PET / CT for the analysis of the effectiveness of treatment

PET / CT examination, St.Moscow

To analyze the effectiveness of treatment for lymphoma, it is important to assess the rate of tumor response to therapy. If the number of active cells in the foci is reduced to a minimum or they disappear completely, this is considered a complete metabolic response. In patients with such a response, in a short time (after 2-3 courses), longer remissions are observed. Otherwise, when the number of active cells does not decrease or increases, the patient needs a correction of the treatment regimen.

With the help of CT or MRI, it is difficult to confirm or deny the achievement of remission; in 30-60% of cases, a wrong diagnosis is made.The fact is that connective tissue remains at the site of the tumor focus in a number of patients, the lymph nodes can be completely replaced by it (fibrosis). Areas of fibrosis on CT or MRI studies are visible as a structural change in the organ. Only positron emission tomography helps to see whether active malignant cells remain in such foci.

As a result, PET / CT can improve the effectiveness of treatment and improve the prognosis:

  • Timely transfer of patients whose tumor does not respond to treatment to high-dose chemotherapy or the appointment of radiation therapy increases the chances of survival;
  • 90,085 Reducing the intensity of therapy, avoiding high doses of chemotherapy or radiation therapy in patients in remission reduces the risk of complications and increases long-term survival.

Prices for PET / CT examination in Moscow

Prices for positron emission tomography in Moscow depend on the type of study. You can check the cost by calling the round-the-clock information service or see the price list.

The federal network of nuclear medicine centers “PET-Technology” provides patients with diagnostic and medical care in accordance with international quality standards. The appropriateness of PET / CT in each specific case of lymphoma is determined by a hematologist.Our centers in Moscow and other cities are equipped with modern equipment for PET / CT diagnostics; our staff employs qualified radiologists who have undergone training in leading medical clinics and diagnostic institutions in Russia and the world.

CT of lymph nodes with contrast



Computed tomography of lymph nodes with contrast is a method for diagnosing the general condition, size, structure of lymphoid tissue.

What

Shows

Intravenous administration of a contrast agent increases the clarity, brightness and detail of the image. As a rule, the examination is indispensable in identifying or refuting oncological ailments, in the study of blood vessels. Since the dye accumulates, the lymph nodes are brighter illuminated in the presence of pathology.

Signs of diseases become visible, which cannot be seen with the classic scan.These include hyperplasia, vasoconstriction, changes in the composition of blood flow, heterogeneity, conglomerates, contour changes, infiltration of surrounding tissues, adipose tissue of the node gates.

Basically, diagnostics is prescribed for lymph node metastasis, lymphogranulomatosis, lymphocytic leukemia.

Common symptoms that indicate the development of a cancerous tumor are a sharp weight loss of up to 10%, fever, weakness of the body, increased sweating at night, anemia.

Lymph nodes located next to adipose tissue or large vessels are most often scanned. For example, the lymph nodes of the neck, armpits, groin area.

Preparation

Before starting CT scan of lymph nodes with the introduction of contrast, you need to prepare the body. To do this, you should pass laboratory blood tests for creatinine and urea. These examinations can be performed within the walls of the “Health Clinic”.

Procedure

The course of the tomography procedure with contrast when studying the lymph nodes is as follows – the first part of the images is performed, then the patient is injected with a dye based on iodine or barium.The process continues, while those areas that were in doubt are now displayed brighter.

The total duration is about 10-15 minutes.

After the injection, the patient may notice dizziness, nausea, blurred eyes, and general weakness. The symptoms go away on their own within a couple of hours.

Interpretation takes 15-20 minutes. After this time has elapsed, the results are returned as snapshots. In addition, there are documents with a presumptive diagnosis, a description of the identified changes.

The most complete picture of the examination is obtained thanks to the Brilliance CT 16 tomograph manufactured by Philips Medical Systems. Modern equipment allows to reduce the time of the procedure by means of a scanning step of about 0.5-1.5 mm. Due to such a slice thickness, not only the speed of tomography increases, but also the accuracy of the study.

It should be noted that the radiation dose is minimized, since the X-ray radiation is narrowly directed.

Testimonials


Signed up on the site – very convenient.
Came to the time and immediately went into the office. There was no need to wait for the CT scan. Pleasant doctor Vasilenko T.G. asked before the study, I did a CT scan of the abdominal cavity. And after the procedure she explained everything, everything is quick and clear, the staff is friendly.

Ekaterina. view full review


I would like to thank the administrator Irina for her professional work, efficiency, cleanliness, and a favorable atmosphere. We arrived half an hour earlier by appointment and we were received ahead of time.Disk, clear pictures and conclusion were received in about 30 minutes.
The cost was the same as promised. The contract and the check were attached. They did not deceive in anything.

Yegor Dmitrievich. view full review


We have the most affordable price for this type of diagnostics in Moscow! For this amount, you get a high-quality examination on a device of the highest international class, with a description from a doctor with 7 years of experience. The helpful staff will surround you with care and attention.We are located in the very center of Moscow, 1 minute walk from the metro!


How to reach us:

Green color marks the way to the parking lot at our Diagnostic Center.
Red dotted dots – marked the pedestrian path from the station. Metro Kitay-Gorod, exit No. 6. Walk to the Health Clinic for 1 minute, the main thing is not to miss the entrance to the arch of the house, it is 20 meters from the exit from the metro. In the courtyard of this house is the entrance to our Diagnostic Center Health Clinic.

Free parking is provided for the patients of the Diagnostic Center. Reservation of a place for a car is made no later than an hour before arrival at the clinic. Call: +7 (495) 628-22-05


Contraindications

As with any other medical service, there are contraindications. You can learn more from our administrators by phone or by chat, in the right corner of the page. We are always in touch.

The equipment of the “Health Clinic” allows you to obtain high-quality images of internal tissues with excessive fat deposits.Therefore, excess body weight up to 130 kg is not a limitation.


Consultation can be obtained by phone: +7 (495) 628-22-05



Survey price

The Health Clinic has a single price for CT with the introduction of a contrast agent to diagnose the condition of the lymph nodes.

Special prices are valid for patients who applied to the clinic on their own – not through the portals for finding doctors and diagnostics.

Service description Price in rubles Price until 07.06.

CT of lymph nodes (with bolus multiphase contrast enhancement)

17,000 8 190

Three-dimensional, volumetric reconstruction for study

1 200 1 200

Study tape

500

If you have not found a service in the price list, please call us at +7 (495) 961-27-67,
You will be given the necessary information.