Lymphoid in neck: Swollen lymph nodes – Symptoms and causes
Swollen cervical lymph nodes: What does it mean?
The lymphatic system is a network of organs and tissues that helps support immunity. The lymph nodes are tiny, kidney-shaped structures that act as filters within this system. Their role is to trap and kill viruses and bacteria before these pathogens can return to the bloodstream.
Lymph nodes exist in different areas of the body, including the neck, or “cervical,” region. Nodes in this area are called “cervical lymph nodes.”
Sometimes, the cervical lymph nodes may swell. This article outlines the potential causes of this swelling, as well as information on treatment options and when to see a doctor.
Cervical lymph nodes are located in the sides and back of the neck. These glands are usually very small. However, when a lymph node is greater than 1 centimeter in diameter, it is enlarged.
The cervical lymph nodes sit deep inside the neck. For this reason, most people without medical training are unable to feel them, even when they are swollen. However, a doctor may be able to feel one or more bumps beneath the skin when examining the neck region.
In some cases, a person with swollen cervical lymph nodes may experience pain and swelling in the neck area.
Many conditions can cause swollen cervical lymph nodes. Each cause is usually accompanied by additional symptoms.
Some possible causes of swollen cervical lymph nodes include:
Infection is one of the most common causes of swollen lymph nodes anywhere in the body.
When there is an infection somewhere in the body, the lymph nodes in that area fill with white blood cells. The white blood cells then start to destroy the pathogens responsible for the infection.
The accumulation of white blood cells in the lymph nodes is what causes them to swell.
Some common infections that may lead to swollen cervical lymph nodes include:
Additional signs of infection depend on the specific illness but may include:
Lymph nodes that swell as a result of infection are usually painful when a person touches them. However, they also tend to return to their normal size once the infection clears.
Less commonly, swollen cervical lymph nodes may be a sign of cancer. Cancers that affect the lymph nodes are called lymphomas. These cancers typically cause swelling of the lymph nodes in more than one area of the body.
There are two main types of lymphoma: Hodgkin lymphoma and non-Hodgkin lymphoma. Non-Hodgkin lymphoma may develop in lymph nodes anywhere in the body, whereas Hodgkin lymphoma tends to develop in the neck, chest, or armpits.
These two conditions share the following symptoms:
A person who experiences any of these symptoms in addition to enlarged lymph nodes should see their doctor. Hodgkin lymphoma is highly treatable if a person receives a diagnosis and starts undergoing treatment in the early stages.
Non-Hodgkin lymphoma is less treatable, but this is because doctors may not be able to diagnose it until it has reached an advanced stage.
HIV is a common cause of swollen lymph nodes. The nodes are particularly prone to swelling in the early, or “acute,” stage of HIV. This is when the body begins fighting the infection.
HIV can cause swelling of the lymph nodes anywhere in the body. However, it most commonly causes swelling in the cervical lymph nodes.
A 2016 study investigated lymph node abnormalities in 100 participants with HIV and swollen lymph nodes. Of the participants, 60% had swelling in the cervical lymph nodes.
Some additional symptoms of HIV include:
Medication side effects
Rarely, swollen lymph nodes can occur as a side effect of a medication. When medication is the cause, swelling may develop in any of the nodes, including the cervical lymph nodes.
Though rare, antiseizure medications and chemotherapy drugs such as granulocyte colony stimulating factor may cause swelling of the lymph nodes.
A doctor can usually detect a swollen cervical lymph node by feeling a person’s neck. Additional tests are often necessary to determine the size of the node and whether or not any other lymph nodes are swollen.
Diagnosing the exact cause of the swollen lymph nodes can be more difficult. To aid the diagnosis, a doctor will ask about the person’s symptoms and medical history. They may also order the following diagnostic tests:
If necessary, the doctor may also perform a biopsy of the cervical lymph nodes to check for the presence of cancer cells.
The treatment options for swollen lymph nodes depend on the underlying cause, as outlined below:
A swollen lymph node usually occurs as a result of infection. In such cases, the lymph node should return to its normal size once the infection has cleared.
Swollen lymph nodes typically do not require treatment unless they are painful. However, if the symptoms are bothersome, the following home remedies may help:
- applying a warm compress several times per day to ease the soreness
- taking over-the-counter nonsteroidal anti-inflammatory medications to reduce discomfort
- getting plenty of rest, which helps the body fight off the infection
If symptoms persist or worsen despite home treatment, a person should see their doctor. The doctor may prescribe antibiotics to help clear the underlying infection.
Share on PinterestChemotherapy and radiation therapy are possible treatments for lymphoma.
Image credit: Coronation Dental Specialty Group, 2009.
The treatments for Hodgkin lymphoma and non-Hodgkin lymphoma depend on several factors, including:
- the type of lymphoma a person has
- the stage the cancer is at
- the person’s overall health
Some potential treatment options include:
A person with HIV may receive antiretroviral medications to help keep the virus under control. These drugs work by reducing the amount of the virus in a person’s blood and bodily fluids.
In most cases, swollen cervical lymph nodes indicate that the body is fighting an infection. Treatment is not usually necessary, since the node should return to its normal size once the infection clears.
However, a person should see a doctor if there are no other obvious signs of infection present. This could indicate that the swelling is due to another cause, such as cancer or HIV.
The following symptoms should prompt a person to see their doctor:
- pain and swelling that lasts for longer than a few days
- additional symptoms, such as fever, unexpected weight loss, or fatigue
- a swollen cervical lymph node that is hard and painless
- a rapid change in the size of the lymph node
- swelling in more than one area of lymph nodes, such as in the neck and the groin
Swollen cervical lymph nodes are common, and they do not usually indicate a serious medical condition. In most cases, swelling is a temporary response to an infection.
Sometimes, however, swollen lymph nodes might signal a more serious underlying condition. A person should see their doctor if the swelling persists, worsens, or is accompanied by other symptoms.
A hard, painless cervical lymph node also requires prompt medical attention.
The treatment of swollen cervical lymph nodes depends on the underlying cause. A person can ask their doctor about the treatment options available to them.
Enlarged Cervical Lymph Nodes
Cervical lymph nodes are the lymph nodes in the neck region. Swollen lymph nodes, described as lymphadenopathy or “swollen glands” can develop due to a variety of conditions, including infections and cancer.
Lymph nodes are part of the immune system, and they are distributed throughout the body. You can’t usually see them or feel them under your skin, and your doctor might gently examine the cervical lymph nodes in your neck to check for swelling or tenderness during your physical examination.
Illustration by Brianna Gilmartin, Verywell
Your cervical lymph nodes run along the sides and back of your neck. Most of the time, you won’t notice your lymph nodes because they are small and located deep under your skin and muscles.
But, on occasion, an infection may cause swollen bumps to develop beneath the skin, at the location of your cervical lymph nodes. Fever and other symptoms of infection may be present as well. Cervical lymphadenopathy may or may not cause pain or tenderness.
Oftentimes, you can feel the swollen nodes when you gently touch your neck. Usually, cervical lymphadenopathy can be felt more than it is seen. Depending on the underlying condition, the lymph nodes may be only slightly enlarged, or they may grow large enough to be visibly disfiguring.
The swelling will usually resolve once the underlying condition is treated. However, lymphadenopathy may persist with certain chronic conditions, like HIV.
Infections caused by pathogens like bacteria and viruses can cause swollen cervical lymph nodes to develop. Staphylococcal infection is a common bacterial culprit.
In children, viral infections (especially viral upper respiratory tract infections) are common causes of cervical lymphadenopathy. Other viruses such as the Epstein-Barr virus. varicella-zoster virus (shingles), and HIV are associated with swollen cervical lymph nodes.
Cervical lymphadenopathy is commonly seen in:
- The common cold
- Ear infections
- Scalp infections
- Strep throat
- Infections of the nose, throat, or mouth
- Dental infections
When you have swollen lymph nodes in your neck, you might also have swollen lymph nodes in your groin and underarms. If swelling affects more than one area of lymph nodes, the condition is usually described as generalized lymphadenopathy.
Cervical Lymph Nodes and Cancer
Swollen cervical nodes are rarely a sign of cancer. However, painless swelling of one or more lymph nodes, especially the cervical lymph nodes, is a key warning sign of lymphoma, including Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). In fact, cervical lymphadenopathy can be one of the few outward signs of lymphoma in the early stages.
- HL is often characterized by the swelling of cervical lymph nodes and usually follows a predictable procession, moving from one lymph node to the next.
- NHL may cause cervical lymphadenopathy with a haphazard development that will more likely cause generalized lymph node swelling.
Squamous cell carcinoma of the head and neck and metastatic carcinomas are other malignancies in which cervical lymphadenopathy is common.
Possible Signs of Cancer
Signs may include:
- Lymphadenopathy lasting for more than six weeks
- Firm, hard, and painless lymph nodes
- A lymph node larger than 2 centimeters (3/4 inch)
- Rapidly increasing size
- Significant and unintentional weight loss
- Night sweats
Swollen Lymph Glands (Lymph Nodes) – Causes, Treatment, Info
What are swollen glands?
Dr Sarah Jarvis MBE
What are lymph glands?
Detail of lymph gland names
Small lymph glands (sometimes called lymph nodes) occur throughout the body. Lymph glands that are near each other often form into groups or chains. Examples of where lymph glands group together are the sides of the neck, the armpits and the groins. The diagram shows the main groups of lymph glands in the head and neck. However, lymph glands occur in many other places in the body.
Lymph glands are joined together by a network of lymph channels. Lymph is a fluid that forms between the cells of the body. This watery fluid travels in the lymph channels, through various lymph glands, and eventually drains into the bloodstream.
Lymph and lymph glands are major parts of the immune system. They contain white blood cells (lymphocytes) and antibodies that defend the body against infection.
What causes swollen lymph glands?
Lymph glands are normally pea-sized. You can sometimes feel them as lumps under the skin. People often feel their lymph glands in the neck. Lymph glands under the skin become more noticeable and easier to feel if they swell. They can swell to the size of marbles or even bigger.
You cannot see or feel lymph glands that are deeper in the chest or tummy (abdomen) but they may be uncomfortable or tender.
Causes of swollen lymph glands include the following:
Infection – the common cause
The lymph glands near to an infection swell quickly and become tender as the immune system ‘fights off’ infecting germs (bacteria, viruses, etc). The lymph glands usually go back to their normal pea size when the infection is over. It can take a week or so for them gradually to go back to normal after the infection. Examples of infections include the following:
Cancers, lymphomas and leukaemias – the less common causes
Some cells from a cancer can break off and spread (metastasise) to nearby lymph glands via the lymph channels. These cancer cells then grow and multiply in the lymph glands and cause the glands to swell. For example:
As a rule, swollen lymph glands due to cancers, lymphomas and leukaemias develop more slowly than those due to infections. They also tend to be painless at first.
Other less common causes
Rarely, swollen lymph glands can be due to causes such as:
What is the treatment for swollen lymph glands?
The treatment depends on the cause. Swollen lymph glands are like a marker of various conditions, all with different outlooks and treatments. So, for example, the common cause is due to a viral infection. In this case no specific treatment may be advised and the lymph glands will normally go back to normal after a week or so. However, swollen lymph glands caused by a cancer, lymphoma or leukaemia may need extensive treatment.
What should I do if I find swollen lymph glands?
Swollen lymph glands due to viral infections are common. For example, swelling of neck lymph glands may go up and down if you have frequent throat infections. This is of little concern. However, you should see your doctor if your lymph glands have not gone down after two weeks.
Swollen lymph glands are more of a concern if there is no apparent reason for them to swell. Tell your doctor if:
- You find swollen lymph glands and you do not know why they have swollen. For example, you do not have an infection to cause them to swell.
- You find swollen lymph glands just above or just below your collar bone (clavicle). Swollen glands in this area are more likely to suggest a cause for concern.
- Swollen lymph glands due to an infection do not go down again within two weeks.
Local Lymph Node Swelling in the Neck, No Antibiotic Treatment
You have a swollen lymph node in your neck that is not infected. The lymph nodes are part of the immune system. They are found under the jaw and along the side of the neck, in the armpits, and in the groin. A nearby infection or inflammation causes the lymph nodes in that area to swell. They may also be mildly tender. This is normal.
Antibiotics are not used for a swollen lymph node that is not infected. You can use warm compresses and pain medicine to treat this condition. The pain will get better over the next 7 to 10 days. The swelling may take 1 to 2 weeks or more to go away.
Rarely, a bacterial infection occurs inside the lymph node itself. When this happens, the lymph node becomes very painful and the nearby skin gets red and warm. You may also have a fever. If this happens, call your healthcare provider. You may need to take antibiotics. You may also need to have the lymph node drained.
Follow these guidelines when caring for yourself at home:
Make a warm compress by running warm water over a washcloth. Put the compress on the sore area until the compress cools off. Repeat this for 20 minutes. Use the compress 3 times a day for the first 3 days, or until the pain and redness start to get better. The heat will make more blood flow to the area and speed the healing process.
You may use acetaminophen or ibuprofen to control pain and fever, unless another medicine was prescribed for this. Don’t use ibuprofen in children under 6 months of age. If you have chronic liver or kidney disease, talk with your healthcare provider before using these medicines. Also talk with your provider if you’ve had a stomach ulcer or digestive tract bleeding. Don’t give aspirin to anyone under 18 years of age who is ill with a fever. It may cause severe liver damage.
Follow up with your healthcare provider, or as advised.
When to seek medical advice
Call your healthcare provider right away if any of these occur:
Redness over the lymph node
Swelling or pain in the lymph node gets worse
Lymph node is getting soft in the middle
Pus or fluid drains from the lymph node
You have trouble breathing or swallowing
Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider
You have questions or concerns
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Lymph Nodes and Cancer
What is the lymph system?
The lymph (or lymphatic) system is a part of your body’s immune system. It includes a network of lymph vessels and lymph nodes. Lymph vessels are a lot like the veins that collect and carry blood through the body. But instead of carrying blood, these vessels carry the clear watery fluid called lymph. Lymph fluid also contains white blood cells, which help fight infections.
Lymph fluid would build up and cause swelling if it were not drained in some way. Lymph vessels draw up the lymph fluid from around the cells to send it towards the chest. There, lymph fluid collects into a large vessel that drains into a blood vessel near the heart.
Lymph nodes and what they do
Lymph vessels send lymph fluid through nodes throughout the body. Lymph nodes are small structures that work as filters for foreign substances, such as cancer cells and infections. They contain immune cells that can help fight infection by attacking and destroying germs that are carried in through the lymph fluid. Lymph nodes are located in many parts of the body, including the neck, armpit, chest, abdomen (belly), and groin. They contain immune cells that can help fight infection by attacking and destroying germs that are carried in through the lymph fluid.
There are hundreds of lymph nodes throughout the body. Each lymph node filters the fluid and substances picked up by the vessels that lead to it. Lymph fluid from the fingers, for instance, works its way toward the chest, joining fluid from the arm. This fluid may filter through lymph nodes at the elbow, or those under the arm. Fluid from the head, scalp, and face flows down through lymph nodes in the neck. Some lymph nodes are deep inside the body, such as between the lungs or around the bowel, to filter fluid in those areas.
Swollen lymph nodes
When there’s a problem, such as infection, injury, or cancer, lymph nodes in that area may swell or enlarge as they work to filter out the “bad” cells. Swollen lymph nodes (lymphadenopathy) tell you that something is not right, but other symptoms help pinpoint the problem. For instance, ear pain, fever, and enlarged lymph nodes near your ear are clues that you may have an ear infection or cold.
Some areas where lymph nodes commonly swell are in the neck, groin, and underarms. In most cases, only one area of nodes swells at a time. When more than one area of lymph nodes is swollen it’s called generalized lymphadenopathy. Some infections (such as strep throat and chicken pox), certain medicines, immune system diseases, and cancers like lymphoma and leukemia can cause this kind of swelling. Your health care provider will look for more information to figure out the cause of the swelling. Lymph node swelling is often caused by something other than cancer.
Cancer in the lymph nodes
Cancer can appear in the lymph nodes in 2 ways: it can either start there or it can spread there from somewhere else.
Cancer that starts in the lymph nodes is called lymphoma. You can read more about lymphoma in Hodgkin Lymphoma and Non-Hodgkin Lymphoma.
More often, cancer starts somewhere else and then spreads to lymph nodes. That is the focus of this section.
How does cancer spread to lymph nodes?
Cancer can spread from where it started (the primary site) to other parts of the body.
When cancer cells break away from a tumor, they can travel to other areas through either the bloodstream or the lymph system. If they travel through the lymph system, the cancer cells may end up in lymph nodes. Most of the escaped cancer cells die or are killed before they can start growing somewhere else. But one or two might settle in a new area, begin to grow, and form new tumors. This spread of cancer to a new part of the body is called metastasis.
In order for cancer cells to spread to new parts of the body, they have to go through several changes. They must become able to break away from the original tumor and attach to the outside wall of a lymph or blood vessel. Then they must move through the vessel wall to flow with the blood or lymph to a new organ or lymph node.
When cancer does spread to lymph nodes, it usually spreads to nodes near the tumor itself. These are the nodes that have been doing most of the work to filter out or kill the cancer cells.
How is cancer in lymph nodes found?
Normal lymph nodes are tiny and can be hard to find, but when there’s infection, inflammation, or cancer, the nodes can get larger. Those near the body’s surface often get big enough to feel with your fingers, and some can even be seen. But if there are only a few cancer cells in a lymph node, it may look and feel normal. Lymph nodes deep in the body cannot be felt or seen. So doctors may use scans or other imaging tests to look for enlarged nodes that are deep in the body. Often, enlarged lymph nodes near a cancer are assumed to contain cancer.
The only way to know whether there is cancer in a lymph node is to do a biopsy. Doctors may remove lymph nodes or take samples of one or more nodes using needles. The tissue that’s removed is looked at under the microscope by a pathologist (a doctor who diagnoses illness using tissue samples) to find out if there are cancer cells in it. The pathologist prepares a report, which details what was found. If a node has cancer in it, the report describes what it looks like and how much was seen.
When a surgeon operates to remove a primary cancer, they may remove one or more of the nearby (regional) lymph nodes as well. Removal of one lymph node is considered a biopsy, but when many lymph nodes are removed, it’s called lymph node dissection. When cancer has spread to lymph nodes, there’s a higher risk that the cancer might come back after surgery. This information helps the doctor decide whether more treatment, like chemo, immunotherapy, targeted therapy or radiation, might be needed after surgery.
What does it mean if there’s cancer in my lymph node?
If cancer is found in one or more lymph nodes, it could mean that more tests are needed to know how far the cancer has spread. This information is used to determine the stage of your cancer and the best treatment options.
For more information on staging, see Cancer Staging, or find your cancer type for more detailed information.
Effects of removing lymph nodes
When lymph nodes are removed, it can leave the affected area without a way to drain off the lymph fluid. Many of the lymph vessels now run into a dead end where the node used to be, and fluid can back up. This is called lymphedema, which can become a life-long problem. The more lymph nodes that are removed, the more likely it is to occur. To learn more about what to look for, ways reduce your risk, and how to manage this side effect, see Lymphedema.
Removing lymph nodes during cancer surgery is highly unlikely to weaken a person’s immune system, since the immune system is large and complex and is located throughout the body.
Swollen Lymph Nodes and Glands: Causes, Diagnosis, Treatment, Emergencies
Swollen lymph nodes are a sign that your body is fighting off an infection or an illness. Most of the time, they return to normal size when their job is done.
Lymph nodes are round, bean-shaped glands, and you have them throughout your body. There are clusters of them in places like your neck, under your arm, and in the crease between your thigh and your torso (where your leg begins). You can sometimes feel these clusters as little bumps, especially if they’re swollen.
They’re part of your lymphatic system. Along with your spleen, tonsils, and adenoids, they help protect you from harmful germs.
Symptoms of Swollen Lymph Nodes
The most common signs are:
Because swollen lymph nodes are usually linked to some type of illness, you might also have other symptoms, depending on what that illness is:
Runny nose, sore throat, or fever (caused by an upper respiratory infection)
Swelling of clusters of lymph nodes in different places in your body (caused by an infection or an immune system disorder, like rheumatoid arthritis)
Hard lymph nodes that won’t move or get bigger quickly (signs of certain types of cancer)
Causes of Swollen Lymph Nodes
Lymph nodes have immune cells called lymphocytes in them. They attack bacteria, viruses, and other things that can make you sick. When you’re fighting off harmful germs, your body makes more of those immune cells — that causes the swelling.
Your lymph nodes come across all kinds of germs, so they can be swollen for lots of reasons. Usually, it’s something that’s relatively easy to treat, like:
- A virus, like a cold
- A bacterial infection, like an ear infection, skin infection, or infected tooth
Much less often, it can be a more serious illness. They can include:
- Tuberculosis, an infection that usually affects your lungs
- Lyme disease, an infection spread through a tick bite
- A problem with your immune system, like lupus or rheumatoid arthritis
- HIV/AIDS, an infection spread through sexual contact and IV drug use
- Certain kinds of cancer, including:
When to See a Doctor for Swollen Lymph Nodes
In most cases, swollen glands return to normal size after the illness or infection has passed. But here are some things to watch for:
Glands that swelled up very suddenly
Glands that are much larger than they should be, not just mildly swollen
Glands that feel hard or don’t move when you push on them
Glands that stay swollen for more than 5 days in children or 2 to 4 weeks in adults
The area around the glands turns red or purple, it feels warm or you see pus
Swelling in your arm or groin
Sudden weight loss
A fever that doesn’t go away
If you notice any of these, see your doctor.
Swollen Lymph Nodes Diagnosis
Your doctor will start by asking you about your medical history and giving you a physical exam. They might be able to get an idea of what’s making your glands swell by where they are in your body.
They also may recommend one of these tests to find out more about what’s going on:
Ultrasound. High-frequency sound waves are used to let your doctor see what’s happening inside your body.
Magnetic resonance imaging scan (MRI). A powerful magnet and radio waves are used to make detailed images of your organs and tissues.
Biopsy. Lymph node tissue is removed and looked at under a microscope.
PET scan. This looks at the chemical activity in parts of your body. It may help identify a variety of conditions like some cancers, heart disease and brain disorders. This is done less commonly.
CT scan. A series of X-rays are taken from different angles and put together to form a more complete picture.
Swollen Lymph Node Treatment and Home Remedies
If your swollen lymph nodes aren’t caused by something serious, they will go away on their own. A few things may help with any discomfort while you wait for it to run its course:
Warm compress. A washcloth rinsed in hot water and placed on the area that hurts may help ease pain.
Rest. Getting good rest can help you get over a mild illness faster.
Over-the-counter pain relievers: Acetaminophen, aspirin, ibuprofen, or naproxen may make you feel better. (Talk to your doctor before giving aspirin to children or teenagers.)
If something more serious is causing the swelling, treatment can include:
Cancer That Spreads To Lymph Nodes | Signs, Treatments
The body’s lymphatic system helps fight disease and infection. Lymph nodes, also called lymph glands, are a key part of this network of vessels, tissues and organs. Lymph nodes are small, bean-shaped organs that produce and store blood cells, filter waste materials and harmful germs from the body’s tissues, and carry immune cells that fight infection.
There are hundreds of lymph nodes scattered in groups throughout the body, with large concentrations of the glands in the neck, armpits, abdomen and groin. The lymph system is part of the body’s immune system, producing white blood cells—B lymphocytes (B cells) or T lymphocytes (T cells)—that fight infection. The lymph system also includes the tonsils, spleen and thymus.
The lymph system is part of the body’s circulatory system. Lymph vessels are similar to the veins in the cardiovascular system. Instead of blood, the lymphatic vessels carry a clear, watery fluid called lymph (pronounced limf). This lymphatic fluid brings oxygen and other nutrients to tissue cells and takes away waste products from the cells. Each lymph node filters the lymphatic fluid draining from the vessels that lead to it.
The lymph fluid filtered by the lymph nodes, no matter where they’re located, moves to the chest, where it collects into a large vessel that drains into a blood vessel near the heart. From there, the filtered fluid, along with salts and proteins, moves into the bloodstream. Each group of lymph nodes filters a specific region of the body.
Swollen lymph nodes: What do they mean?
Swollen lymph nodes, or swollen glands, are a symptom of many illnesses—from the common cold to some forms of cancer—and a sign that something is wrong in the body. The swelling or enlargement, called lymphadenopathy, occurs in the lymph nodes when they’re filtering cells affected by a condition, such as an infection, injury or cancer. The most common reason lymph nodes swell is because of an infection, particularly viral infections such as a cold. It’s much rarer for swollen lymph nodes to be a symptom of a more serious condition such as cancer.
The lymph nodes are likely to swell in one specific region depending on the illness. This will usually occur in the neck, armpits or groin. Less common is when lymph nodes swell in several regions at the same time. That condition may be brought on by infections such as strep throat or mononucleosis, a reaction to certain medicines, an immune system disorder such as rheumatoid arthritis, and forms of cancer such as lymphoma and leukemia.
When lymph node swelling persists and is accompanied by other symptoms, such as fever or night sweats, or when there’s no obvious infection, it may be time to seek medical advice or evaluation from a doctor.
When touching an affected area, swollen lymph nodes may feel soft and round, like lumps the size of a pea, peanut or grape. If they’re painful when touched, that may be a sign of inflammation. Since lymph nodes appear in parallel—as, for instance, on both sides of the neck—you can feel lymph glands on both sides to see whether they are a normal size on one side and enlarged on the other, which may be a sign of infection.
In determining a diagnosis, it’s important for doctors to look at other symptoms or factors. Swollen lymph nodes near the ear may indicate an ear infection, for instance. Swollen glands in the neck area near the collarbone, combined with a sore throat and cough, may be a sign of an upper respiratory infection. When multiple regions of lymph nodes are swollen, it may indicate a body-wide disease that needs immediate attention.
Besides reviewing your medical history, doctors may use some of the following methods to diagnose the cause of swollen lymph nodes:
- Physical examination, feeling with fingers the nodes in the affected area to check their size and whether they feel hard, tender or warm
- Lab tests, including blood tests to check for suspected underlying conditions
- Imaging tests, including an X-ray, computed tomography (CT) scan, magnetic resonance imaging (MRI) or ultrasound test
- Biopsy to remove sections of lymph tissue or an entire lymph node to examine under a microscope
Cancer in the lymph nodes
In rare cases, lymph node swelling may be related to cancer. Some cancers start in the lymph nodes. Non-Hodgkin lymphoma and Hodgkin lymphoma are types of lymph system cancers, as is acute lymphocytic leukemia.
More often, a cancer may appear in the lymph nodes as a metastasis, spreading from somewhere else in the body. Some cancer cells break off from a tumor and metastasize in another location. Those cancer cells may travel through the bloodstream and reach other organs, or go through the lymph system and reach lymph nodes. However, most of the cancer cells traveling through the bloodstream or lymph system will die or be killed off before they have a chance to metastasize, according to the American Cancer Society (ACS).
When cancer is present in a lymph node, a biopsy helps determine what type of cancer it is when the removed tissue or node is examined under a microscope. The cancer cells will look like the cancer cells of the tumor where they originated, so breast cancer cells in the lymphatic system will still look like breast cancer.
Lymph nodes and staging cancer
Oncologists use cancer staging to determine the extent of cancer in the body. Lymph nodes play an important role in one of the most commonly used staging systems, called TNM. The TNM system is based on the extent of the tumor (T), how much it has spread to nearby lymph nodes (N) and the presence of metastasis (M). Each letter is assigned a numerical value based on clinical observations.
If no cancer is found in the lymph nodes near the cancer, the N is assigned a value of 0. If nearby or distant nodes show cancer, the N is assigned a number that increases based on the number of nodes affected, the size and extent of the cancer, how large the nodes are and where they’re located. The numbers for each initial are added up. The higher the sum, the more advanced the cancer. The lower the TNM score, the easier it may be to treat.
Treatment for cancer in the lymph nodes
Treatment for cancer in the lymph nodes varies depending on the tumor size and location and whether the cancer has metastasized to other areas of the body.
Surgery may be used to treat some forms of metastatic cancer that has spread to the lymph nodes. Other treatment options for cancer in the lymph nodes may include chemotherapy, radiation therapy, a stem cell transplant, immunotherapy or targeted therapy.
There’s a higher risk for cancer to come back following surgery when a cancer has spread to lymph nodes. In those cases, chemotherapy or radiation therapy may be recommended after surgery.
Removing lymph nodes during cancer surgery is “highly unlikely” to weaken the patient’s immune system, because it is “large and complex and is located throughout the body,” the ACS says. Lymph node removal may leave the affected part of the body unable to drain off lymph fluid, which may lead to a fluid backup (lymphedema) and may become a continuing problem. The greater the amount of lymph nodes removed, the greater the chance for lymphedema to occur.
Lymphoma – symptoms and signs of the disease
Contents of the article:
Lymphoma (lymphoma) is a malignant tumor of immune cells. In it, lymphocytes increase to gigantic sizes, divide uncontrollably and affect the lymphatic system: lymph nodes, bone marrow, thymus gland.
Lymphoma differs from other oncological diseases by dissemination throughout the body: with the flow of lymph, degenerated malignant cells enter the internal organs and critically disrupt their work.The disease runs asymptomatically for a long time, and when it begins to manifest itself, often the entire body is already affected.
Most lymphomas are characterized by a progressive course and high malignancy with metastasis. Nevertheless, with their early detection, a favorable prognosis reaches ~ 90%.
- Annually, about 25,000 patients with cancer of this type are diagnosed in Russia – this is 4% of all cancer patients.
- Men get sick more often than women.
- Age peak incidence – 30-34 years and after 60 years.
- At risk are patients with arthritis of two or more joints.
- The provoking factor is a selenium deficiency in the body.
- There is an assumption that dyeing hair more than 1 time per month with dark dye increases the risk of developing lymphoma by 26%.
- Vitamin D is believed to have protective properties against lymphoma.
- Thanks to modern techniques and drugs, over the past 10 years, mortality from lymphomas in Russia has decreased by 27%.
Types of lymphomas
There are two main groups of the disease – Hodgkin’s lymphoma and non-Hodgkin’s lymphomas. They develop from different types of cells, differ in the nature of their course, and respond differently to therapy.
Hodgkin’s lymphoma (HLM) – lymphogranulomatosis, malignant granuloma, characterized by damage to B-lymphocytes. Differs in an aggressive course, while responding well to treatment. Source:
I.I. Yakovtsova, V.D. Sadchikov, V.M. Sadchikova, O. V.Dolgaya, S.V. Danilyuk, A.E. Oleinik Hodgkin’s lymphoma: evolution of clinical classifications // Bulletin of problems of biology and medicine, 2013, No. 3, v.2 (103), pp. 62-69
Non-Hodgkin’s lymphomas (NHL) affect not only B lymphocytes, but also T lymphocytes. A total of 30 subtypes have been identified, most of which are less aggressive, but also more difficult to treat.
Classification of non-Hodgkin lymphomas according to WHO 4th edition 2008:
- B-lymphoblastic NHL;
- heavy chain disease;
- B-cell prolymphocytic leukemia;
- hairy cell leukemia;
- diffuse large B-cell NHL;
- Burkitt’s leukemia;
- NHL from cells of the mantle zone;
- lymphoplasmacytic NHL;
- mediastinal diffuse large B-cell NHL;
- nodal B-cell NHL of the marginal zone;
- primary exudative NHL;
- Plasma cell plasmacytoma / myeloma;
- splenic NHL of the marginal zone;
- follicular NHL;
- chronic lymphocytic leukemia;
- extranodal B-cell NHL of the marginal zone;
- T-lymphoblastic NHL;
- aggressive NK cell leukemia;
- anaplastic large cell NHL with primary skin lesions;
- anaplastic large cell NHL with primary systemic involvement;
- angioimmunoblastic T-cell NHL;
- hepatolienal T-cell NHL;
- Cesari’s fungal mycosis;
- unspecified peripheral T-cell NHL;
- T-cell panniculitis-like NHL of the subcutaneous tissue;
- T-cell leukemia;
- T-cell leukemia from large granular lymphocytes;
- T-cell prolymphocytic leukemia;
- extranodal NK / T-cell lymphoma of the nasal type;
- enteropathic T-cell NHL.
The most common lymphomas in clinical practice: Hodgkin’s, follicular and diffuse large B-cell. Source: G.S.
Tumyan Non-Hodgkin’s lymphomas // Clinical hematology oncology, 2015, 8 (4), pp. 455-470
By the nature of the lesion and pathogenesis, all lymphomas are divided into 3 main groups:
- aggressive – they are characterized by rapid development with pronounced symptoms;
- extranodal – the primary lesion is formed not in the lymph nodes, but immediately in the internal organs;
- indolent – are distinguished by their slow and favorable course; may not require therapy, sometimes it is enough to be regularly observed by a doctor.
There is a specific treatment regimen for each type of lymphoma.
Stages of lymphoma
Depending on the extent of the tumor, the stage of the pathological process is determined. According to the international classification AnnArbor, there are 4 stages of the disease:
- At the 1st stage, one group of lymph nodes may be involved in the lymphoma process.
- On the 2nd, it is allowed to involve two or more groups on one side of the diaphragm.
- At the 3rd stage, the defeat of the lymph nodes on both sides of the diaphragm descends.
- At the 4th stage, the internal organs are involved in the process – the brain, heart, liver, spleen, stomach, intestines.
Each stage is additionally labeled with titers A and B. A titer indicates the absence of key symptoms – fever, severe night sweats and a sharp weight loss. Title B indicates that there are such manifestations.
Causes of lymphoma
No single causative factor for the development of the disease has been identified.At the moment, scientists believe that the pathological process is triggered by a complex of reasons. These include:
- hereditary predisposition;
- regular contact with toxins and carcinogens;
- herpes virus, hepatitis, Helicobacter pylori and other infectious diseases;
- autoimmune and immunodeficiency states;
- recurrent pneumonia;
- Immunosuppressive therapy after kidney transplant, stem cells, etc.etc .;
90,015 breast implant insertion surgeries (presumably).
In addition to the main symptoms – fever, severe night sweats and a sharp weight loss – the pathology is characterized by:
- weakness and increased fatigue;
- swollen lymph nodes (often, but not always; however, they are painless and do not shrink with antibiotic treatment, as in infectious diseases).
90,015 temperature rise;
90,015 weight loss;
Sometimes itching is possible. With chest swelling, difficulty breathing, shortness of breath, and coughing are possible. When the neoplasm is localized in the abdominal cavity, indigestion, nausea, vomiting, and bursting pains in the abdomen and lower back are observed. With damage to the bone marrow, patients complain of pain in the bones. If the pathology involves the facial and cranial structures, there are complaints of headaches and bursting pains in the face and neck.
Diagnosis of lymphomas
The diagnosis is made by the results of microscopic examination of a biopsy – a sample of lymphoid tissue.The type of tumor is determined based on the results of differential biopsy.
To identify tumors in different parts of the body, methods of radiation diagnostics are used: X-ray, scintigraphy, magnetic resonance imaging, positron emission and computed tomography. If necessary, to clarify some of the features of the pathological process, laboratory blood tests are prescribed – enzyme immunoassay by flow cytometry, molecular genetic and cytogenetic studies. Source:
Wang HW, Balakrishna JP, Pittaluga S, Jaffe ES Diagnosis of Hodgkin lymphoma in the modern era // Br J Haematol.2019 Jan; 184 (1): 45-59. doi: 10.1111 / bjh.15614. Epub 2018 Nov 8
Most common treatments for lymphoma:
- radiation therapy;
- biological therapy;
- stem cell transplant;
- surgical intervention.
They are used both as separate courses and in a complex.The choice of the treatment regimen depends on the type of tumor and the general condition of the patient.
Indolent lymphomas may not require treatment, but only the supervision of a hematologist. Therapy is indicated at the first signs of progression of the pathological process. With localized tumors, there is sufficient radiation therapy for the affected structures. For generalized forms, chemotherapy is indicated.
In an aggressive course of the disease, one of the most effective treatment regimens is chemotherapy according to the CHOP protocol in combination with immunotherapeutic drugs from the group of monoclonal antibodies.For highly aggressive types of tumors, high-dose chemotherapy in combination with hematopoietic stem cell transplantation can be prescribed.
Treatment of selected types of lymphomas
The main method of treatment for Hodgkin’s lymphoma LGM is chemotherapy. Antineoplastic cytotoxins are prescribed in different dosage forms. Chemotherapy is cyclical – drug courses alternate with periods of rehabilitation. Source:
Sermer D, Pasqualucci L, Wendel HG, Melnick A, Younes A Emerging epigenetic-modulating therapies in lymphoma // Nat Rev Clin Oncol.2019 Aug; 16 (8): 494-507.doi: 10.1038 / s41571-019-0190-8
Radiotherapy – high-power radiation – as an independent treatment of LGM can be justified in some cases – when one, maximum two groups of lymph nodes are involved in the process. Most often it is prescribed in combination with chemotherapy. In the later stages of the disease, the method is indicated as a palliative treatment.
Biological preparations – monoclonal antibodies – in the treatment of lymphoma are used to activate the immune system.Radiation therapy is carried out regionally, in the area of the lymph nodes involved in the oncological process.
In some cases, spleen removal is justified in the treatment of LGM. If enlarged lymph nodes compress adjacent organs, excision may be indicated.
In case of relapses of the disease, as well as in order to destroy cancer cells that are not affected by standard dosages of radiation and chemotherapy, high therapeutic doses are prescribed, destroying together with the tumor bone marrow tissue.After such a course, organ transplantation is indicated. Own or donated stem cells taken in advance form a new immune system.
The combination of radiation and chemotherapy also demonstrates good results in the treatment of NHL. In some cases, the innovative technique of lumbar-puncture administration of antitumor antibodies is successfully used.
NHL with aggressive course are difficult to treat. The most effective way to combat this disease is bone marrow transplantation.
The prognosis for patients with lymphomas depends on the stage of the process, the age and condition of the patient, as well as on the results of therapy. Young patients with Hodgkin’s lymphoma usually recover completely in the early stages. In 8 out of 10, stable remission is achieved. Five-year survival rate at stage 1 is 95%, at stage 4 – 65%.
In NHL of the spleen, lymph nodes and mucous membranes, the average five-year survival rate is about 70%.With NHL of the gastrointestinal tract, salivary glands, eye orbits, the average five-year survival rate is about 60%. A less favorable prognosis in aggressive NHL of the mammary glands, ovaries, central nervous system and bones – a five-year survival rate on average less than 30%.
Clinical guidelines after lymphoma treatment and prevention
Avoid risk factors – intoxication and contact with carcinogens. Get vaccinated, and if you get an infectious disease, do not self-medicate.
See your doctor at the first sign of lymphoma.Get a preventive check-up every year, eat a healthy diet and try to live a healthy lifestyle.
- I.I. Yakovtsova, V.D. Sadchikov, V.M. Sadchikova, O. V. Dolgaya, S.V. Danilyuk, A.E. Oleinik. Hodgkin’s lymphoma: evolution of clinical classifications // Bulletin of problems of biology and medicine, 2013, no. 3, v.2 (103), pp. 62-69.
- G.S. Tumyan. Non-Hodgkin’s lymphomas // Clinical hematology oncology, 2015, 8 (4), pp. 455-470.
- Wang HW, Balakrishna JP, Pittaluga S, Jaffe E. Diagnosis of Hodgkin lymphoma in the modern era // Br J Haematol. 2019 Jan; 184 (1): 45-59. doi: 10.1111 / bjh.15614. Epub 2018 Nov 8.
- Sermer D, Pasqualucci L, Wendel HG, Melnick A, Younes A. Emerging epigenetic-modulating therapies in lymphoma // Nat Rev Clin Oncol. 2019 Aug; 16 (8): 494-507.doi: 10.1038 / s41571-019-0190-8.
The information in this article is provided for reference purposes and does not replace the advice of a qualified professional.Do not self-medicate! At the first signs of the disease, you should consult a doctor.
90,000 Benign tumors of the neck (cyst, lipoma) ”Department of Endocrine Surgery
Neck tumors are a small but very diverse group of lesions in terms of clinical manifestations. Among them, tumors of the neck organs and extraorgan tumors that arise from the soft tissues of the neck can be distinguished.One of the main lymphatic collectors is located in the neck region, the defeat of the nodes of which often occurs when the lymphoreticular tissue is affected.
A neck tumor can be benign or malignant. Surgical treatment followed by radiation therapy. From other diseases, various forms of goiter are often found.
Classification of a neck tumor
Distinguish between organ tumors, extraorgan tumors, tumor lesions of the lymph nodes of the neck – primary and secondary (metastatic).
- Organ tumors retain structural elements of a normal organ (for example, thyroid tumors, carotid glomus). Malignant tumors originate mainly from organs located in the neck.
- Extra-organ tumors are derived from the mesenchyme, muscle and nervous tissue. They can be benign (fibroma, lipoma, neuroma) or malignant (lymph node metastases).
- A separate group is represented by neck cysts: lateral neck cyst and median neck cyst, which are benign tumors, but rapidly growing with deformation and compression of the neck organs.Suppuration of neck cysts can lead to a serious complication – phlegmon of the neck.
- Tumor lesions of the cervical lymph nodes (primary with hemoblastosis, secondary – with metastases).
Symptoms of a neck tumor
Any lump under the skin on the neck is always alarming and alarming. Each person, once faced with this, can confirm that with the onset of such changes, they begin to listen to them and even interpret the emerging symptoms in their own way or try to predict the next stage of their sensations.
To save yourself from unnecessary anxiety, it is important to know if a tumor is developing on the neck and what it might actually be. In other words, we are talking about self-diagnosis, since based on the analysis of all changes, it is possible to determine the degree of their danger. If you notice or palpate a swelling in the neck that grows or does not shrink within 2 weeks, it is necessary to consult a doctor. An absolute indication for consulting a specialist is the presence of pain in the area of the tumor.
Diagnostics: how a tumor of the neck is diagnosed
Malignant tumors of the head and neck account for 5% of cases of malignant neoplasms detected annually. If a patient over 40 years of age has a mass for more than 4 weeks, it should be considered malignant until proven otherwise.
As in any other case, start with detailed questioning and physical examination. It is not worth rushing with a biopsy (incisional or total), since in most malignant tumors it increases the risk of local recurrence.Search for the primary tumor. If a malignant tumor of the head and neck is suspected, the patient is referred to an otorhinolaryngologist or endocrine surgeon.
When a primary neck tumor is found, it is biopsy (TAPB). To determine the prevalence and detect metastases, CT or MRI is performed – from the base of the skull to the upper aperture of the chest. Chest x-rays are taken to rule out lung metastases.
To confirm the diagnosis, the formation can be punctured.Unlike an incisional biopsy, a puncture does not increase the risk of local recurrence. However, in lymphoma, the diagnostic value of a puncture is low, and the suspicion of lymphoma is one of the few indications for a total lymph node biopsy. With an increase in the supraclavicular lymph node, mammography (in women) and examination of the digestive tract and genitourinary system are shown.
If the primary tumor cannot be found, direct laryngoscopy, bronchoscopy, esophagoscopy and posterior rhinoscopy with biopsy of suspicious mucosal areas are performed.
Treatment: how a neck tumor is treated
Treatment depends on the location of the tumor and the stage of the disease. With a growing neck tumor, surgical treatment is necessary, the operation should be performed in a specialized center, radically with an express histological examination, by a highly specialized head and neck surgeon or an endocrine surgeon, if necessary, with radiation therapy or combined chemotherapy and radiation therapy. Unlike adults, in children, only 10% of masses of the neck are of a malignant nature, therefore, first of all, inflammatory diseases and congenital anomalies are excluded.
A tumor of the neck is of various origins and often its malignant or benign nature can be judged only during the operation, after histological examination. Before removing it, it is necessary to find out the nature of the process (malignant or benign).
Good day.My problem is that at the beginning of June of this year I found enlarged lymph nodes. I went to the clinic for tests, and the ultrasound, as a result, the therapist said everything is ok, go home.
According to ultrasound, in the right submandibular region there are several enlarged lymph nodes up to 20/12/16 mm with clear contours and sharply activated peripheral blood flow. Several similar lymph nodes up to 19/6 mm along the right sternocleidomastoid muscle in the middle and lower third of the neck. Conclusion: Changes in the lymph nodes of the neck on the right require exclusion of lymphoproferative disease.
In the network, I got a referral to an oncologist, he sent me to a puncture in an oncological hospital. Cytological examination: In the test material, blood elements, a small amount of lymphoid cells (mainly mature lymphocytes), a few groups of epithelium-like cells morphologically similar to the epithelium of the salivary gland without signs of atypia. No elements of a malignant neoplasm were found.
Ultrasound: The thyroid gland is usually located, not enlarged (anteroposterior size: right lobe-13 mm; left lobe-13 mm; isthmus 4 mm).The echogenicity of the gland is moderately increased, the contours are even, the echo structure is not changed. On the right neck, mainly in the upper one / 3 obs. oval-shaped lymph nodes, with smooth contours, with a heterogeneous hypoechoic bark, up to 17 * 10 mm in size, merging into conglomerates up to 25 * 12 mm in size in the upper / 3 neck.
No pathological lymph nodes were found on the left neck.
In the submandibular region on the right, there are oval-shaped lymph nodes, with smooth contours, with a heterogeneous hypoechoic cortex, up to 17 * 13 mm in size, merging into conglomerates up to 35 * 11 mm in size.
No pathological lymph nodes were found in the paratracheal region.
On October 11, 2017, a total biopsy of the lymph node in the neck was done.
Please tell me based on these data what should I do and what could it be ??? Lymphoma?
Enlarged lymph nodes under the jaw on the right and on the neck
Biopsy and histology data
one.1-1.6-histological structure of the lymph node is somewhat erased due to the formation of nodule-like / follicle-like structures of various sizes and shapes over the entire area, containing light centers in the center, in which there is no polarity. Light centers are represented to a sick degree by large cells, which are also found outside the nodular structures.
Conclusion: Pathomorphological changes in the lymph node may be characteristic of its involvement in lymphoma.For the purpose of differential diagnosis, an immunohistochemical examination is carried out.
Immunohistochemical description: In the control preparation, stained with hematoxylin and eosin, the structure is completely preserved, the capsule is thin, the sinuses can be traced. There are numerous secondary follicles of various sizes, with the preservation of the mantle zone, with large light centers, from some of which polarity can be traced.
Results of immunohistochemical studies: The immune architecture of the node was studied in reactions with antibodies to CD20, CD3, CD23, CD10, Bcl-6, Ki67, Bcl-2.No cells with an abnormal phenotype and / or abnormal localization were found. The cells with Ki-67 expression (proliferating) are concentrated in the light centers of the follicles, where the proliferation index is over 90%. Outside the follicles, the proliferative index is about 2-3%.
Thus, pathomorphological changes in the submandibular lymph node correspond to reactive hyperplasia. Signs of clonal cell proliferation (as well as of other origin) were not found in the course of the study.
Treatment: Reactive hyperplasia of the submandibular lymph node, without signs of tumor growth.
Quality of life and reaction of the lymphoid tissue of the palatine tonsils in patients with COPD under the action of antioxidant drugs (clinical and morphological study)
A.V. KUZNETSOV 1 , MD, I.S. IRKHINA , S.V. ASTRAKOV 2 , Doctor of Medical Sciences, Professor, T.I. POSPELOVA 1 , Doctor of Medical Sciences, Professor, O.V. POPKOVA 2
1 Novosibirsk State Medical University , 2 City Clinical Hospital No. 25
In clinical practice, it is not uncommon for a patient with chronic obstructive pulmonary disease (COPD) to be simultaneously diagnosed with arterial hypertension ) and chronic heart failure (CHF).A study was carried out of the effect of the antioxidant drug Mexidol on the quality of life and the degree of control of broncho-obstructive syndrome (BOS) in such patients.
Purpose of the study – to study the effect of the drug Mexidol on the quality of life and the degree of control of bronchial obstruction (BO) in patients with COPD against the background of hypertension and CHF, as well as to determine the possibilities of assessing the antihypoxic effect of this drug in such patients using the method of performing cytograms of palatine tonsils (NM).
A study was carried out to study the effect of the antioxidant and antihypoxant drug Mexidol on the quality of life and the degree of control of bronchial obstruction (BO) in patients with COPD on the background of AH and CHF. In addition, the possibilities of assessing the antihypoxic effect of the drug in such patients were determined using the method of performing cytograms of NM in accordance with the method for assessing hypoxia, enshrined in patent No. 23
MATERIALS AND METHODS
The study included 107 patients aged 50 to 75 years (mean age 66.5 ± 2.2 years).The diagnosis was made according to generally accepted criteria on the basis of clinical and instrumental signs of lesions of the respiratory parts of the lungs and respiratory failure. Patients were divided into groups as follows: 1st group (control) – not suffering from COPD, AH and CHF – 37; Group 2 – patients with COPD, AH and CHF without basic COPD therapy – 20 people. Further, depending on the therapy, the patients were divided as follows: Group 3 (comparison) – 30 patients with COPD, AH and CHF, whose complex treatment included Mexidol (Farmasoft, Russia) at a dose of 125 mg 2 times a day orally within 2 months.Mexidol is a 2-ethyl-6-methyl-3-hydroxypyridine succinate, an antioxidant and antihypoxant of direct energizing action with a wide range of pharmacological effects. Group 4 (comparison) included 20 patients with COPD, AH and CHF who received standard therapy, which did not include Mexidol. The standard therapy regimens for cardiac pathology included ACE inhibitors, digoxin, calcium antagonists, diuretics, and selective β-blockers. For COPD, patients without basic therapy received fenoterol / ipratropium bromide on a situational basis, tiotropium bromide was used as the basic drug.
The groups were comparable in gender and age, duration of the disease, degree of bronchial obstruction (grade 2-3) and functional class of CHF (FC 2-3). Palatine tonsil cells were obtained by scraping. From the material obtained, smears were made, which were stained according to Romanovsky – Giemsa. The cells in the smears were identified and counted (500 cells in each observation) by the generally accepted method of continuous passage of the smear using a light microscope at a magnification of 900 times.The analysis of the obtained data was carried out using standard statistical methods, all information is presented in the form of average standard values and their deviations (M + m). Differences were considered significant at p <0.05. Before starting therapy with Mexidol and after 2 months. After oral administration of the drug, scrapings were performed from patients with NM to assess the cytological picture, reflecting the degree of hypoxic changes.
RESULTS AND DISCUSSION
The inclusion of Mexidol in the standard course therapy of patients with COPD with AH and CHF contributed to a faster stabilization of symptoms of bronchial obstruction in the absence of worsening CHF FC (p <0.001) than in the comparison group.Mexidol did not adversely affect serum potassium, sodium, glucose and bilirubin levels. The level of total cholesterol, triglycerides of blood plasma did not change during the course of treatment (p> 0.1). Against the background of Mexidol therapy, a decrease in the number of episodes of dyspnea was noted, there was a tendency to a decrease in blood pressure and heart rate, which correlates with an improvement in the NM cytogram. In the comparison group, these indicators tended to improve, but no statistically significant differences were found.When analyzing the main indicators of hemodynamics, it was found that while taking Mexidol, the distance of the 6-minute walk test increases, which indicates an increase in exercise tolerance (p <0.001).
Positive dynamics of cytological parameters of oxygen metabolism indicates a decrease in hypoxia. Against the background of traditional therapy, no significant differences were observed between cytograms at the beginning and at the end of the observation period. When analyzing the effect of various types of therapy on the blood system, it was revealed that in both groups, against the background of the treatment, there was a decrease in the number of platelets, somewhat less pronounced in the main group.The data are preliminary, suggesting the possibility of a decrease in blood viscosity as hypoxia decreases during treatment with Mexidol. Analysis of the dynamics of clinical signs of COPD, occurring against the background of AH and CHF 2–3 FC, showed that 16 patients, whose complex treatment included Mexidol, had a higher compliance with respect to therapy with both Mexidol and inhalation and cardiac therapy drugs. The main group showed a tendency to a decrease in shortness of breath, a decrease in the frequency of interruptions in the work of the heart, and there was a significant decrease in pastiness or edema.The total score of SHOKS decreased (p <0.01) by the 2nd month of observation.
When examining NM in all patients of groups 1, 2, 3 and 4, they looked like small elevations of the mucous membrane of a normal color, located in the amygdala fossa. Severe hypotrophy was noted. In smears in patients of groups 1, 2, 3 and 4, cells of stratified squamous epithelium, blasts, large and medium lymphocytes, small lymphocytes, mitoses, plasma cells, monocytes, Humprecht shadows, phagocytes, process cells – fibroblasts and reticular cells were found , polynuclear cells (basophils, eosinophils, neutrophils), prolymphocytes, myelocytes.Of the listed cytological parameters of NM, the number of small lymphocytes significantly changed in patients of groups 2, 3 and 4. At the same time, the appearance of islets of proliferation (hyperplasia) of cells of stratified squamous epithelium was noted ( Fig. 1 ).
For comparison, the appearance of the NM epithelium in apparently healthy patients ( Fig. 2 ).
Early studies revealed the proliferation of epithelium in NM cell smears in chronic tonsillitis as a response to inflammation .However, in the patients of these groups, tonsillitis or any other pathology on the part of NM was excluded. In addition, in all patients, pronounced MI hypotrophy was observed, the cause of which is the well-known physiological age-related changes in BM. Thus, the results of clinical studies prove a decrease in the ability to respond to immunization and an increase in the activity of autoimmunity with age. At the same time, somatic hyperimutation was completely preserved or even increased in the eighth decade of life. The percentage of simple and B-cell subpopulations changes during the second period of life.This makes one think that even with increasing age, the remaining human capabilities for generating a variety of immunoglobulins are preserved by a similar spectrum of immunoglobulin rearrangements once initiated by the reaction of the germinal center . LM involution is also expressed in a decrease in the proliferation of B-lymphocytes . A decrease in the number of lymphocytes in smears of NM cells of patients of the 2nd and 3rd groups suffering from COPD against the background of CHF and AH is most likely also a consequence of the involution of NM, aggravated by chronic heart failure and pulmonary heart failure.A certain role in the proliferation of cells in the germinal centers of NM is assigned to the FANCD2 protein: high expression of this protein was found in patients with Fanconi anemia, in hematopoietic cells, in the squamous epithelium of the head and neck region, respiratory epithelium, epithelium of the cervix and breast and follopian tubes [4 ]. The proliferation of the epithelium associated with lymphoid tissue has been studied experimentally . However, in our observations, proliferation is not detected in patients of the 1st group who do not suffer from COPD against the background of CHF and AH.The proliferation of the NM epithelium in patients with these diseases (groups 2 and 3) is so pronounced that we can talk about epithelial hyperplasia. It should be thought that the reason for this is the substances that induce the proliferation of the NM epithelium, which are synthesized in non-physiological amounts during hypoxia. Hypoxia is one of the leading syndromes in heart failure and pulmonary heart failure. Under hypoxia, an increase in the expression of endothelial growth factor (VEGF) and endothelin-1 (ET-1) was found .Hypoxia and suffocation syndrome (breathing disorder) are closely interrelated and represent a serious cardiovascular disease. Hypoxia is most likely the primary stimulant for the development of hypertension and increased activity of the sympathetic nervous system . It has been clinically established that genetic factors can influence the heterogeneity of response angiogenesis in cardiovascular diseases, proliferative diabetic retinopathy and neoplasia. Angiogenic ligands and the pigment epithelium derivative factor are also potentiated by hypoxia .The presented data from the scientific literature and our own studies allow us to conclude that the proliferation of the epithelium of NM patients suffering from COPD against the background of CHF and AH is induced by various factors (known and unknown) that increase their activity or are synthesized again under conditions of hypoxia.
The indicated cytological indicators of NM in the conditions of using Mexidol as part of the main therapy for COPD against the background of CHF and AH change significantly in comparison with those indicators in the conditions of only basic therapy and are close to the indicated indicators of the 1st control group of patients ( table.1 ).
|Table 1. Some indicators of the cellular composition of the palatine tonsils of the examined patients|
|Patient groups||Number of proliferation sites, pcs.||Number of cells in the areas of proliferation, pcs.||Diameter of proliferation sites, μm||Number of lymphocytes,%|
|Group 1||–||–||–||14.6 ± 0.71%|
|Group 2||11.5 ± 0.26 *||39.3 ± 1.6 *||135 ± 14.26||6.7 ± 0.2% *|
|Group 3||2.0 ± 0.1 *||5.4 ± 0.23 *||10.5 ± 0.08 *||13.7 ± 0.14 *|
|Group 4||5.1 ± 0.1 *||16.3 ± 0.17 *||64 ± 1.1 *||12.5 ± 0.8|
|* Differences are significant at p ≤ 0.05.|
The revealed proliferation of the NM epithelium, as well as the change in the number of lymphocytes and justified as an indicator of the degree of hypoxia, which is the essence of the patent used in the work and indicated above, is also confirmed by foreign publications [5, 9].
These clinical data confirm the beneficial effect of Mexidol on the clinical manifestations of bronchial obstruction and heart failure, probably due to a decrease in the degree of hypoxia in patients while receiving Mexidol.
Peak flowmetry (PF) indices for 2 months. observations in patients of the Mexidol group indicate their stabilization.
During the course of therapy, Mexidol was well tolerated by the patients, only 1 (0.3%) patient had side effects, which is comparable to the frequency of undesirable manifestations when using placebo.
Thus, even the course therapy with Mexidol in patients with COPD, ongoing against the background of AH and CHF 2–3 FC, was effective in reducing the phenomena of hypoxia in this group of patients.
The use of Mexidol in the complex therapy of patients with COPD, comorbid with hypertension, complicated CHF 2–3 FC, has a positive effect on the quality of life of such patients and the degree of control of biofeedback even with course treatment.
Mexidol is an effective and safe drug for the treatment of patients with COPD in combination with CHF 2–3 FC, has good tolerance and a minimum number of side effects comparable to placebo.
Long-term use of Mexidol in patients with COPD, ongoing against the background of hypertension complicated by CHF, in individually selected doses requires further study to assess the full potential of the drug to reduce the degree of hypoxia in patients with bronchial obstruction.
1. Theodor I.L., Chumakov F.I., Shatokhina S.N., Mikhailova G.E. Cytological diagnosis of diseases of the ENT organs. M .: MONIKI, 1995.
2. Kolar GR, Mehta D, Wilson PC, Capra JD. Diversity of the Ig repertoire is maintained with age in spite of the reduced germinal center cells in human tonsil lymphoid tissue. Scand J Immunol., 2006,
64 (3): 314-324.
3. Siegel G. Theoretical and clinical aspects of the tonsillar function.Int J Pediatr Otorhinolaryngol. 1983,6 (1): 61-75.
4. Holzel M, van Diest PJ, Bier P et al. FANCD2 protein is expressed in proliferating cells of human tissues that are cancer-prone in Fanconi anemia. J Pathol. 2003,201 (2): 198-203.
5. Takeuchi T, Kitagawa H, Imagawa T, Uehara M. Proliferation and cellular kinetics of villous epithelial cells and M cell in the chicken caecum. J Anat. 1998, 193 (Pt 2): 233-239. (1)
6. Chen XY, Zeng YM, Hunag ZY et al.Effect of chronic intermittent hypoxia on hypoxia inducidle factor-1alpha in mice. Zhonghua Jie He He Hu Za Zhi 2005,28 (2): 93-96.
7. Prabhakar NR, Peng YJ, Jacono FJ, Kumar GK, Dick YE. Cardiovascular alterations by chronic intermittent hypoxia: importance of carotid body chemoreflexes. Clin Exp Pharmacol Physiol., 2005,
32 (5-6): 447-449.
8. Chan CK, Pham LN, Zhou J. Differential expression of proand antiangiogenic factors in mouse straindependent hypoxia-induced retinal neovascularization.Lab Invest. 2005, 85 (6): 721-733.
9. Postolow F, Fediuk J, Nolette N, Hinton M, Dakshinamurti S. Hypoxia and nitric oxide exposure promote apoptotic signaling in contractile pulmonary arterial smooth muscle but not in pulmonary epithelium. Pediatr Pulmonol., 2011, Dec, 46 (12): 1194-208. (2)
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90,000 Pharyngitis – what is it? Causes, symptoms, treatment
What is pharyngitis?
This is an inflammation of the pharyngeal mucosa and its lymphoid tissue.With pharyngitis, the throat is sore, sore, and irritated. The pain is worse when swallowing. Typically, pharyngitis develops with influenza and SARS. Viral pharyngitis usually goes away on its own. Some other less common forms of pharyngitis may require treatment.
- pain and sore throat;
- pain worse when swallowing;
- difficult to swallow;
- swollen cervical lymph nodes;
- White spots or streaks on the tonsils, back of the pharynx;
- hoarse or hoarse voice.
Concomitant symptoms of ARVI or influenza may include: cough, sneezing, runny nose, stuffy nose, fever, pain in the head and body, nausea or vomiting.
When to see a doctor?
Show the child to the doctor if the child’s sore throat persists after breakfast.
Call an ambulance immediately if:
- child has difficulty breathing;
- he cannot swallow;
- The infant is unusually salivating, which may indicate an inability to swallow saliva.
If pharyngitis is in an adult, see a doctor if:
- severe or prolonged (more than a week) sore throat;
- sore throat often;
- Difficulty breathing, swallowing or opening your mouth;
- ear pain;
- joint pain;
- fever above 38.3 for more than three days;
- blood in saliva or sputum;
- pain when turning the head;
- nodes and tumors in the neck;
- hoarseness, hoarseness lasts more than two weeks.
Meet our otorhinolaryngologist (ENT doctor) – Yegor Olegovich Levchenko
As a rule, it is a viral infection (ARVI), in some cases – bacterial (streptococcus, pneumococcus). In addition, the cause of pharyngitis can be:
- allergies to dust, mold, pet hair, pollen. Since allergies cause a runny nose, fluid can drain down the back of the nasopharynx and irritate the throat;
- dry air, especially in the morning;
- tobacco smoke, chemical irritants;
- overexertion of the vocal cords (prolonged performances, loud screams in sports, etc.)
- Gastroesophageal reflux – reflux of stomach contents back into the esophagus. May be accompanied by heartburn, a lump in the throat, hoarseness.
- HIV. Pharyngitis can be a sign of a recent HIV infection in the body. Also, people who have been infected with HIV for a long time may develop secondary acute and chronic pharyngitis caused by cytomegalovirus, oral candidiasis and common viruses that cause ARVI. These complications can be dangerous in HIV-positive people.
- malignant tumors of the throat, tongue, trachea can also manifest themselves as pharyngitis, coupled with hoarseness, noise during breathing, blood in saliva and sputum, and a “knot” on the neck.
Rare causes of pharyngitis include throat abscess and epiglottitis, a serious condition in which the epiglottis, which looks like a petal between the trachea and the larynx, becomes inflamed and blocks air from entering the respiratory tract. As a rule, epiglottitis in children is caused by a hemophilic infection, which should be vaccinated on time.
Risks and measures to prevent pharyngitis
Pharyngitis often affects children and adolescents, adults also get sick, but somewhat less often.Also, the risks of pharyngitis increase with dry air, throat irritation with tobacco smoke or chemical reagents, with allergies, weakened immunity, chronic or frequent infections of the nasopharynx.
You can reduce the likelihood of illness in the same way as in the case of other nasopharyngeal infections: wash your hands, do not drink from the same cup with others, close your mouth when coughing and sneezing (do not “share” your viruses), wipe the screen and keyboards of phones and other devices, etc.
Diagnosis of pharyngitis
Usually ENT examines the patient’s throat, as well as his nose and ears, gently palpates the lymph nodes, listens to breathing with a stethoscope.
Streptococcal test is a simple and reliable way to diagnose bacterial pharyngitis. The doctor takes a scraping from the child’s throat, and within 24-48 hours the result is ready. Streptococcal pharyngitis will have to be treated with antibiotics.
We have our own laboratory in the clinic, so you can always take all the necessary tests with us!
Viral pharyngitis usually resolves within 5-7 days. The child should be provided with:
- rest and the ability to sleep as much as he wants;
- Drink plenty of fluids to relieve sore throat and prevent dehydration;
- air humidification;
- Sore throat can be relieved with both warm drinks and cold ice cream, especially fruit ice;
- for sore throat helps to gargle with a solution of table salt – a teaspoon per 250 ml of warm water;
- Children over 4 years of age can be offered lozenges for sore throat.Do not give candy to small children – they may choke;
- do not smoke in front of a sick child, avoid sharp odors irritating the throat;
- Sore throat and fever may be relieved by medication with paracetamol and ibuprofen. Do not give aspirin to children – in rare cases, it can cause life-threatening Reye’s syndrome.
Confirmed bacterial pharyngitis is treated with antibiotics. You should not interrupt or discontinue the course, because this increases the likelihood of the infection spreading to the joints, heart, kidneys and other organs.Continue taking antibiotics even if the symptoms are completely gone.
You can sign up for a consultation with our doctor by phone: + 7 812 327 03 01 or online on the clinic’s website.
It is important to position your computer or phone screen so that your eyes are looking straight ahead. What to do to avoid a hump on your neck?
A healthy and beautiful back gives everyone confidence. The appearance of a hump on the neck spoils not only the appearance, but can also lead to health problems. The hump in the neck, which is popularly called the “widow” (or withers), most often occurs in women, but also occurs in men, according to STV.
Galina Matulenko, osteopathic doctor:
What is a knoll or withers? This is an accumulation of lymphoid tissue in the area of the seventh cervical vertebra. Strong enough muscles of the trapezium and its ligaments, many other ligaments are attached to the neck. Blood flow, lymph flow is disturbed and an accumulation of lymphoid tissue is formed.
Another reason for the occurrence of such a defect is called a number of psychological problems, when a person takes on more responsibilities than he can fulfill.
Since the accumulation of lymphoid tissue can squeeze other muscles and blood vessels that supply the brain with blood, it is accompanied by pressure, pain, heaviness. This can result in increased blood pressure and impaired cerebral circulation.
Sedentary work, a sedentary lifestyle and improper posture can aggravate the problem.It is important to line up your computer or phone screen correctly so that your eyes are looking straight ahead and not down.
In older women, it can look like puffiness of the face, swelling, premature aging, double chin – anything that disrupts blood and lymph flow in the neck area and is usually accompanied by cosmetic defects of the face.
Performing gymnastic exercises in the morning and in the evening will help in the fight against the hump in the neck.If there is no pain, you can add physical activity.
Sergey Petrov, fitness trainer:
Any exercise that indirectly involves the neck can be used to tone the neck muscles. Since most strength exercises involve a large amount of body muscles, therefore, by and large, any exercise can be used.
It is very good to contact an osteopath about this, he will help to align the vertebrae correctly: upper, cervical and thoracic, relax the ligaments, neck muscles surrounding these vertebrae, and to establish lymph flow.
If its appearance is associated with edema or congestion in the neck, then, of course, improving blood circulation through exercise will help get rid of this problem.
Gymnastics in the morning and gymnastics in the evening. In the morning – the one that invigorates, and in the evening – relaxes. You can also add massage and proper nutrition to this. These steps will help prevent a lump in your neck.