Pulmonary Sarcoidosis | Cedars-Sinai

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What is pulmonary sarcoidosis?

Sarcoidosis is a rare disease
caused by inflammation. It often occurs in the lungs and lymph nodes, but it can occur
in almost any organ.

Sarcoidosis in the lungs is called
pulmonary sarcoidosis. It causes small lumps of inflammatory cells in the lungs. These
lumps are called granulomas and can affect how the lungs work. The granulomas generally
heal and disappear on their own. But, if they don’t heal, the lung tissue can remain
inflamed and become scarred and stiff. This is called pulmonary fibrosis. It changes
the
structure of the lungs and can affect your breathing. Bronchiectasis can also
occur. This is when the airways become thickened and widened from ongoing (chronic)
inflammation or infection. But, these problems are not common.

What causes pulmonary sarcoidosis?

Experts don’t know what causes
pulmonary sarcoidosis. They think that bacteria, viruses, or chemicals might trigger
the
disease. It may also be genetic. This means a person is more likely to develop
sarcoidosis if someone in their close family has it. This is an active area of
research.

What are the symptoms of pulmonary sarcoidosis?

Most people with sarcoidosis don’t
have symptoms and likely don’t know they have the disease. It can affect many organs,
causing a variety of symptoms. Pulmonary sarcoidosis can reduce the amount of air
the
lungs can hold and cause lung stiffness.

Symptoms may be a bit different for
each person. Symptoms may include:

• Shortness of breath, which often gets worse with activity
• Dry cough that won’t go away
• Chest pain
• Wheezing

Sarcoidosis can also cause symptoms not directly related to the lungs, such as:

• Extreme tiredness (fatigue)
• Fever
• Inflammation of the eyes and pain, burning, blurred vision, and light sensitivity
• Night sweats
• Pain in the joints and bones
• Skin rashes, lumps, and color changes on face, arms, or shins
• Swollen lymph nodes
• Weight loss

The symptoms of pulmonary
sarcoidosis may look like other conditions or health problems. Talk with your healthcare
provider for a diagnosis.

How is pulmonary sarcoidosis diagnosed?

In addition to a complete health
history and physical exam, tests used may include:

• Chest X-ray.  This imaging test is
  used to assess the lungs, as well as the heart. Chest X-rays may show important
  information about the size, shape, and location of the lungs, large breathing tubes
  (bronchi), and the area in the middle of the chest separating the lungs
  (mediastinum).
• CT scan. This imaging test uses
  X-rays and computer technology to make horizontal images (called slices) of the body.
  A CT scan shows detailed images of any part of the body, including the lungs. CT
  scans are more detailed than regular X-rays. They can be used to diagnose lung
  diseases, watch disease progression, and assess response to treatment.
• Pulmonary function tests. These are
  tests that help to measure the lungs’ ability to move air in and out of the lungs.
  The tests are often done with special machines into which the person must
  breathe.
• Blood tests. These can be used to check the amount of carbon dioxide and oxygen in the blood,
  evaluate liver and kidney function, and look for infection and other diseases.
• Bronchoscopy. A long, thin, flexible
  tube (bronchoscope) with a light at the end is put down the throat and into the
  lungs. This lets the doctor to view the bronchi, the main airways of the lungs. It
  is
  done to help evaluate and diagnose lung problems. Lung tissue samples (biopsies) and
  lung washings (lavage) that remove cells from the lungs can be done through the
  tube.
• Bronchoalveolar lavage.  A sterile
  saline solution is put into the lungs through a bronchoscope and then suctioned out.
  The saline carries out cells from the lower respiratory tract. These cells can be
  checked under a microscope to help find inflammation and infection. The test can help
  rule out certain causes.
• Lung biopsy. A small piece of tissue,
  cells, or fluid from the lungs is taken out and checked under a microscope.

Sarcoidosis is often diagnosed when
other lung disorders are ruled out.

How is pulmonary sarcoidosis treated?

Treatment is generally done to control symptoms and improve the function of organs
affected by the disease. Steroid medicine, such as prednisone, may help reduce inflammation.
It can be taken by mouth or inhaled. Other medicines, such as methotrexate, may be
used in severe cases or if steroids don’t work.

In many cases, no treatment is needed for pulmonary sarcoidosis. Different treatments
work better for different people. Sometimes more than one treatment is used. Most
medicines used to treat sarcoidosis suppress the immune system.

You may also join a rehab program that includes education, exercise, and support.
In severe cases, which are not common, oxygen therapy and even lung transplant may
be needed.

Key points about pulmonary sarcoidosis

• Sarcoidosis is caused by inflammation.
  Most cases are found in the lungs and lymph nodes. But it can occur in almost any
  organ.
• Sarcoidosis in the lungs is called pulmonary sarcoidosis. It causes small lumps of
  inflammatory cells, called granulomas, in the lungs. They can affect how the lungs
  work.
• Experts don’t know what causes this
  condition.
• Symptoms include shortness of breath,
  which often gets worse with activity. Also a dry cough that will not go away, chest
  pain, and wheezing.
• Treatment is generally done to control
  symptoms or to improve the function of organs affected by the disease. Steroids are
  often used. Rehab programs that include education, exercise, and support are also
  used.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your healthcare
  provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments,
  or tests. Also write down any new instructions your healthcare provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also
  know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that
  visit.
• Know how you can contact your healthcare provider if you have questions.

Medical Reviewer: Alan J Blaivas DO

Medical Reviewer: Marianne Fraser MSN RN

Medical Reviewer: Daphne Pierce-Smith RN MSN CCRC

© 2000-2021 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

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Hodgkin lymphoma | NHS inform

Hodgkin lymphoma is a type of blood cancer. It can affect children at any age but is more common in older teenagers and young adults. Each year in the UK, there are around 70 children aged 0-14 years, 120 young people aged 15-19 years, and 180 young people aged 20-24 years, diagnosed with Hodgkin lymphoma.

More children than ever are surviving childhood cancer. There are new and better drugs and treatments, and we can now also work to reduce the after-effects of having had cancer in the past.

It is devastating to hear that your child has cancer, and at times it can feel overwhelming, but there are many healthcare professionals and support organisations to help you through this difficult time.

Understanding more about the cancer your child has, and the treatments that may be used, can often help parents to cope. We hope you find the information here helpful. Your child’s specialist will give you more detailed information and, if you have any questions, it is important to ask the specialist doctor or nurse who knows your child’s individual situation.

What is Hodgkin lymphoma?

Hodgkin lymphoma is a type of cancer that occurs in the lymphatic system. There are two main types of Hodgkin lymphoma: classical Hodgkin lymphoma, which affects 95% of patients, and Lymphocyte Predominant Hodgkin Lymphoma (LPHL), which only affects 5% of patients. This information is about classical Hodgkin lymphoma, but it includes a short section about LPHL.

The lymphatic system

The lymphatic system is part of the immune system, the body’s natural defence against infection and disease.

The lymphatic system is made up of the bone marrow, thymus, spleen, and lymph nodes (or lymph glands). Lymph nodes are connected by a network of tiny lymphatic vessels that contain lymph fluid. Lymphomas can start anywhere in the lymphatic system, but Hodgkin Lymphoma is most likely to start in the lymph nodes in the neck. The other areas where lymph nodes are likely to swell are above the collar bone, the armpit, the groin and inside the chest. Glands can swell in these areas as part of the body’s response to infection, not just cancer, which is why a biopsy is needed to diagnose lymphoma.

The number of lymph nodes varies from one part of the body to another. In some parts of the body, there are very few lymph nodes, whereas under your arm there may be 20-50.

There are two main types of lymphoma: non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL). Although these are both types of lymphoma, there are differences between them, which means they need different treatment.

Causes

The exact cause of Hodgkin lymphoma is not known. In most people that develop Hodgkin lymphoma, no cause is found. However, there is increasing evidence that infections, such as the virus that causes glandular fever, may play a part in the development of Hodgkin lymphoma, especially in childhood. Poor immunity may also be a risk factor for developing the disease. Very rarely, more than one member of a family may develop Hodgkin lymphoma but it is not inherited from parents and you cannot catch it from another person.

Signs and symptoms

The first sign of Hodgkin lymphoma is usually a painless swelling of one gland, or a group of lymph glands, which continues for some weeks or even months. The first glands that are likely to be affected are in the neck or above the collarbone, most often only on one side. However, it’s important to remember that children’s glands can also become swollen when they have a common infection that causes a sore throat or a cold. If glands in the chest are affected, this can cause a cough or breathlessness. This is caused by the pressure the glands exert on the airways.

Sometimes, a child with Hodgkin lymphoma may have a high temperature (fever), night sweats, weight loss or itchy skin.

How Hodgkin lymphoma is diagnosed

As lymph glands can swell for lots of reasons, a biopsy is carried out to diagnose Hodgkin lymphoma. A biopsy is when a swollen lymph gland is removed and the cells are looked at under a microscope. It’s a small operation which is usually done under a general anaesthetic. Sometimes only a small part of the lymph gland has to be removed, which can be done under a local anaesthetic.

If Hodgkin lymphoma is diagnosed after the biopsy, further tests are carried out to find out the exact size and position of the lymphoma, and to see whether it has spread beyond the original area. These tests include x-rays, blood tests, CT, MRI and PET scans.

Very often, a bone marrow sample will be taken. This is because the lymphoma cells can spread to the bone marrow as well as to other lymph glands.

The tests that are carried out are called staging tests. Any tests and investigations that your child needs will be explained to you. The Children’s Cancer and Leukaemia Group (CCLG) has more information about what the tests and scans involve.

Staging

The stage of Hodgkin lymphoma describes the size and position of the cancer and whether it has spread. Staging is very important because the type of treatment your child receives will depend on the stage of the disease. The staging system for Hodgkin lymphoma is as follows:

Stage 1

Only one group of lymph nodes is affected and the lymphoma is only on one side of the diaphragm (the sheet of muscle under the lungs that controls breathing).

Stage 2

Two or more groups of lymph nodes are affected, but they are only on one side of the diaphragm.

Stage 3

The lymphoma is in lymph nodes both above and below the diaphragm.

Stage 4

The lymphoma has spread outside the lymph nodes to other organs such as the liver, lungs or bone marrow.

As well as giving each stage a number, doctors also use a letter code – either A, B, or E:

• A means your child has no symptoms.
• B means your child has one or more of the following symptoms: a fever, night sweats or significant weight loss.
• E means that the lymphoma has grown from the lymph gland to extranodal tissue (tissue in places outside the lymph nodes).

A number and letter is used in the staging of every child with Hodgkin lymphoma. This helps the doctor decide on a treatment plan for your child.

Treatment

Children with Hodgkin lymphoma are usually treated with chemotherapy, but sometimes radiotherapy is also needed. The type and amount of treatment given depend on the stage of the disease when it is diagnosed. Your child’s doctor will discuss the treatment options with you.

Chemotherapy

This is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells.

It is usual for a combination of drugs to be used, which will often be given every few weeks over a number of months. A combination of drugs is used because each chemotherapy drug works in a different way. Using several drugs together increases the effectiveness of the treatment. It also means lower doses of individual drugs can be used, which may reduce the possibility of long-term side effects.

Radiotherapy

This is used in less than half of people with Hodgkin lymphoma. It treats cancer by using high energy rays that destroy the cancer cells while doing as little harm as possible to normal cells.

Side effects of treatment

Treatment for Hodgkin lymphoma can cause side effects, and your child’s doctor will discuss these with you before the treatment starts. Any possible side effects will depend on the particular treatment being used and the part of the body that is being treated.

Some general side effects of chemotherapy that can occur during treatment include:

• feeling sick (nausea) and being sick (vomiting)
• hair loss
• low blood count which can lead to an increased risk of infection, bruising and bleeding
• tiredness

Changes to your child’s sense of taste and changes in their bowel may also happen. If your child has side effects from the treatment it is important to discuss them with your doctor or nurse. They may be able to help reduce them.

Late side effects of treatment

The cure rate for Hodgkin lymphoma is very high, which means some children may develop side effects many years after treatment. The chance of developing late side effects depends on where the original tumour was, how far it spread, and the type of treatment your child had.

These late side effects can affect the normal organs such as the heart, kidneys and lungs. Following treatment for Hodgkin lymphoma, there is a small increase in the risk of developing another cancer in later life. There is also a chance that fertility may be affected. Teenage boys who are diagnosed after puberty should have the option of sperm banking before treatment starts. In this situation, sperm can be stored for possible use in later years.

Your child’s doctor or nurse will explain more about any possible late side effects.

Clinical trials

Many children have their treatment as part of a clinical research trial. Trials aim to improve our understanding of the best way to treat an illness, usually by comparing the standard treatment with a new or modified version.

The aim of treatment for Hodgkin lymphoma is to cure the cancer with the fewest possible short and long-term side effects. This is particularly important in childhood Hodgkin lymphoma where cure rates are high. It is important to get the balance right between curing the cancer and having the lowest risk of long-term side effects.

If appropriate, your child’s medical team will talk to you about taking part in a clinical trial and will answer any questions you may have. Written information is often provided to help explain things.

Taking part in a research trial is completely voluntary, and you’ll be given plenty of time to decide whether it’s right for your child.

Treatment guidelines

Sometimes, clinical trials are not available for your child’s tumour. This may be because a recent trial has just finished, or because the tumour is very rare. In these cases, you can expect your doctors and nurses to offer treatment which is agreed to be the most appropriate, using guidelines which have been prepared by experts across the country. The Children’s Cancer and Leukaemia Group (CCLG) is an important organisation which helps to produce these guidelines.

Follow-up care

About 90% of children who develop Hodgkin lymphoma are cured. When your child completes treatment, they will then go into a follow-up phase, seeing doctors and nurses in out-patient clinics usually for around five years. Clinic visits will be every 3-4 months to start with and there will be occasional scans, x-rays, and blood tests done for several years after completing treatment.

If the cancer comes back, a different course of treatment can be given. If you have specific concerns about your child’s condition and treatment, it’s best to discuss them with your child’s doctor, who knows the situation.

Lymphocyte predominant Hodgkin lymphoma (LPHL)

This is a rare type of Hodgkin lymphoma that affects around 5% of patients. LPHL usually grows at a slower rate than classical Hodgkin lymphoma and normally requires less intensive treatment. Young people with LPHL may have a single swollen gland or group of swollen glands in one area only, such as the neck or groin. The swollen gland often grows very slowly and may be present for many months before a biopsy and diagnosis happens. The biopsy and staging tests will be carried out as with classical Hodgkin lymphoma. The treatment given will depend on the stage of the disease, but most patients are diagnosed with an early stage of the disease.

LPHL is usually treated with surgery or low-dose chemotherapy. It may return many years after treatment, and further treatment may be required, but it is rarely a life-threatening condition. In rare cases, patients have advanced LPHL and receive more intensive chemotherapy. There is also a link between LPHL and developing a more aggressive non-Hodgkin lymphoma.

Your feelings

As a parent, the fact that your child has cancer is one of the worst situations you can be faced with. You may have many emotions, such as fear, guilt, sadness, anger and uncertainty. These are all normal reactions and are part of the process that many parents go through at such a difficult time. It’s not possible to address here all of the feelings you may have. However, the CCLG booklet Children & Young People’s Cancer; A Parent’s Guide talks about the emotional impact of caring for a child with cancer and suggests sources of help and support.

Your child may have a variety of powerful emotions throughout their experience with cancer. The Parent’s Guide discusses these further and talks about how you can support your child.

Lymph Nodes – Swollen

Is this your child’s symptom?

• Increased size of one or more lymph nodes. Most are in the neck.
• Also, includes swollen lymph nodes in the armpit or groin
• It’s larger than the same node on the other side of the body
• Normal nodes are usually less than ½ inch (12 mm) across. This is the size of a pea or baked bean.

Causes of Swollen Lymph Nodes

• Neck Nodes. The cervical (neck) nodes are most commonly involved. This is because of the many respiratory infections that occur during childhood.
• Viral Throat Infection. This is the most common cause of swollen nodes in the neck. The swollen nodes are usually ½ to 1 inch (12 -25 mm) across. They are the same on each side.
• Bacterial Throat Infection. A swollen node with a bacterial throat infection is usually just on one side. It can be quite large; over 1 inch (25 mm) across. This is about the size of a quarter. Most often, it’s the node that drains the tonsil.
• Tooth Decay or Abscess. This causes a swollen, tender node under the jawbone. Only one node is involved. The lower face may also be swollen on that side.
• Armpit Swollen Nodes. Causes include skin infections (such as impetigo). A rash (such as poison ivy) can do the same.
• Groin Swollen Nodes. Causes include skin infections (such as athlete’s foot). A retained foreign object (such as a sliver) can be the cause.
• Shaving. Teen girls can cause low-grade infections when shaving the legs.
• Widespread Swollen Nodes. Swollen nodes everywhere suggest an infection spread in the blood. An example is infectious mono. Widespread rashes such as eczema can also cause all the nodes to enlarge.
• Normal Nodes. Lymph nodes can always be felt in the neck and groin. They are about the size of a bean. They never go away.

Lymph Nodes: What They Drain

• The lymph nodes are filled with white blood cells. They filter the lymph fluid coming from certain parts of the body. They fight infections.
• Neck Nodes in Front. These drain the nose, throat and lower face.
• Neck Nodes in Back. These drain the scalp.
• Armpit Nodes. These drain the arms and upper chest wall.
• Groin Nodes. These drain the legs and lower stomach wall.

Common Objects Used to Guess the Size

• Pea or pencil eraser: ¼ inch or 6 mm
• Dime: ¾ inch or 1.8 cm
• Quarter: 1 inch or 2.5 cm
• Golf ball: 1 ½ inches or 3.8 cm
• Tennis Ball: 2 ½ inches or 6.4 cm

When to Call for Lymph Nodes – Swollen

Call Doctor or Seek Care Now

• Node in the neck causes trouble with breathing, swallowing or drinking
• Fever over 104° F (40° C)
• Skin over the node is red
• Node gets much bigger over 6 hours or less
• Your child looks or acts very sick
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• 1 or more inches (2. 5 cm or more) in size by measurement
• Very tender to the touch
• Age less than 3 months old
• Node limits moving the neck, arm or leg
• Toothache with a swollen node under the jawbone
• Fever lasts more than 3 days
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• In the neck and also has a sore throat
• Large nodes at 2 or more parts of the body
• Cause of the swollen node is not clear
• Large node lasts more than 1 month
• You have other questions or concerns

Self Care at Home

• Mildly swollen lymph node

Seattle Children’s Urgent Care Locations

If your child’s illness or injury is life-threatening, call 911.

Care Advice for Small Lymph Nodes

1. What You Should Know About Normal Nodes:
   • If you have found a pea-sized or bean-sized node, this is normal. Normal lymph nodes are smaller than ½ inch or 12 mm.
   • Don’t look for lymph nodes, because you can always find some. They are easy to find in the neck and groin.
2. What You Should Know About Swollen Nodes from a Viral Infection:
   • Viral throat infections and colds can cause lymph nodes in the neck to get bigger. They may double in size. They may also become tender.
   • This reaction is normal. It means the lymph node is fighting the infection and doing a good job.
   • Here is some care advice that should help.
3. Pain Medicine:
   • To help with the pain, give an acetaminophen product (such as Tylenol).
   • Another choice is an ibuprofen product (such as Advil).
   • Use as needed.
4. Fever Medicine:
   • For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol).
   • Another choice is an ibuprofen product (such as Advil).
   • Note: Fevers less than 102° F (39° C) are important for fighting infections.
   • For all fevers: Keep your child well hydrated. Give lots of cold fluids.
5. Do Not Squeeze:
   • Don’t squeeze lymph nodes.
   • Reason: This may keep them from shrinking back to normal size.
6. Return to School:
   • Swollen lymph nodes alone cannot be spread to others.
   • If the swollen nodes are with a viral illness, your child can return to school. Wait until after the fever is gone. Your child should feel well enough to participate in normal activities.
7. What to Expect:
   • After the infection is gone, the nodes slowly return to normal size.
   • This may take 2 to 4 weeks.
   • However, they won’t ever completely go away.
8. Call Your Doctor If:
   • Node gets 1 inch (2.5 cm) or larger in size
   • Big node lasts more than 1 month
   • You think your child needs to be seen
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the ‘Call Your Doctor’ symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 05/30/2021

Last Revised: 03/11/2021

Copyright 2000-2021. Schmitt Pediatric Guidelines LLC.

See the Symptoms of Swollen Lymph Nodes

Swollen lymph nodes, referred to as lymphadenopathy, may grow in several parts of the body, including the neck sides, the neck below the jaw, the head, the shoulders, the groin.

The lymph nodes also consist of the thymus, spleen, bone marrow, tonsils and lymph vessels and are included within the lymph system. As a partner of the immune system the lymphatic system works to combat infection. You can contact an ENT doctor in OKC for this problem.

One of the functions of the lymph nodes is the filtering toxic and waste products from the lymph. It contains lymphocytes considered to be white blood cells that are divided into several types: T cells and B cells. The B cells release the antibodies and T cells, the thyme, help destroy cells that have been infected.

In the process of fighting disease, the body produces an enlarged lymph node. The normal size of a lymph node would be a size of a pea.

Symptoms of Swollen Lymph Nodes

Swollen lymph node symptoms may differ according to the patient. In areas where the lymphatic nodes are affected, you can experience pain. However, in these places, the skin may even turn red or purple. Tender bumps on or below skin may be there.

A sore throat is a common sign of upper respiratory tract infection. The common cold and flu are a few examples of URIs.

Because URIs can cause the lymph nodes to swell, they can make it difficult for patients to swallow or even to breathe. Night sweats, coughing, running nose, fever, headaches, or other flu symptoms may be associated with these.

Moreover, people with inflamed lymph nodes may have reduced appetite. Appetite decrease can lead to undesirable weight loss and energy.

Swollen Lymph Node Causes

Different causes of swollen lymph nodes are found. Bacterial, fungal, or viral infections most often lead to lymphadenopathy. The development of lymphadenopathy is affected by a wide variety of conditions, such as HIV, TB, measles, toxoplasma and cat scratch fever. In addition, the risk of lymphatic node swelling is increased by skin infections such as impetigo and cellulitis.

A variety of autoimmune conditions are known to cause lymphadenopathy, such as systemic lupus erythematosus and rheumatoid arthritis.

Furthermore, lymph node inflammation can be a cancer influence. The disease that could cause the lymph nodes to be swollen, but does not occur in most cases, is Lymphoma, a cancer which affects the lymph system. Lymph node swelling may also be caused by leukemia, blood cancer, and bone marrow.

In contrast, lymphadenopathy is associated with breast cancer. A person suffering from breast cancer may have removed part of their lymph nodes in the treatment.

Some drugs potentially affect the lymph nodes adversely. The following drugs include:

You can visit OKOA if you are searching for good ENT doctors in OKC to get appropriate treatment.

**Disclaimer: The information on this page is not intended to be a doctor’s advice, nor does it create any form of patient-doctor relationship.

Breast Cancer & Lymph Node Status

What are lymph nodes?

Lymph nodes are small clumps of immune cells that act as filters for the lymphatic system. The lymphatic system runs throughout the body, like the circulatory (blood) system, and carries fluid and cells.

If breast cancer spreads, the lymph nodes in the underarm (the axillary lymph nodes) are the first place it’s likely to go.

Figure 4.4 shows the location of the axillary nodes.

What is lymph node status?

Lymph node status is highly related to prognosis (chances for survival).

• Lymph node-negative means none of the axillary lymph nodes contain cancer.
• Lymph node-positive means at least one axillary lymph node contains cancer.

Prognosis is better when cancer has not spread to the lymph nodes (lymph node-negative) [13]. 

The more lymph nodes that contain cancer, the poorer prognosis tends to be [13].

Learn about lymph node status and breast cancer stage.

Lymph node status and tumor size

Lymph node status is related to tumor size. The larger the tumor, the more likely it is the breast cancer has spread to the lymph nodes (lymph node-positive) [14].

Physical exams and pathology exams

Sometimes, positive lymph nodes can be felt during a physical exam. However, a pathologist’s exam of the lymph nodes removed during a biopsy or surgery is needed to determine lymph node status.

During a physical exam, your health care provider will feel under your arm to check if the lymph nodes are enlarged. If the lymph nodes feel enlarged, it’s likely the breast cancer has spread. However, the cancer may have spread to the lymph nodes even if they don’t feel enlarged.

The pathologist will check the nodes under a microscope. Nearly one-third of women with negative lymph nodes based on a physical exam have nodes with cancer found during the pathology exam [14]. And, some women with enlarged nodes during a physical exam have cancer-free nodes [14].

Assessing lymph nodes (sentinel node biopsy and axillary dissection)

Sentinel node biopsy is the most common way to check the axillary lymph nodes for cancer.

In some cases, an axillary dissection (which removes more tissue than a sentinel node biopsy) is done.

Learn more about sentinel node biopsy, axillary dissection and lymph node assessment.

Updated 12/12/20

Neck Masses and Swollen Glands

Do you have a sore throat, headache, and fatigue? It is possible that you could have swollen lymph nodes, also called “swollen glands.” Typically, if your glands are swollen, it is an indication that your body is fighting an infection or some other type of illness. This could be an indication of something more serious as cancer.

Purpose of Lymph Nodes

Helping your body battle infections and other diseases, lymph nodes are bean-shaped, small masses of tissue components of a large lymphatic system. When lymphatic fluid moves through your body, lymphocytes (immune cells) within the lymph glands trap viruses, bacteria and other possibly harmful substances and destroy them. This helps keep these pathogens from spreading any further.

Locations

No doubt, you are already aware of the lymph nodes found in your neck. However, you actually have hundreds of lymph nodes located throughout your entire body. Your tonsils are also classified as lymph tissues. Sometimes, they can become swollen and inflamed to fight illnesses like tonsillitis. This condition is most common in children, but adults can also contract it. Other areas of the body where you might feel swollen lymph nodes include:

• Behind your ears
• Under your jaw
• The lower part of the back of your head
• Your armpits
• Your groin area

Symptoms and Signs

Under normal circumstances, you should not be able to feel your glands. Normally, they are approximately one half inch in diameter. However, when you or your child fights off an illness, these glands may swell to double or triple their regular size. At this point, they can be felt very easily. Additional signs and symptoms of swollen glands include:

• Pain or tenderness when pressure is applied
• Sore throat, fever and or sores in the mouth
• Warm, red and swollen skin over the gland
• Glands that feel “lumpy”

Causes and Concerns

Soft, tender and moveable swollen glands are typically signs of an inflammation or infection. Lymph nodes that are painless, feel hard to the touch, and resist movement need further examination by a head and neck specialist, as they could be warning signs of more serious conditions. The most common causes of swollen glands include:

• Bacterial infections including strep throat
• Infected teeth or mouth sores
• Viral infections including mononucleosis, also known as “mono”
• Skin infections
• Ear infections
• Sexually transmitted diseases, also known as STDs
• Cancers like Hodgkin’s disease, non-Hodgkin’s lymphoma, leukemia and breast cancer
• Immunodeficiency conditions such as rheumatoid arthritis (RA), lupus and HIV infections
• Possible side effects from vaccines or other types of medications

Solutions and Options

After the illness has been treated and you feel better overall, your lymph nodes should shrink back to normal. Treatment of your swollen glands tends to be cause-dependent. The following home remedies can prove to be helpful in reducing the pain and discomfort you are experiencing:

• Non-prescription pain relievers: Tylenol (acetaminophen), and anti-inflammatory medications like Advil (ibuprofen), reduce the swelling and inflammation.However, do not ever administer aspirin to a child, as there is a significant risk for Reye’s syndrome.
• Warm, wet compresses: Apply to the affected areas for soothing effect.
• Rest: Make sure to get lots of rest, as this helps your body recover from illness.

When to see a Doctor

There are some symptoms and indications that your swollen glands require treatment from a healthcare professional. Additional treatment may be required if swollen glands are accompanied by:

• A high fever (more than 104 degrees F)
• Breathing difficulties
• Problems swallowing
• Night sweats
• Unexplained loss of weight
• Reddened skin over top of the swollen lymph nodes
• Large swollen nodes that are very tender, hard to the touch and do not reduce in size

Summary

The majority of cases of swollen glands are no cause for great concern. They usually go away with basic treatment at home. However, the more serious symptoms mentioned above should never be ignored. If you are experiencing persistent or problematic swollen glands, contact our office for an appointment. One of our competent head and neck specialists can offer you a solution and treatment.

Additional Reading:

Department of Surgery – Lymphadenectomy

A lymphadenectomy, also known as  lymph node dissection, is a surgical procedure to remove one or more lymph nodes or groups of lymph nodes, which are then evaluated for the presence of cancer. It is important to know whether cancer has spread to the lymph nodes. After the lymph nodes are removed a sample of tissue is checked under a microscope for signs of cancer. For a regional lymphadenectomy, some of the lymph nodes in the tumor area are removed; for a radical lymphadenectomy, most or all of the lymph nodes in the tumor area are removed. Also called lymph node dissection.

What are Lymph Nodes

The lymphatic system is responsible for returning excess fluid from body tissues to the circulatory system and for defending against foreign or harmful agents such as bacteria, viruses, or cancerous cells. The major components of the lymphatic system are lymph capillaries, lymph vessels, and lymph nodes. Lymph is a clear fluid found in tissues that originates from the circulatory system. Lymph capillaries are tiny vessels that carry excess lymph to larger lymph vessels; these in turn empty to the circulatory system. Lymph nodes are small, oval- or bean-shaped masses found throughout the lymphatic system that act as filters against foreign materials. They tend to group in clusters in such areas as the neck (cervical lymph nodes), under the arm (axillary lymph nodes), the pelvis (iliac lymph nodes), and the groin (inguinal lymph nodes).

Diagram of Female Lymphatic System

Blausen.com staff. “Blausen gallery 2014”.  Wikiversity

Why It’s Done

The lymphatic system plays an important role in the spread of cancerous cells to distant organs in the body. Cancer cells may break away from the primary tumor site and travel through the bloodstream or lymphatic system to other sites in body. This is especially true of breast cancer, melanoma, head and neck cancer, differentiated thyroid cancer, as well as lung, gastric and colorectal cancer. Cancer cells from these tumors may then begin growing at distant sites or in the lymph nodes themselves, a process known as metastasis. Removal of the lymph nodes enables doctors to determine if a cancer has begun to metastasize. A lymphadenectomy may also prevent further spread of abnormal cells.

Patients with a positive or “involved” sentinel lymph node are likely have cancer in other lymph nodes indicating the need for more aggressive treatment such as a selective or complete lymphadenectomy. In this procedure, also known as a “formal lymph node dissection”, some or all of the regional lymph nodes are removed and evaluated for cancer, the intent being to prevent further metastasis of the melanoma, regionally or to distant organs.

Sentinel Lymph Node Biopsy

Sentinel lymph node biopsy is the removal of the sentinel lymph node during surgery. The sentinel lymph node is the first lymph node to receive lymphatic drainage from a tumor. It is the first lymph node where the cancer is likely to spread. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells.

Breast Cancer

Lymph node mapping and sentinel lymph node biopsy are done to check for cancer in the sentinel lymph node (the first lymph node the cancer is likely to spread to from the tumor) during surgery. In sentinel lymph node biopsy, a radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are found, more lymph nodes will be removed and tissue samples will be checked for signs of cancer. This is called a lymphadenectomy.

After the sentinel lymph node biopsy, the surgeon removes the tumor using breast-conserving surgery or mastectomy. If cancer cells were not found in the sentinel lymph node, it may not be necessary to remove more lymph nodes. If cancer cells were found, more lymph nodes will be removed through a separate incision. This is called a lymph node dissection.

Axillary Lymph Node Biopsy

Breast cancer cells are most likely to spread first to lymph nodes located in the axilla, or armpit area, next to the affected breast. However, in breast cancers close to the center of the chest (near the breastbone), cancer cells may spread first to lymph nodes inside the chest (under the breastbone) before they can be detected in the axilla.

The number of lymph nodes in the axilla varies from person to person but usually ranges from 20 to 40. Historically, removal of these lymph nodes (in an operation called axillary lymph node dissection, or ALND) was done for two reasons: to help stage breast cancer and to help prevent a regional recurrence of the disease. (Regional recurrence of breast cancer occurs when breast cancer cells that have migrated to nearby lymph nodes give rise to a new tumor.)

Because removing multiple lymph nodes at the same time has been associated with adverse effects, the possibility that SLNB alone might be sufficient for staging breast cancer in women who have no clinical signs of axillary lymph node metastasis, such as swollen or “matted” (clumped or stuck together) nodes, was investigated.

Melanoma

Patients being evaluated for advanced melanoma will first undergo a sentinel lymph node biopsy  near the site of the tumor. The sentinel node is the first lymph node that cancer cells encounter as they travel along the lymphatic vessels. 

The draining sentinel node is identified by the surgeon through a procedure known as “sentinel lymph node mapping”. The node is then excised (removed) and evaluated by a pathologist for the presence of cancer. If the sentinel node is free of cancer, this is highly predictive of freedom from metastasis in the nearby regional lymph nodes.

About the Procedure

A lymphadenectomy is usually performed under general anesthesia . An incision is made in the skin above the area of the affected lymph nodes.  The lymph nodes, nearby lymphatic tissue and some underlying soft tissue are then removed and evaluated (dissected).  Complications of the procedure include:

• Lymphedema, swelling of a limb affected by removal of lymph nodes
• Numbness, tingling, or pain in area of surgery
• Sloughing (breakdown) of skin in the area of surgery

Lymphedema and breast cancer

This information will help you understand what lymphedema is and what your risk of developing it is.

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Information on the lymphatic system

Figure 1. Normal lymph drainage

The lymphatic system has 2 functions:

• helps fight infections;
• promotes the outflow of fluid from different parts of the body.

Your lymphatic system is made up of lymph nodes, lymphatic vessels, and lymph fluid (see Figure 1).

• Lymph nodes are small bean-shaped glands located along the lymph vessels. Your lymph nodes filter lymphatic fluid, trapping bacteria, viruses, cancer cells, and metabolic waste.
• The lymph vessels are tiny tubes, similar to blood vessels, through which fluid flows to and from the lymph nodes.
• Lymphatic fluid is a clear fluid that travels through the lymphatic system. It carries cells that help fight infections and other diseases.

During breast cancer surgery, your doctor may remove some of the lymph nodes to see if the cancer has spread to them. The following lymph nodes can be removed:

• Sentinel lymph nodes. These are the first nodes in the armpit (armpit) through which lymphatic fluid flows away from a breast tumor.These nodes are identified by injecting a special dye into the breast.
• Axillary lymph nodes . This is a group of lymph nodes in the armpit that drain lymph fluid away from the breast and arm. If cancer cells are found in the sentinel node, you may have more than one axillary lymph node removed. The number of nodes is different for all people.

Sometimes, as a result of the removal of the lymph nodes, it becomes difficult for the lymphatic system to cope with the excretion of fluid.In this case, lymphatic fluid can accumulate where the lymph nodes were removed. This extra fluid causes a swelling called lymphedema to form.

Lymphedema can develop in the arm, hand, breast, or trunk on the treated side (the side where the lymph nodes were removed).

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Understanding the risk of developing lymphedema

Figure 2. Assessment of the risk of developing lymphedema

Most patients do not develop lymphedema after surgery, but in some cases it does.The risk of developing lymphedema in a particular person is rather difficult to determine for the following reasons:

• There is no standard test to diagnose lymphedema;
• Removal or damage to lymph nodes affects everyone differently;
• lymphedema may develop immediately after surgery or years later;
• The development of lymphedema at the present time can be caused by previously used methods of treatment.

The risk of developing lymphedema depends on how the lymph nodes are removed.Figure 2). To remove lymph nodes, 2 types of operations can be performed: sentinel lymph node biopsy and axillary lymph node removal.

A sentinel lymph node biopsy in the armpit is removed from one to several lymph nodes to check for cancer cells. The risk of developing lymphedema after a sentinel lymph node biopsy is low. It is estimated that up to 7 out of every 100 people who have sentinel lymph node biopsy develop lymphedema.

More lymph nodes are removed in the armpit during axillary lymph node removal. This is done to remove additional lymph nodes that may contain cancer cells. After removal of axillary lymph nodes, the risk of developing lymphedema is higher than after a sentinel lymph node biopsy. About 15–25 out of every 100 people who have their axillary lymph nodes removed may develop lymphedema.

The risk of developing lymphedema may also increase if the lymphatic system is damaged.This damage can be caused by:

• radiotherapy of the affected armpit;
• Infection or serious injury (eg, severe burn) to the affected arm, hand, fingers, or breast after surgery;
• tumor growth in or near the armpit on the side undergoing surgery;
• overweight when diagnosed with breast cancer;
• set or shed more than 10 pounds (4.5 kg) in a month after surgery.

It is impossible to predict exactly which patient will develop lymphedema.

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Reducing the risk of developing lymphedema

Taking the following steps may help reduce your risk of developing lymphedema.

• Maintain a healthy body weight or try to achieve it in a safe way.
• Exercise and stretch your muscles regularly. Discuss with your doctor or nurse what exercises are right for you.
  • When resuming exercise and daily activities, do it slowly and gradually. If you feel uncomfortable, stop and take a break. Exercise shouldn’t hurt.
• In case of a cut or scratch on the arm or hand on the affected side:
  1. Wash area with soap and water.
  2. Apply an antibacterial ointment such as Bacitracin ^® or Neosporin ^® .
  3. Apply a bandage such as Band-Aid ^® .
• In the event of a burn to the arm or hand on the affected side:
  1. Apply a cold compress to the affected area or place it under cool tap water for about 10 minutes.
  2. Wash area with soap and water.
  3. Apply a bandage such as Band-Aid.
• If you notice any signs of infection (such as redness, swelling, warmer-than-usual skin in this area, or soreness), call your healthcare provider.

If you have a sentinel lymph node biopsy:

• On the affected arm, you can draw blood for analysis, give injections (injections), put IV drips and measure blood pressure. However, ask healthcare providers to do this on an unaffected arm if possible.
• If you begin to notice any signs of lymphedema, always use your unaffected arm. If this is not possible, discuss with your healthcare provider which hand is safest to use.

When removing an axillary lymph node:

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Signs of lymphedema

Mild edema after surgery is normal. The swelling may persist for up to 6 weeks, but it is temporary and will gradually disappear. After surgery, you may also have pain and other sensations such as tingling and pinching.
These are typical sensations and are not necessarily signs of lymphedema.

If you are at risk of lymphedema, watch for the following symptoms in the arm, hand, breast, and trunk on the treated side:

• Feeling of heaviness, pain or aches
• Feeling of tightness in the skin
• Reduced flexibility
• Edema
• Changes in the skin such as tightness or depressions (when pressure marks on the skin)

If you have any signs of lymphedema or are in doubt, call your healthcare provider.

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Sentinel lymph node biopsy

Sentinel lymph node biopsy technology using indocyanine green

The patient’s left arm is swollen (see picture). She was previously diagnosed with cancer, which was successfully treated. As part of the operation, the axillary lymph nodes were removed. Subsequently, an edema of the hand developed, which is called lymphostasis.

The axillary lymph nodes receive the lymph flowing from the mammary gland, and cancer cells migrate from the tumor in the mammary gland through the lymphatic pathways into them. Preoperative diagnosis of lymph node lesions is imperfect if cancer cells are obtained during puncture (puncture) of the lymph node, and there is metastasis. But if the lymph nodes are outwardly normal and metastases in them are not visible according to ultrasound (as well as puncture of an enlarged lymph node), this does not mean the absence of metastases.

In such situations, lymph node metastases are found on histological examination in 20-30% of cases. Therefore, during radical operations, it is necessary to remove all axillary lymph nodes, but through the same lymph nodes, lymph flows from the hand.In the case when they are removed, the outflow of lymph occurs through other nodes, slows down sharply and lymphatic edema of the hand – lymphostasis – may develop. The likelihood of developing lymphostasis is 15-40%, it is quite rarely as severe as in the photograph, usually it is less.

Sentinel lymph node biopsy in patients with no metastatic lymph node involvement on preoperative examination is a good alternative for these patients to avoid unnecessary removal of the lymph nodes. The concept of sentinel lymph node biopsy implies that the location and morphological assessment of the status of the lymph node that first receives lymph from the organ affected by the malignant tumor makes it possible to assess the likelihood of metastatic involvement of other lymph nodes. In the absence of such a lesion, predict with a high degree of certainty the absence of metastases in subsequent lymph nodes and refuse to remove them without prejudice to the effectiveness of anticancer treatment.With regard to breast cancer, we are talking about the preservation of axillary lymph nodes and the prevention of complications associated with axillary lymphadenectomy – lymphatic edema of the upper limb, lymphatic edema of the mammary gland (during organ-preserving operations), impaired skin sensitivity on the shoulder and in the axillary region.

Historically, sentinel lymph node biopsy technology is based on radionuclide lymphography; lymphotropic dye (isosulfan or methylene blue) could be used as an additional imaging method. Over the past 10 years, there has been a growing interest in fluorescence lymphography as a method for finding the sentinel lymph node. The first study dates back to 2005. Over the past years, the method has been evaluated in about 300 breast cancer patients (Japan, England, Germany, USA) and has established itself as an effective way to find a sentinel lymph node, which is either no worse than or better than a radionuclide node.

Method principle

Indocianin green (ICG) is used to visualize the lymph node in the armpit that first receives lymph from the breast.The drug has the ability to fluoresce in infrared light, and its fluorescence through tissues can be recorded by a special video camera. The drug is injected intradermally into the areola. After 2-3 minutes, the screen displays the lymphatic drainage pathways, along which you can find the first lymph node, that is, the sentinel. The lymph node is removed and sent for histological examination.

The successive steps of this manipulation are presented in the photos:

1. Introduction of indocyanine green (0 min.)

2. Obtaining an image of the dominant lymph drainage pathway (3 min.)

3. Fluorescent knot in the wound (6 min.)

4. Fluorescent knot on the preparation (14 min.)

Biopsy technique

• Diagnostics is carried out by the well-known oncologist-mammologist of Russia, Doctor of Medical Sciences Sergei Mikhailovich Portnoy. Sentinel Lymph Node Biopsy (Sentinel Lymph Node Biopsy), based on fluorescence lymphography, is the most advanced method today.The photodynamic eye-camera displays an image in the infrared range and allows you to perform the procedure as accurately as possible and avoid the use of radionuclides. On the territory of the Russian Federation, it is represented only in the Frau Klinik.

Histological examination may reveal a metastatic lesion of the sentinel lymph node, and may confirm the absence of metastasis in it.

In the first case, it is necessary to remove the remaining axillary lymph nodes, that is, to perform axillary lymphadenectomy.In the second case, this operation is not necessary, since it is possible to preserve healthy lymph nodes and avoid the development of lymphostasis.

Today we have extensive experience in such operations. With the help of this technology, it is almost always possible to find a lymph node, and in 97% of cases it turns out to be a true signaling node (that is, if it is not affected by metastasis, there are also no metastases in other nodes). An additional advantage of this technology is the absence of patient exposure (no radionuclides are used).

• Oncomammology

• Mastopathy

• Cystic pathology

• Seals, units

• Pain

Optional

Lymphoma – symptoms and signs of the disease

Contents of the article:

Lymphoma (lymphoma) – a malignant tumor of immune cells. With 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 is asymptomatic 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%.

Lymphoma statistics:

• 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 are less aggressive but also more difficult to treat.

Classification of non-Hodgkin’s 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 lesion;
• 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 lymphomas. 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. In accordance with 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, the involvement of two or more groups on one side of the diaphragm is allowed.
• At the 3rd stage, the defeat of the lymph nodes on both sides of the diaphragm descends.
• At the 4th stage, internal organs are involved in the process – the brain, heart, liver, spleen, stomach, intestines.

Each stage is additionally labeled with A and B titers. 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 .;
• breast implant insertion surgeries (presumably).

Symptoms

In addition to the main symptoms – fever, severe night sweats and a sharp weight loss – the pathology is characterized by:

• weakness and increased fatigue;
• temperature rise;
• weight loss;
• swollen lymph nodes (often, but not always; however, they are painless and do not shrink with antibiotic treatment, as in infectious diseases).

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 a differential biopsy.

To detect 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

Treatment methods

Most common treatments for lymphoma:

• radiation therapy;
• chemotherapy;
• radiotherapy;
• biological therapy;
• stem cell transplant;
• surgical intervention.

They are used both as separate courses and as a complex. The choice of the treatment regimen depends on the type of tumor and the general condition of the patient.

Therapeutic tactics

Indolent lymphomas may not require treatment, but only the observation 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.

Predictions

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 tend to make a full recovery 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.

Seek medical attention at the first sign of lymphoma.Get a preventive check-up every year, eat a healthy diet, and try to live a healthy lifestyle.

Sources:

• 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.

Read also

90,000 Lymph node cancer: 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 causes painful lymph nodes. Typically, lymph nodes are painless and tightly fused, in contrast to painful and mobile lymph nodes during inflammation.

In non-Hodgkin’s 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.)

National Medical Research Center of Oncology named after V.I. N.N. Blokhin

For almost 70 years, the Oncology Center has been a unique symbiosis of science and clinical practice, a multidisciplinary approach to the treatment of cancer patients, a surgical school known far beyond the borders of Russia.

Morphological, immunological and genetic diagnostic methods are studied and improved here.

Blokhin’s specialists are the authors of clinical guidelines for oncology.

More than 35 thousand patients of all ages undergo antitumor treatment at the Oncology Center annually.Almost 6,000 more Russian citizens receive assistance remotely – through telemedicine consultations.

Oncology center is:

• Combined patient care
• Own production of chemopharmaceutical and radiopharmaceuticals
• Proprietary methods of tumor immunotherapy
• Advanced technologies for the rehabilitation of cancer patients
• “Competence centers” for various nosologies, including the first center of competence in Russia for the treatment of patients with tumors without an identified primary focus
• Own blood transfusion department, whose donors supply blood and blood components exclusively to patients of the Oncology Center
• The first and only cancer center with a specialized rehabilitation department for cancer patients
• The largest pedagogical school in the field of oncology in Russia

For many years, the Cancer Center has been a member of the International Union Against Cancer (UICC) at the World Health Organization (WHO) and a member of the Association of European Cancer Institutes (OECI) in Geneva.

In 2019, the Research Institute of Pediatric Oncology and Hematology of N.N. N.N. Blokhin became a full member of the leading world organization that unites transplant centers in Europe and the world – the European Group for Blood and Bone Marrow Transplantation (EBMT).

National Medical Research Center of Oncology. N.N. Blokhin:

• World-class cancer care accessible to everyone
• Innovations in Oncology
• Unique experience for colleagues

90,000 Old tattoos cause lymphoma in women

Some time ago, a 30-year-old Australian resident came to the hospital.The woman complained of enlarged lymph nodes. The examination revealed an increase in lymph nodes in the chest and lungs. Doctors suspected lymphoma.

A careful microscopic examination of the removed lymph node revealed that this induration was an accumulation of immune cells completely stained with black pigment without signs of malignant degeneration.

It was assumed that in this way the patient’s immune system reacted to the pigment that came from the tattoo on her back, which she did 15 years ago, or from the tattoo on her left shoulder, made two years ago.

Doctors believe that the inflammation of the lymph nodes is caused by a strong immune response to the old tattoo ink. Each time the needle pierces the dermis and injects ink, the body sends macrophages to the wound site to “eat” foreign pigment particles in an attempt to cleanse the wound. The “eaten” pigment gets inside the macrophage, but is not destroyed by it, but accumulates in the cell cytoplasm. As a result of such a reaction of the body, macrophages die, and the tattoo pigments remain in the skin.In parallel with phagocytosis, the process of regeneration (restoration) of the damaged skin occurs.

In some cases, the immune response to the introduction of foreign particles may be more aggressive than in the case of this patient.

Dr. Christian Bryant, who was one of the woman’s doctors, was 99% certain that his patient had lymphoma, but he later said that neither he nor his colleagues had ever seen anything like it.He also said that he had found several pigmented lymph nodes that were mistaken for melanoma. It is reported that the woman periodically experienced skin irritation at the site of the tattoos (itching, swelling), but after the removal of the lymph nodes, the patient’s well-being improved. Doctors have encountered similar cases before, but it was always about fresh tattoos.

Expert opinion:

To date, there are no data on the prevalence of tattoos in Russia and statistics on the negative medical consequences of this procedure.Over 45 million people in the United States have tattoos. About 70% of them are women. Along with the growing prevalence of tattoos, piercings and other procedures, the number of medical complications from them is growing. For tattoos, these are, first of all, infectious complications and allergic reactions.