Where are lymph nodes located in the body. How does the lymphatic system work. What are the main components of the lymphatic system. What are common lymphatic system diseases.

The Essential Role of the Lymphatic System in Human Health

The lymphatic system plays a crucial role in maintaining our body’s health and immunity. This complex network of tissues and organs works tirelessly to rid our bodies of toxins, waste, and other unwanted materials. Its primary function revolves around the transportation of lymph, a fluid rich in infection-fighting white blood cells, throughout the body.

But how exactly does this system operate, and what are its key components? Let’s delve deeper into the fascinating world of the lymphatic system to uncover its secrets and understand its vital importance to our overall well-being.

The Anatomy of the Lymphatic System: A Network of Vessels and Nodes

The lymphatic system is composed of an intricate network of vessels and nodes that work in harmony to keep our bodies healthy. These lymphatic vessels bear a striking resemblance to the veins and capillaries of our circulatory system, forming a highway for lymph fluid to travel through the body.

Scattered along this network are hundreds of lymph nodes, acting as checkpoints and filtration stations for the lymph. These nodes are strategically positioned throughout the body, from the head down to the knee area. Some are nestled deep within our bodies, surrounding vital organs like the lungs and heart, while others are closer to the surface, such as those found under the arm or in the groin.

The Distribution of Lymph Nodes

• Head and neck region
• Armpit (axillary nodes)
• Chest and abdomen
• Groin area
• Around major organs (lungs, heart, etc.)

Can you feel your lymph nodes? In some cases, yes. When your body is fighting an infection, certain lymph nodes may become swollen and palpable, particularly those in the neck, armpits, and groin.

The Spleen: The Largest Lymphatic Organ

While lymph nodes are numerous and widely distributed, the spleen holds the title of the largest lymphatic organ in the body. Located on the left side of the body, just above the kidney, this remarkable organ serves multiple critical functions.

The spleen acts as a sophisticated blood filter, controlling the amount of red blood cells and regulating blood storage in the body. Moreover, it plays a pivotal role in our immune defense, helping to fight off infections by creating white blood cells called lymphocytes when it detects potentially harmful microorganisms in the blood.

Is the spleen essential for survival? Interestingly, humans can live without a spleen. However, individuals who have lost their spleen due to disease or injury are more susceptible to infections, highlighting the organ’s importance in our immune system.

The Thymus and Tonsils: Specialized Lymphatic Structures

The lymphatic system includes other specialized structures that contribute to our body’s defense mechanisms. Two notable examples are the thymus and tonsils.

The Thymus: Training Ground for T Cells

Nestled in the chest just above the heart, the thymus plays a crucial role in our adaptive immune system. This small organ serves as a training ground for immature lymphocytes, preparing them to become active T cells. These T cells are essential in our body’s defense, helping to destroy infected or cancerous cells.

Tonsils: The First Line of Defense

Tonsils are large clusters of lymphatic cells found in the pharynx. Often referred to as the body’s “first line of defense” in the immune system, tonsils sample bacteria and viruses that enter the body through the mouth or nose. This early detection system helps alert the immune system to potential threats.

Why do some people have their tonsils removed? While tonsillectomies are less common today than in the past, they may still be recommended for individuals who experience frequent throat infections. However, the decision to remove tonsils is made on a case-by-case basis, considering the overall health and specific circumstances of each patient.

Lymph: The Life-Giving Fluid of the Lymphatic System

At the heart of the lymphatic system is lymph, a clear and colorless fluid that plays a vital role in our body’s health. The term “lymph” originates from the Latin word “lympha,” meaning “connected to water,” which aptly describes its nature and function.

How is lymph formed? Lymph begins its journey as plasma, the liquid component of blood. After plasma delivers nutrients to cells and removes cellular debris, most of it returns to the venous circulation. The remainder becomes lymph, embarking on a one-way journey through the lymphatic system.

The Unique Flow of Lymph

Unlike blood, which circulates continuously throughout the body, lymph flows in only one direction – upward toward the neck. This unidirectional flow is crucial for the lymphatic system’s function in removing waste and fighting infections.

Where does the lymph ultimately go? The lymphatic vessels connect to two subclavian veins, located on either side of the neck near the collarbones. Here, the lymph re-enters the circulatory system, completing its journey and contributing to the body’s overall fluid balance.

Common Diseases and Disorders of the Lymphatic System

While the lymphatic system is robust, it can be affected by various diseases and disorders. Understanding these conditions is crucial for early detection and treatment.

Lymphadenopathy: Enlarged Lymph Nodes

Lymphadenopathy, or the enlargement of lymph nodes, is one of the most common lymphatic system issues. This condition often occurs when the body is fighting an infection, causing the lymph nodes to produce more white blood cells and subsequently swell.

What causes lymphadenopathy? The swelling can be triggered by various factors, including:

• Bacterial infections (e.g., strep throat)
• Viral infections (e.g., mononucleosis, HIV)
• Localized skin infections
• Inflammatory conditions
• Cancer

The location and extent of lymph node swelling can provide valuable clues about the underlying cause. For instance, localized swelling might indicate a specific infection in that area, while generalized lymphadenopathy could suggest a more systemic condition like HIV infection.

Lymphedema: When Lymph Flow Is Obstructed

Lymphedema is a condition characterized by swelling due to lymph node blockage. This obstruction prevents the normal flow of lymph, leading to fluid accumulation in the affected area.

What are the common causes of lymphedema? This condition can arise from various factors:

• Surgery (especially cancer-related procedures that remove lymph nodes)
• Radiation therapy
• Infections
• Obesity
• Chronic venous insufficiency

Lymphedema can significantly impact a person’s quality of life, causing discomfort, reduced mobility, and increased risk of infections. Early diagnosis and proper management are crucial in minimizing its effects.

Lymphatic Cancers: A Serious Concern

Cancers involving the lymphatic system represent a serious health concern. These malignancies can originate in the lymphatic system itself or spread from other parts of the body.

What are some examples of lymphatic cancers? The most common types include:

• Hodgkin’s lymphoma
• Non-Hodgkin’s lymphoma
• Lymphocytic leukemia

Early detection and advances in treatment have significantly improved the prognosis for many lymphatic cancers. However, ongoing research continues to seek more effective and less invasive treatment options.

Treating Lymphatic System Disorders: A Multidisciplinary Approach

Given the complexity and diverse nature of lymphatic system disorders, their treatment often requires a multidisciplinary approach. Various medical specialists may be involved in diagnosing and treating these conditions.

Key Specialists in Lymphatic System Care

• Immunologists: Often the primary specialists for lymphatic system diseases
• Vascular surgeons: May be involved in treating lymphatic vessel disorders
• Dermatologists: Can address skin-related lymphatic issues
• Oncologists: Specialize in treating lymphatic cancers
• Physiatrists: Help manage physical symptoms and improve quality of life
• Lymphedema therapists: Specialize in manual drainage of the lymphatic system

How is lymphedema treated? Treatment for lymphedema often involves a combination of approaches, including:

1. Manual lymphatic drainage: A specialized massage technique to encourage lymph flow
2. Compression garments: To help prevent fluid buildup
3. Exercise: To promote lymph drainage and improve overall circulation
4. Skincare: To prevent infections in the affected area
5. In some cases, surgical interventions may be considered

The treatment plan is typically tailored to the individual patient, considering the severity of the condition, its cause, and the patient’s overall health status.

The Future of Lymphatic System Research and Treatment

As our understanding of the lymphatic system continues to grow, so do the possibilities for improved diagnosis and treatment of lymphatic disorders. Researchers are exploring various avenues to enhance our ability to manage these conditions effectively.

Emerging Areas of Research

• Advanced imaging techniques for better visualization of the lymphatic system
• Targeted therapies for lymphatic cancers
• Gene therapy approaches for inherited lymphatic disorders
• Development of artificial lymphatic vessels
• Immunotherapy strategies leveraging the lymphatic system

What potential breakthroughs are on the horizon? While it’s difficult to predict specific outcomes, ongoing research holds promise for several areas:

1. More precise and less invasive diagnostic tools
2. Personalized treatment plans based on genetic profiling
3. Novel drug delivery systems utilizing the lymphatic network
4. Regenerative medicine approaches to restore lymphatic function

These advancements could revolutionize how we approach lymphatic system disorders, potentially leading to more effective treatments and improved quality of life for patients.

Maintaining a Healthy Lymphatic System: Lifestyle Factors

While medical interventions are crucial for addressing lymphatic system disorders, lifestyle factors also play a significant role in maintaining the health of this vital system. By adopting certain habits and practices, individuals can support their lymphatic system’s function and potentially reduce the risk of related health issues.

Key Lifestyle Factors for Lymphatic Health

• Regular exercise: Promotes lymph flow and overall circulation
• Proper hydration: Helps maintain optimal lymph fluid levels
• Balanced diet: Supports immune function and reduces inflammation
• Stress management: Chronic stress can negatively impact the immune system
• Avoiding toxins: Reduces the burden on the lymphatic system

How can you support your lymphatic system through diet? Consider incorporating these foods:

1. Leafy green vegetables: Rich in chlorophyll, which aids in lymphatic function
2. Citrus fruits: High in vitamin C, supporting immune health
3. Nuts and seeds: Provide essential fatty acids for lymph health
4. Herbs like ginger and turmeric: Known for their anti-inflammatory properties
5. Berries: Packed with antioxidants that support overall health

By adopting these lifestyle practices, individuals can play an active role in maintaining their lymphatic health, complementing medical care when needed.

The lymphatic system, with its intricate network of vessels, nodes, and specialized organs, plays a crucial role in our body’s defense against disease and maintenance of fluid balance. From the largest lymphatic organ, the spleen, to the smallest lymph nodes, each component contributes to our overall health and well-being. Understanding this system’s function, recognizing its disorders, and knowing how to support its health empowers us to take better care of our bodies. As research continues to uncover new insights into the lymphatic system, we can look forward to improved diagnostic tools and treatment options, offering hope for those affected by lymphatic disorders and enhancing our ability to maintain optimal health.

Lymphatic System: Facts, Functions & Diseases

The lymphatic system is a network of tissues and organs that help rid the body of toxins, waste and other unwanted materials. The primary function of the lymphatic system is to transport lymph, a fluid containing infection-fighting white blood cells, throughout the body. 

The lymphatic system primarily consists of lymphatic vessels, which are similar to the veins and capillaries of the circulatory system. The vessels are connected to lymph nodes, where the lymph is filtered. The tonsils, adenoids, spleen and thymus are all part of the lymphatic system.

Description of the lymphatic system

There are hundreds of lymph nodes in the human body. They are located deep inside the body, such as around the lungs and heart, or closer to the surface, such as under the arm or groin, according to the American Cancer Society. The lymph nodes are found from the head to around the knee area. 

The spleen, which is located on the left side of the body just above the kidney, is the largest lymphatic organ, according to the U.S. National Library of Medicine (NLM). “The spleen . . . acts as a blood filter; it controls the amount of red blood cells and blood storage in the body, and helps to fight infection,” said Jordan Knowlton, an advanced registered nurse practitioner at the University of Florida Health Shands Hospital. 

If the spleen detects potentially dangerous bacteria, viruses, or other microorganisms in the blood, it — along with the lymph nodes — creates white blood cells called lymphocytes, which act as defenders against invaders. The lymphocytes produce antibodies to kill the foreign microorganisms and stop infections from spreading. Humans can live without a spleen, although people who have lost their spleen to disease or injury are more prone to infections.

The lymphatic system helps keep the body healthy by eliminating infections and diseases. (Image credit: by Ross Toro, Infographics Artist)

The thymus is located in the chest just above the heart, according to Merck Manual. This small organ stores immature lymphocytes (specialized white blood cells) and prepares them to become active T cells, which help destroy infected or cancerous cells. 

Tonsils are large clusters of lymphatic cells found in the pharynx. According to the American Academy of Otolaryngology, they are the body’s “first line of defense as part of the immune system. They sample bacteria and viruses that enter the body through the mouth or nose.” They sometimes become infected, and although tonsillectomies occur much less frequently today than they did in the 1950s, it is still among the most common operations performed and typically follows frequent throat infections.

Lymph is a clear and colorless fluid; the word “lymph” comes from the Latin word lympha, which means “connected to water,” according to the National Lymphadema Network. 

Plasma leaves the body’s cells once it has delivered its nutrients and removed debris. Most of this fluid returns to the venous circulation through tiny blood vessels called venules and continues as venous blood. The remainder becomes lymph, according to the Mayo Clinic.

Unlike blood, which flows throughout the body in a continue loop, lymph flows in only one direction — upward toward the neck. Lymphatic vessels connect to two subclavian veins, which are located on either sides of the neck near the collarbones, and the fluid re-enters the circulatory system, according to the Mayo Clinic.

Diseases and disorders of the lymphatic system

Diseases and disorders of the lymphatic system are typically treated by immunologists. Vascular surgeons, dermatologists, oncologists and physiatrists also get involved in treatment of various lymphatic ailments. There are also lymphedema therapists who specialize in the manual drainage of the lymphatic system.

The most common diseases of the lymphatic system are enlargement of the lymph nodes (also known as lymphadenopathy), swelling due to lymph node blockage (also known as lymphedema) and cancers involving the lymphatic system, according to Dr. James Hamrick, chief of medical oncology and hematology at Kaiser Permanente in Atlanta.

When bacteria are recognized in the lymph fluid, the lymph nodes make more infection-fighting white blood cells, which can cause swelling. The swollen nodes can sometimes be felt in the neck, underarms and groin, according to the NLM.

Lymphadenopathy is usually caused by infection, inflammation, or cancer. Infections that cause lymphadenopathy include bacterial infections such as strep throat, locally infected skin wounds, or viral infections such as mononucleosis or HIV infection, Hamrick stated. “The enlargement of the lymph nodes may be localized to the area of infection, as in strep throat, or more generalized as in HIV infection. In some areas of the body the enlarged lymph nodes are palpable, while others are to deep to feel and can be seen on CT scan or MRI.”

Inflammatory or autoimmune conditions occur when a person’s immune system is active, and can result in enlargement of lymph nodes. This can happen in lupus, according to Hamrick. 

Lymphoma:

This refers to cancer of the lymph nodes. It occurs when lymphocytes grow and multiply uncontrollably. There are a number of different types of lymphoma, according to Dr. Jeffrey P. Sharman, director of research at Willamette Valley Cancer Institute and medical director of hematology research for the U.S. Oncology Network.

“The first ‘branch point’ is the difference between Hodgkin lymphoma and non-Hodgkin lymphoma (NHL),” Sharman said. Non-Hodgkin lymphoma is more common of the two, according to the Lymphoma Research Foundation. 

The most common types of NHL are follicular, which accounts for about 30 percent of all NHL cases; diffuse large B-cell lymphoma (DLBCL), which comprises 40 to 50 percent of NHL cases; and Burkitt’s lymphoma, which accounts for 5 percent of NHL cases. “The remainder of cases makes up the bewildering complexity of NHL,” Sharman said.

“Though there can be a significant range within an individual category, the clinical approach to each category is unique and the expectations of patient outcome varies by category,” Sharman said.

When a person has had surgery and/or radiation to remove a cancer, the lymphatic flow back to the heart and can result in swelling or lymphedema, Hamrick noted. This most commonly occurs in women who have had surgery to remove a breast cancer. Part of the operation to remove the breast cancer involves removing lymph nodes in the armpit. 

The more lymph nodes removed the higher the risk of chronic bothersome swelling and pain due to lymphedema in the arm, Hamrick explained. “Fortunately, modern surgical techniques are allowing for fewer lymph nodes to be removed, and thus fewer cases of severe lymphedema for breast cancer survivors.”

Some interesting research has been done on why people possibly get lymphoma. For example, VU University Medical Center in Amsterdam researched a nationwide Dutch pathology registry between 1990 and 2016. From the research, they estimated that the risk of developing anaplastic large cell lymphoma in the breast after getting implants is 1 in 35,000 at age 50, 1 in 12,000 at age 70, and 1 in 7,000 at age 75. The study was published in the Jan. 4, 2018 issue of the journal JAMA Oncology.

Castleman disease:

This disease refers to a group of inflammatory disorders that cause lymph node enlargement and can result in multiple-organ dysfunction, according to the Castleman Disease Cooperative Network. While not specifically a cancer, it is a similar to a lymphoma and is often treated with chemotherapy. It can be unicentric (one lymph node) or multicentric, involving multiple lymph nodes. 

Lymphangiomatosis:

This disease involves multiple cysts or lesions formed from lymphatic vessels, according to the Lymphangiomatosis & Gorham’s Disease Alliance. It is thought to be the result of a genetic mutation. 

Tonsil stones are another problem that can happen to the lymphatic system. Small bits of debris catches on the tonsils and white blood cells attack the debris and leave behind hard a hard biofilm that breaths oxygen. They are not smooth like regular stones, though. “Instead, they look like prunes, with crevices where bacteria can accumulate,” said Chetan Kaher, a dentist in London. Usually, tonsil stones fall away and get swallowed, but sometimes they need to be manually removed.

Diagnosis and treatment

Diseases of the lymphatic system are usually diagnosed when lymph nodes are enlarged, Hamrick noted. This may be discovered when the lymph nodes become enlarged enough to be felt (“palpable lymphadenopathy”) or are seen on imaging studies such as CT scans or MRIs.

The majority of enlarged lymph nodes are not dangerous; they are the body’s way of fighting off an infection, such as a viral upper respiratory infection. If the lymph nodes become significantly enlarged and persist longer than the infection, then they are more worrisome. There is no specific size cutoff, but typically nodes that persist at larger than a centimeter are more worrisome and warrant examination by a doctor.

Common symptoms of any lymphatic disorder include swelling of the arm or groin, weight loss, fever and night sweats, according to Stephanie Bernik, chief of surgical oncology at Lenox Hill Hospital in New York. “A PET or CAT scan is usually ordered to further investigate.” 

The diagnosis of lymphadenopathy depends on the location of the abnormal lymph nodes and other things that are going on with the patient. If the patient has a known infection, then the lymph nodes can simply be followed to await resolution with treatment of the infection. If the nodes are growing quickly and there is no obvious explanation then typically a biopsy is warranted to look for a cancer or an infection. If the node can be felt then this can be done at the bedside with a needle, according to Hamrick. 

If the lymph node is deeper, such as in the abdomen or pelvis, Hamrick said the biopsy might need to be done by an interventional radiologist using image guidance to place the needle into the node. Sometimes the biopsy needs to be done by a surgeon in the operating room. This is often where the most tissue can be obtained to make a diagnosis, he said.

With many types of lymphoma and leukemia, there are unique treatment options for each type, according to Sharman. “There is no one ‘summary’ of treatment options. Treatment options can include traditional chemotherapy, immunotherapy (such as using antibodies or immune modulating drugs), and even radiation.”

Treatment of lymphatic diseases depends on treating the underlying cause. Infections are treated with antibiotics, supportive care (while the immune system does its job, as in a viral infection) or antivirals. Lymphedema can be treated by elevation, compression and physical therapy. Cancers of the lymphatic system are treated by chemotherapy, radiotherapy, surgery, or a combination of those modalities, Hamrick noted. 

In last several years, Sharman noted that there has been explosion of new treatment options. “There are a handful of newly approved drugs that target the actual disease causing processes within cells. Ibrutinib, idelalisib, obinutuzumab, lenalidomide have been approved in various indications and it is likely that we will see multiple more in coming years.”

Additional reporting by Alina Bradford, Live Science contributor

You use your eyes to see, your ears to hear and your muscles to do the heavy lifting. Well, sort of. In fact, most body parts are far more complicated than that, while some seem to have no business being inside there at all.

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Additional resources

Anatomy, Lymph Nodes – StatPearls

Introduction

The lymphatic system is composed of lymphatic vessels and lymphoid organs such as the thymus, tonsils, lymph nodes, and spleen. These assist in acquired and innate immunity, in filtering and draining the interstitial fluid, and recycling cells at the end of their life cycle. The fluid that leaks from end-stage capillaries returns to the vascular system via the superficial and deep lymphatic vessels, which in turn drain into the right lymphatic duct and the thoracic duct. The right lymphatic duct travels on the medial border of the scalenus anterior muscle and drains the lymph from the right upper quadrant of the body. The thoracic duct starts at the cisterna chyli and has highly variable anatomy. The right lymphatic duct and the thoracic duct drain into the right and left subclavian arteries, respectively, at the jugulovenous angle.[1]

Lymph nodes are found at the convergence of major blood vessels, and an adult will have approximately 800 nodes commonly sited in the neck, axilla, thorax, abdomen, and groin. These filter incoming lymph and play a role in infection as well as in malignancy. This paper will discuss the structure and function of lymph nodes, as well as the anatomical divisions of these.

Structure and Function

Lymph nodes are kidney-shaped and receive lymph via multiple afferent vessels, and filtered lymph then leaves via one or two efferent vessels. Nodes typically have an associated artery and vein, which terminates into a high endothelial venule (HEV). The HEV is the site of trans-endothelial migration of circulating lymphocytes due to T and B-cell endothelial surface receptors.[2]

Lymph nodes usually range in size from 1 to 2 cm and are enclosed in an adipose tissue capsule. Normal size depends upon location, as well as the axis which is being measured. The long axis should be 1 cm or less. They are considered pathological if they lose their oval shape, if there is a loss of the hilar fat, if there is an asymmetrical thickening of the cortex and if they are persistently enlarged.[3]

Lymph Node Structure[4]

Capsule

The capsule of the lymph node is dense connective tissue stroma and collagenous fibers. The capsule sends trabeculae inside the lymph node, which pass inward, radiating towards the center.

Subscapular Sinus

The subcapsular sinus is the space between the capsule and the cortex, which allows the transportation of the lymphatic fluid.; this is also called the lymph path, the lymph sinus, or the marginal sinus.  The subcapsular sinus is present beneath the capsule and is traversed by both reticular fibers and cells. It receives the afferent vessels, continues with the trabecular sinuses, and joins the medullary sinus in the medulla of the lymph node. 

Cortex

The cortex of the lymph node is the layer beneath the subcapsular sinus. The cortex is formed of the outer cortex and the inner part known as the paracortex. The outer cortex layer is also named the B-cell layer, is rich in CXCR5 chemokines, and consists mainly of B-cells arranged into follicles. The immature B-cells develop into a germinal center when challenged with an antigen. Following this, resting B-cell and dendritic cells surround the germinal center to form a mantle zone. The paracortex layer, also called the T-cell layer, consists of T-cells that interact with the dendritic cells and is rich in CCR7 chemokines.[5]

Medulla

The medulla is the innermost layer of the lymph node and contains large blood vessels, sinuses, and medullary cords. The medullary cords contain antibody-secreting plasma cells, B-cells, and macrophages. The medullary sinuses (or sinusoids) are vessel-like spaces that separate the medullary cords. The medullary sinuses receive lymph from the trabecular sinuses and cortical sinuses and contain reticular cells and histocytes. The medullary sinus drains the lymph into the efferent lymphatic vessels.

Function of Lymph Node[6]

The primary function of lymph nodes is filtering interstitial fluid collected from soft tissues and eventually returning it to the vascular system. Filtering this exudative fluid allows for exposure of T-cells and B-cells to a wide range of antigens. For antigen-specific B and T cells to activate, they must first suffer exposure to antigens with the aid of antigen-presenting cells, dendritic cells, and follicular dendritic cells. These form part of both the innate immune response and play a role in adaptive immunity.

Embryology

Lymph nodes begin their development in utero as mesenchymal condensation, which later bulges to form a lymph sac. At the 13th gestational week, the T-cell region begins to develop, and by the 17th gestation week, the interdigitating reticulum cells (a subtype of T-cells) are found in the paracortical lymph node region, surrounded by lymphoid cells. B-cell regions within lymph nodes start their development at the 14th gestation week at the marginal sinus with a population of dendritic reticulum cell precursors, lymphoblasts, immunoblasts, and plasmablasts. By the 20th gestation week, incipient primary follicles are observable in the outer cortex containing lymphocytes. During the 12th and 14th gestation weeks, lymph nodes undergo granulopoiesis and erythropoiesis to produce undifferentiated blast cells, monocytes, and macrophages temporarily.[7][8]

Blood Supply and Lymphatics

Lymph Nodes of the Head and Neck

The lymph nodes in the head and neck are paired and broadly split into superficial and deep nodes.

Superficial

• Occipital nodes – At the lateral border of the trapezius muscles

• Mastoid (post-auricular) nodes – At the insertion of the sternocleidomastoid muscle on the mastoid process of the temporal bone

  • These drain the posterior neck, the superior portion of the external ear, and the ear canal until the tympanic membrane.

• Pre-auricular nodes – Anterior to the tragus of the ear

• Superficial parotid nodes – Overlying the parotid gland.

  • These drain the nose, the nasal cavity, part of the external ear canal, and the lateral orbit

• Submental nodes – Overlying the mylohyoid muscle.

• Submandibular nodes – Found in the submandibular triangle, bounded by the inferior edge of the mandible and the anterior and posterior bellies of the digastric muscle, overlying the mylohyoid and hyoglossus muscles

  • These drain the submental and facial nodes, the cheeks, the upper lip, and the marginal areas of the lower lip.

• Facial nodes – Comprised of maxillary, buccinator, and supramandibular lymph nodes

  • These drain the mucus membranes of the inside of the cheek, the nasal mucosa, the eyelids, and the conjunctiva.

• Superficial cervical
  • Anterior superficial cervical – Along the anterior jugular vein.
  • Posterior superficial cervical – Along the external jugular vein

Deep

• Deep parotid – Found deep to the parotid gland.

• Deep cervical – Found along the internal jugular vein. These are named prelaryngeal, pretracheal, retropharyngeal, infrahyoid, jugulodigastric, jugulo-omohyoid, and supraclavicular nodes, depending on their anatomical positional.

In terms of anatomical dissection, these more easily split into levels of the neck.[9]

Level I

• Level Ia (submental nodes) – anteriorly, in the midline between the anterior bellies of the paired digastric muscles

• Level Ib (submandibular nodes) – in the submandibular triangle, as described above.

Level II

These nodes, also called the upper internal jugular nodes, are found in an anatomical area bounded by the base of the skull superiorly, the hyoid bone inferiorly, the submandibular gland anteriorly, the posterior border of the sternocleidomastoid muscle laterally, and the internal carotid artery medially. The spinal accessory nerve separates the level IIa and IIb nodes.

Level III

These nodes are also names the middle internal jugular nodes and are bound superiorly by the hyoid bone, the cricoid cartilage inferiorly, the anterior edge of the sternocleidomastoid muscle anteriorly,  the posterior margin of the sternocleidomastoid muscle, and the common carotid artery medially.

Level IV

These nodes are also named the lower internal jugular nodes and include Virchow’s node. The anatomical area in which they are found is bound superiorly by the cricoid cartilage, the clavicle inferiorly, the sternocleidomastoid muscle anteriorly, and the common carotid artery medially.

Level V

These are also named the posterior triangle nodes and are bounded by the convergence of the sternocleidomastoid and trapezius muscles superiorly, the clavicle inferiorly, the sternocleidomastoid muscle anteriorly and medially, and the trapezius muscle posteriorly.

• Level Va – superior to the cricoid cartilage and include the spinal accessory nodes

• Level Vb – inferior to the cricoid cartilage and include the transverse cervical nodes and  the supraclavicular nodes

Level VI

This level is also named the anterior compartment and contains the anterior jugular, pre-tracheal, para-tracheal, pre-cricoid, pre-laryngeal, and thyroid nodes. It is bound superiorly by the hyoid bone, inferiorly by the suprasternal notch, by the platysma muscle anteriorly, and the common carotid artery laterally.

Lymph Nodes of the Upper Limb

The deep and superficial lymphatics in the upper limb eventually drain into the axillary nodes. However, there are supratrochlear and cubital lymph nodes at the level of the elbow, brachial lymph nodes, and deltopectoral lymph nodes. The drainage of the upper limbs is particular due to the presence of sentry or sentinel lymph nodes. These are usually larger than the rest of the lymph nodes and are the first to filter the incoming lymph. However, it is not uncommon for multiple smaller sentry lymph nodes to also be present.[10][11]

Axillary Nodes

• Central nodes – These are found close to the 2nd part of the axillary artery and receive lymph from the anterior, posterior, and lateral nodes.

The apical nodes further form the subclavian lymphatic trunk, which then drains into the right lymphatic duct.

Lymph Nodes of the Lower Limb

The superficial and deep lymphatic vessels of the lower limb drain into the inguinal lymph nodes in the femoral triangle. This anatomical region, also named Scarpa’s triangle, is bounded by the inguinal ligament above, the medial border of the sartorius muscle laterally, and the medial border of the adductor longus muscle medially.[12][13]

Inguinal Nodes

The inguinal lymph nodes split at the level (where the great saphenous vein becomes the deep femoral vein) into sub-inguinal lymph nodes below and superficial inguinal nodes above.[3]

• Sub-inguinal nodes 

  • Superficial sub-inguinal nodes – These are found alongside the proximal saphenous vein and drain the superficial lymphatic vessels.

  • Deep sub-inguinal nodes – These nodes are commonly found alongside the medial femoral vein and collect lymph from the deep lymphatic channels of the lower limb.

• Superficial inguinal nodes – These nodes are traditionally found immediately inferior to the inguinal ligament and drain the perineal area (penis, scrotum, perineum), the gluteal region, and part of the abdominal wall.

 Iliac Nodes:[14]

• External iliac nodes

  • Lateral external iliac lymph nodes – These are found lateral to the external iliac artery.

  • Intermediate external iliac lymph nodes – These are found medial to the external iliac artery and anterior to the external iliac vein.

  • Medial external iliac lymph nodes – These are found medial to the external iliac vein.

• Common iliac nodes – They commonly arise at the level of the aortic bifurcation (4th lumbar vertebra) and extend until the level of the common iliac bifurcation (2nd sacral vertebra)

  • Lateral common iliac lymph nodes – These are found lateral to the common iliac artery.

  • Intermediate common iliac lymph nodes – These appear alongside the posteromedial common iliac artery.

  • Medial common iliac lymph nodes – These are alongside the medial common iliac artery.

Clinical Significance

The lymphatic system is involved in infective, inflammatory, and malignant diseases, and as such, enlargement of lymph nodes can be attributed to multiple causes. In the case of lymphadenopathy of unclear origin, endoscopic ultrasound (EUS) with or without fine-needle aspiration (FNA) can aid in diagnosis.[15] This diagnostic technique has been shown to have high accuracy with up to 85% sensitivity and 100% specificity and is key in detecting and staging malignancy.[16] With lymph nodes that are out of the scope of fine-needle sampling, elastography plays an increasingly important role, similar to obtaining a virtual biopsy.[17] Functional and anatomical data can be acquired using more traditional diagnostic methods such as positron emission tomography (PET) combined with computed tomography. However, this is commonly a whole-body imaging technique and therefore involves high doses of ionizing radiation. Despite the recent advancements in imaging modalities, the diagnosis still heavily relies on clinical correlation with symptoms.

Continuing Education / Review Questions

Figure

Lymphatic System, Cervical lymph nodes, Lymphatics of the mammary gland, Cisterna chyli, Lumbar lymph nodes, Pelvic lymph nodes, Lymphatics of the lower limb, Thoracic duct, Thymus, Axillary lymph nodes, Spleen, Lymphatics of the upper limb, Inguinal (more…)

Figure

Deep Cervical Lymph nodes, Principal gland of tongue, Supraomohyoid gland, Central trunk, Interrupting nodule, Trunks from margin of tongue, Submental gland, Vessels from apex, Vessels from margin of tongue, Vessels from root of tongue. Contributed by (more…)

Figure

Axillary lymph nodes, Deltoideo Pectoral glands, lateral group, Subclavicular group, Central group, Subscapular group, Pectoral group, Cutaneous collecting trunk fro the thoracic wall, Cutaneous collecting trunks, Subareolar plexus, Pectoral group, Mammary (more…)

References

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Johnson OW, Chick JF, Chauhan NR, Fairchild AH, Fan CM, Stecker MS, Killoran TP, Suzuki-Han A. The thoracic duct: clinical importance, anatomic variation, imaging, and embolization. Eur Radiol. 2016 Aug;26(8):2482-93. [PubMed: 26628065]

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Girard JP, Springer TA. High endothelial venules (HEVs): specialized endothelium for lymphocyte migration. Immunol Today. 1995 Sep;16(9):449-57. [PubMed: 7546210]

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Bontumasi N, Jacobson JA, Caoili E, Brandon C, Kim SM, Jamadar D. Inguinal lymph nodes: size, number, and other characteristics in asymptomatic patients by CT. Surg Radiol Anat. 2014 Dec;36(10):1051-5. [PubMed: 24435023]

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Elmore SA. Histopathology of the lymph nodes. Toxicol Pathol. 2006;34(5):425-54. [PMC free article: PMC1892634] [PubMed: 17067938]

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Baldazzi V, Paci P, Bernaschi M, Castiglione F. Modeling lymphocyte homing and encounters in lymph nodes. BMC Bioinformatics. 2009 Nov 25;10:387. [PMC free article: PMC2790470] [PubMed: 19939270]

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Liao S, von der Weid PY. Lymphatic system: an active pathway for immune protection. Semin Cell Dev Biol. 2015 Feb;38:83-9. [PMC free article: PMC4397130] [PubMed: 25534659]

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Markgraf R, von Gaudecker B, Müller-Hermelink HK. The development of the human lymph node. Cell Tissue Res. 1982;225(2):387-413. [PubMed: 6980711]

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Cupedo T. Human lymph node development: An inflammatory interaction. Immunol Lett. 2011 Jul;138(1):4-6. [PubMed: 21333686]

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Grégoire V, Ang K, Budach W, Grau C, Hamoir M, Langendijk JA, Lee A, Le QT, Maingon P, Nutting C, O’Sullivan B, Porceddu SV, Lengele B. Delineation of the neck node levels for head and neck tumors: a 2013 update. DAHANCA, EORTC, HKNPCSG, NCIC CTG, NCRI, RTOG, TROG consensus guidelines. Radiother Oncol. 2014 Jan;110(1):172-81. [PubMed: 24183870]

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Suami H, Taylor GI, Pan WR. The lymphatic territories of the upper limb: anatomical study and clinical implications. Plast Reconstr Surg. 2007 May;119(6):1813-1822. [PubMed: 17440362]

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Cuadrado GA, de Andrade MFC, Akamatsu FE, Jacomo AL. Lymph drainage of the upper limb and mammary region to the axilla: anatomical study in stillborns. Breast Cancer Res Treat. 2018 Jun;169(2):251-256. [PubMed: 29380209]

12.

Pan WR, Wang DG, Levy SM, Chen Y. Superficial lymphatic drainage of the lower extremity: anatomical study and clinical implications. Plast Reconstr Surg. 2013 Sep;132(3):696-707. [PubMed: 23985641]

13.

Pan WR, Levy SM, Wang DG. Divergent lymphatic drainage routes from the heel to the inguinal region: anatomic study and clinical implications. Lymphat Res Biol. 2014 Sep;12(3):169-74. [PubMed: 25229435]

14.

Hsu MC, Itkin M. Lymphatic Anatomy. Tech Vasc Interv Radiol. 2016 Dec;19(4):247-254. [PubMed: 27993319]

15.

Hocke M, Ignee A, Dietrich C. Role of contrast-enhanced endoscopic ultrasound in lymph nodes. Endosc Ultrasound. 2017 Jan-Feb;6(1):4-11. [PMC free article: PMC5331842] [PubMed: 28218194]

16.

Eloubeidi MA, Chen VK, Eltoum IA, Jhala D, Chhieng DC, Jhala N, Vickers SM, Wilcox CM. Endoscopic ultrasound-guided fine needle aspiration biopsy of patients with suspected pancreatic cancer: diagnostic accuracy and acute and 30-day complications. Am J Gastroenterol. 2003 Dec;98(12):2663-8. [PubMed: 14687813]

17.

Popescu A, Săftoiu A. Can elastography replace fine needle aspiration? Endosc Ultrasound. 2014 Apr;3(2):109-17. [PMC free article: PMC4064158] [PubMed: 24955340]

Lymphadenitis | Johns Hopkins Medicine

What is lymphadenitis?

Lymphadenitis is the medical term for enlargement in one or more lymph nodes, usually due to infection. Lymph nodes are filled with white blood cells that help your body fight infections. When lymph nodes become infected, it’s usually because an infection started somewhere else in your body. Rarely, lymph nodes can enlarge due to cancer.

You have about 600 lymph nodes in your body, but normal lymph nodes may only be felt below your jaw, under your arms, and in your groin area.

A normal lymph node is small and firm. When lymph nodes become infected, they usually increase in size, become tender, and may be felt in other areas of your body during a physical exam.

Infections that spread to lymph nodes are usually caused by bacteria, a virus, or a fungus. It is important to learn how the infection spread into your lymph nodes so that the right treatment can be started.

Lymphadenitis can be one of two types:

• Localized lymphadenitis. This is the most common type. Localized lymphadenitis involves one or just a few nodes that are close to the area where the infection started. For example, nodes enlarged because of a tonsil infection may be felt in the neck area.
• Generalized lymphadenitis. This type of lymph node infection occurs in two or more lymph node groups and may be caused by an infection that spreads through the bloodstream or another illness that affects the whole body.

What causes lymphadenitis?

Lymphadenitis occurs when one or more lymph nodes are infected by a bacteria, a virus, or a fungus. When lymph nodes become infected, it’s usually because an infection started somewhere else in your body.

What are the symptoms of lymphadenitis?

The main symptom of lymphadenitis is enlarged lymph nodes. A lymph node is considered enlarged if it is about one-half inch wide. Symptoms caused by an infected lymph node or group of nodes may include:

• Nodes that increase in size
• Nodes that are painful to touch
• Nodes that are soft or matted together
• Redness or red streaking of the skin over nodes
• Nodes that are filled with pus (an abscess)
• Fluid that drains from the nodes to the skin

The symptoms of lymphadenitis may look like other medical conditions or problems. Always see your healthcare provider for a diagnosis.

How is lymphadenitis diagnosed?

If you have lymphadenitis, the most important parts of your diagnosis are usually your history and the physical exam done by your healthcare provider. You may be asked about your symptoms, such as chills and fever, any recent travel, any breaks in your skin, and recent contact with cats or other animals. Then, during the physical exam, your healthcare provider will look for signs of infection near the enlarged lymph nodes.

These tests may be needed to help make the diagnosis:

• Blood tests to look for infection
• Taking a sample of tissue from the lymph node or fluid from inside the lymph node to study under a microscope
• Placing fluid from the lymph node into a culture to see what type of germs grow

How is lymphadenitis treated?

Your healthcare provider will figure out the best treatment based on:

• How old you are
• Your overall health and medical history
• How sick you are
• How well you can handle specific medicines, procedures, or therapies
• How long the condition is expected to last
• Your opinion or preference

The exact type of treatment depends on what type of infection has spread into your lymph nodes. Once an infection has spread into some lymph nodes, it can spread quickly to others and to other parts of your body, so it’s important to find the cause of the infection and start treatment quickly.

Treatment for lymphadenitis may include:

• Antibiotics given by mouth or injection to fight an infection caused by bacteria
• Medicine to control pain and fever
• Medicine to reduce swelling
• Surgery to drain a lymph node that has filled with pus

Can lymphadenitis be prevented?

The best way to prevent lymphadenitis is to see your healthcare provider at the first sign of any infection or if you notice a tender swelling that feels like a little lump just beneath your skin. Make sure to cleanse and use antiseptic on any scratches or breaks in your skin and always practice good hygiene.

Living with lymphadenitis?

Take all your medicines exactly as prescribed and keep all your follow-up appointments. Don’t use any over-the-counter medicines without first talking to your healthcare provider. Cool compresses and elevating the affected part of your body may help relieve pain and swelling while your medicines are doing their work.

In most cases, lymphadenitis clears up quickly with proper treatment, but it may take more time for lymph node swelling to go away. Be sure to let your healthcare provider know if your lymphadenitis symptoms come back. 

When should I call my healthcare provider?

If your symptoms get worse or you have new symptoms, call your healthcare provider. 

Key points about lymphadenitis

• Lymphadenitis is an infection in one or more lymph nodes.
• When lymph nodes become infected, it’s usually because an infection started somewhere else in your body.
• Lymphadenitis can cause lymph nodes to become enlarged, red, or tender.
• Treatment may include antibiotics, and medications to control pain and fever.
• Early treatment of infections can prevent the development of lymphadenitis.

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 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 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 provider if you have questions.

What Causes Swollen Lymph Nodes?

Let’s say you happen to run your hand across your neck one day and discover a small, hard bump that didn’t used to be there. Is this a cause for concern? Is it just your body doing what it is made to do, or could this be the first sign of something serious or even deadly such as cancer? Chances are, if you suddenly notice a bump on the side of your neck or in your armpit, it is probably a swollen lymph node. The trouble is, this could indicate anything from a common cold to life-threatening disease.

What are Lymph Nodes?

Responsible for storing the white blood cells that attack invading infectious agents, your lymphatic system is an important part of your body’s immune system. Consisting of small glands called nodes that filter lymph fluid, reactions by your lymphatic system can be a reliable indicator that your body is fighting off some form of attack, even if the cause of the swelling may not be immediately obvious.

Lymph nodes are found throughout the body. The glands that are typically identified as swollen are those in or around the neck, groin, collarbone, and armpits, as these are close to the surface of the body and easier for you to notice or for your doctor to identify in a physical examination.

What Causes Swollen Glands in the Neck?

As part of your body’s immune system, swollen lymph nodes typically indicate that your body is working hard to fight infection. Other factors can contribute to swollen glands, though, including reactions to medication or more serious causes such as autoimmune disorders or even certain types of cancer.

At the mild end of the spectrum of common causes of swollen glands are various kinds of infections. These could be anything from the flu to more bothersome illnesses such as:

• sinus infections
• tonsillitis
• tooth or gum infections
• mononucleosis
• staph infections
• viral infections
• bacterial infections
• skin infections
• fungal infections
• ear infections
• strep throat
• other upper respiratory infections

While some of these illnesses are systemic and affect the entire body, several of the conditions listed above primarily affect tissues of the head and neck. Other infectious diseases cause different lymph node swelling that may not always involve the neck. Some sexually transmitted infections fall in this category. Syphilis and gonorrhea, for example, both result in swollen lymph nodes, though they typically affect the groin area more prominently than other areas of the body.

When Should I be Worried About Swollen Glands?

Swollen lymph glands could mean nothing more than a common cold, but there are occasions when swollen lymph glands accompany more than just a sore throat. If you discover that you have swollen lymph glands in conjunction with symptoms such as unexplained weight loss or night sweats that can accompany other, more worrying conditions, it may be time to talk to your doctor. Additionally, if your medical history suggests you may be at risk for certain types of cancers or autoimmune diseases, you should definitely consult a health care professional sooner rather than later.

Some of the more worrying causes of swollen lymph glands can cover a range from troubling to life-threatening diseases. Aside from cancers, swollen glands can be a symptom of:

• toxoplasmosis
• tuberculosis
• HIV
• rubella
• herpes
• Lyme disease
• measles
• chicken pox

It is also possible that autoimmune diseases like lupus, rheumatoid arthritis, and Sjorgen’s syndrome could be contributing to the swelling you are experiencing. These autoimmune disorders will typically be accompanied by other, noticeable symptoms, such as the joint pain characteristic of arthritis.

Cancer is the greatest worry when it comes to swollen lymph glands. These include non-Hodgkin lymphoma, which is a form of cancer directly affecting your lymphatic system, or other cancers throughout your body such as breast cancer. Hodgkin diseases, leukemia, and Kaposi sarcoma are all forms of cancer or malignancy that can affect your lymphatic system, resulting in swollen glands. Given the severity of these deadly conditions, seeking treatment quickly after symptoms are identified can be crucial to your overall health or even your life.

Diagnosis and Treatment of Swollen Lymph Nodes

Since swollen glands in your neck could indicate anything from the common cold to cancer, getting a proper diagnosis is crucial in understanding what you are up against. In many cases, your doctor will perform a physical examination, look for signs of other potentially worrying symptoms, and possibly order imaging such as an X-ray or CT scan.

If blood tests or imaging results indicate there may be cause for concern, your doctor may recommend taking a tissue sample from one of your swollen lymph glands in a lymph node biopsy. This allows for more thorough testing to determine whether your symptoms are part of a serious medical condition or just an indication of a passing infection.

If it turns out that you are experiencing swollen glands as a result of a simple infection such as the flu, managing pain and swelling through common over-the-counter remedies like ibuprofen or acetaminophen is often recommended.

It is also possible that lymph nodes may need to be removed if they continue to cause you trouble. The most common example of this is having your tonsils removed. If you are experiencing chronic or recurring tonsillitis, such as in the case of repeated strep throat infections, it is possible that your doctor may recommend having your tonsils removed to prevent repeated infections.

For more serious diseases such as breast cancer or lymphoma, treatment will be far more involved. In these cases, addressing the underlying condition is the priority, which could involve a wide range of treatments from tissue removal to chemotherapy. It is not uncommon for lymph glands to continue to be swollen throughout the course of treatment when malignancies are the cause.

More recently, there are indications that the novel coronavirus responsible for the ongoing COVID-19 pandemic also causes swelling in the lymphatic system. It has also been reported that individuals who have received some versions of the coronavirus vaccine have experienced temporary swelling and tenderness in the lymph nodes of the neck, particularly on the side of the body where the shot was administered. There is no evidence this is indicative of any reason for concern as long as the swelling disappears within a few days.

Don’t Wait to Get Treated

Finding one swollen lymph node is not likely a cause for worry. That said, if you are older, or have a history of medical conditions that indicate you could be at risk for cancer or other serious diseases, swollen glands are something you should keep an eye on. Staying in touch with your doctor could be vitally important, especially if you begin to develop other symptoms such as sudden, unexplained weight loss.

At TrustCare, we know that access to medicine when and where you need it can help make the difference in getting the treatment you need. That is why our locations are open seven days a week to help you get the advice and care you need. If you are beginning to show symptoms that seem concerning, or if it is time to get a regular checkup just to make sure everything is in good order, consider visiting one of our locations today.

What are lymph nodes?

Lymph is clear or white fluid that travels through vessels, moves within tissues and work to keep all the parts of the body clean.

After passing through the channels of the lymphatic system they drain into the lymph nodes.

The lymph nodes act as filters along the lymphatic system. These nodes trap germs like bacteria, viruses, toxins as well as cancer cells and ensure that these are removed from the body. (1)

Structure of the lymph nodes

The lymph nodes, also known as nodes, are small bean shaped structures that look like tiny bulbs and lie along the lymph vessels.

Lymphocytes

The lymph nodes hold the lymphocytes, a type of white blood cell. These act as fighters against foreign invasion by bacteria, viruses, cancer cells or toxins.

The lymphocytes also help control the immune response.

This function is brought about by bringing the lymphocytes in contact with foreign materials – usually protein on the germs or toxins called antigens. Once in contact with the antigens the lymphocytes are activated. (2)

These lymphocytes originate from stem cells in the bone marrow.

Types of lymphocyte

There are two major classes of lymphocytes – B cells and T cells.

The B cells fully develop in the bone marrow while the T cells are removed from the bone marrow in an immature form when they reach other organs like the thymus where they attain maturity to fight infections and foreign antigens. (2)

What is lymph?

The lymph is a clear or whitish fluid that flows through the lymph channels.

It flows through the tiniest of the blood vessels and lymph channels called capillaries and bathe the cells in the tissues of the body.

Like clean blood that flows in the arteries from the heart lymph also it carries oxygen and other nutrients.

While returning from the tissues the lymph carries away carbon dioxide and other toxins.

If lymph is not drained adequately, it might lead to swelling.

The lymph vessels gather all the lymph and send it towards the chest.

There is a large vessel within the chest that brings the lymph into a large blood vessel near the heart.

The filtered fluid, salts, and proteins that come via the lymph channels are all deposited in the blood.

What do the lymph nodes contain?

The lymph nodes contain immune cells that can attack and destroy the germs that the lymph vessels have gathered.

The node filters fluid and substances picked up by the lymph vessels.

Where are the lymph nodes located?

The lymph nodes are located at specific sites in clusters.

For example, all the lymph channels from the fingers, palm, and hand get filtered through lymph nodes at the elbow, or at the arm pits.

The lymph channels from the toes, legs and feet drain at the nodes behind the knees or at the groin.

The channels from the face, head and scalp get filtered at lymph nodes in the neck.

There are deeper lymph nodes as well located between lungs, around the coils of the intestines etc. (3)

What organs form part of the lymphatic system?

The major organs that are part of the lymphatic system are the spleen, thymus, tonsils and adenoids.

Of these the spleen lies within the abdomen (left side under the ribs), the thymus in the chest and the tonsils and the adenoids within the back of the mouth. (4)

Cancer and the lymphatic system

Another major fact is that the lymph channels serve to spread the cancer cells throughout the body. This is called cancer metastasis and frequently occurs via travelling of the cancer cells through the lymphatic system. (2)

Further Reading

19.3C: Lymph Nodes – Medicine LibreTexts

Lymph nodes are small oval-shaped balls of lymphatic tissue distributed widely throughout the body and linked by lymphatic vessels.

Learning Objectives

• Describe the structure and function of lymph nodes

Key Points

• Lymph nodes are well-distributed around the chest, armpits, neck, and abdomen.
• Each lymph node is surrounded by a fibrous capsule that encircles the internal cortex and medulla. The cortex is mainly composed of clusters of B and T cells. The medulla contains plasma cells, macrophages, and B cells, as well as sinuses, which are vessel-like spaces that the lymph flows into, and nodules located within the sinuses.
• Lymph nodes contain a hilum beneath the capsule, which brings blood supply to the tissues of the lymph node.
• Antigen presentation by dendritic cells occurs in the lymph nodes, which triggers an adaptive immune response.
• Lymphadenopathy, the swelling of the lymph nodes, can indicate the presence of an infection or cancer.
• Lymph circulates to the lymph node via afferent lymphatic vessels and drains into the efferent lymphatic vessels just beneath the capsule.

Key Terms

• lymphadenopathy: Swelling of the lymph nodes that can indicate the presence of an infection or cancer.
• lymph node: Small oval bodies of the lymphatic system that act as filters, with an internal honeycomb of connective tissue filled with lymphocytes and macrophages that collect and destroy bacteria, viruses, and foreign matter from lymph.

Lymph nodes are small oval-shaped balls of lymphatic tissue, distributed widely throughout the body and linked by a vast network of lymphatic vessels. Lymph nodes are repositories of B cells, T cells, and other immune system cells, such as dendritic cells and macrophages. They act as filters for foreign particles in the body and are one of the sites where adaptive immune responses are triggered.

Structure of Lymph Nodes

Lymph node structure: This diagram of a lymph node shows the outer capsule, cortex, medulla, hilum, sinus, valve to prevent backflow, nodule, and afferent and efferent vessels.

Lymph nodes are found throughout the body, and are typically 1 to 2 centimeters long. Humans have approximately 500–600 lymph nodes, with clusters found in the underarms, groin, neck, chest, and abdomen. Each lymph node is surrounded by a fibrous capsule that encircles the internal cortex and medulla. The cortex is mainly composed of clusters of B cells in the outer layers and T cells in the inner layers, and may also contain antigen-presenting dendritic cells. The medulla contains plasma cells, macrophages, and B cells as well as sinuses, which are vessel-like spaces that the lymph flows into. Inside each sinus cavity is a nodule, a smaller, denser bundle of lymphoid tissue that usually contains a germinal center, the site of B cell proliferation during antigen presentation. The sinuses are partially divided by capsule tissue, which causes lymph fluid to flow around the nodules in each sinus cavity on their way through the node.

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

Lymph fluid flows into and out of the lymph nodes via the lymphatic vessels, a network of valved vessels that are similar in structure to cardiovascular veins. Each lymph node has an afferent lymph vessel that directs lymph into the node, and an efferent lymph vessel called the hilum that directs lymph out of the node at the concave side of the node. The hilum also contains the blood supply of the lymph node.

Function of Lymph Nodes

Lymph nodes are the primary site for antigen presentation and activation in adaptive immune response in B and T lymphocytes. These lymphocytes are continuously recirculated through the lymph nodes and the bloodstream. Molecules called antigens are found on bacteria cell walls, the cell walls of virus-infected cells, or even chemical substances and toxins secreted from bacteria. These antigens may be taken by cells into the lymph nodes. There, antigen-presenting cells called dendritic cells present the antigen molecule to naive B and T lymphocytes. These undergo cell cycle proliferation into lymphocytes that are able to specifically detect and eliminate pathogens associated with that antigen, through various methods such as cytotoxic action (T cells) and antibody production (B cells).

The lymph nodes also filter the lymph fluid. Macrophages in the sinus spaces phagocytize (engulf) foreign particles such as pathogen, so that lymph fluid that returns to the bloodstream is cleaned of problematic abnormalities. The lymph node is also arranged in such a way that the chance of B and T lymphocytes encountering dendritic cells is quite high, to facilitate antigen presentation.

Lymphadenopathy

Lymphadenopathy describes the clinical condition of swollen lymph nodes. This is usually caused by increased lymph flow into the nodes. This fluid may carry a higher amount of debris, so inflammation occurs as more neutrophils and later macrophages enter the node to remove debris from the lymph.

Lymphadenopathy is a symptom in conditions from trivial, such as a common cold or a minndor infection, to life-threatening, such as cancer or severe infection. Cancers that are severe and widespread from frequent metastases tend to have lymphadenopathy, so cancer staging criteria includes lymph node involvement. Additionally, cancers like lymphomas that have tumors made out of aberrant lymphocytes nearly always show lymphadenopathy, often an early warning sign for this type of cancer.

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The Role of Lymph Nodes in Breast Cancer

One of the first places breast cancer can spread and grow is in nearby lymph nodes, which are part of the body’s lymphatic (lymph) system. The lymphatic system plays an important role in the body’s immune system, which protects you against infection and disease, and is made up of three parts:

1. Lymph, a clear fluid that circulates through the lymphatic system
2. Lymphatic vessels
3. Lymph nodes

The lymph system’s primary function is to circulate the lymph, which contains infection-fighting white blood cells, throughout the body and to flush your body of toxins, waste, and other unwanted materials.

As breast cancer cells multiply, they can enter the lymphatic vessels that are located in a woman’s breast tissue. The lymph fluid then carries the cells throughout the body. Often times, the lymph nodes in the underarm area are the first place breast cancer will start to grow since they are the closest to the breast.

The tests used by the oncologist to determine that there are breast cancer cells in the lymph nodes is called lymph node evaluation.

Determining Lymph Node Involvement

Your breast cancer specialist will remove one or several underarm lymph nodes so they can be biopsied and then examined under a microscope to determine if lymph nodes are involved.

There are two different ways lymph nodes can be checked. The most common and least-invasive method is called sentinel lymph node biopsy. The other is called axillary lymph node dissection.

In most cases, lymph node surgery is done as part of the main surgery to remove the breast cancer. There are times, however, when it may be done as a separate operation.

Sentinel Lymph Node Biopsy (SLNB)

A sentinel lymph node is defined as the first lymph node to which cancer cells are most likely to spread from a primary tumor. There are times more than one sentinel lymph node is present.

During surgery to remove early-stage breast cancer, the sentinel node is identified and then removed so it can be sent to a pathologist (a physician who studies the causes and effects of diseases). The pathologist will determine if there is cancer in it. This procedure to remove the sentinel lymph node so it can be examined is called a sentinel lymph node biopsy (SLNB).

To identify the sentinel node the surgeon will:

• Inject a radioactive substance, a blue dye, or both near the tumor
• Use a device that detects radioactivity to find the sentinel node or looks for lymph nodes that are stained with the blue dye
• Make a small incision (about 1/2 inch) in the overlying skin and remove the node once it has been located

The results of the pathology exam help determine breast cancer stage and help plan treatment.

If no cancer is found in the sentinel nodes (lymph node-negative), surgery to remove more lymph nodes will not be needed because it is unlikely other lymph nodes have cancer. If cancer is found in the sentinel nodes (lymph node-positive), more lymph nodes may be removed with a procedure called axillary dissection. However, in select low-risk cases with pre-specified criteria and only 1 to 2 lymph nodes involved, lymph node axillary dissection can be avoided in cases of breast preservation where radiation therapy is part of the planned management.

Axillary Lymph Node Dissection (ALND)

The axillary lymph nodes run from the breast tissue into the armpit. This area under the arm is called the axilla.

Anywhere from 10 to 40 lymph nodes are removed and examined during an axillary lymph node dissection. These nodes are typically removed during your lumpectomy or mastectomy.

Lymph Node Status and Breast Cancer Treatment

The biopsy results, which is called a pathology report, will show how many lymph nodes were removed and how many were “involved” (tested positive for cancer). This is referred to as lymph node status.

Breast cancer that has not spread to nearby lymph nodes, is referred to as node-negative status. If the report indicates that cancer is present in the lymph nodes, this is referred to as node-positive status. Positive results also mean that the cancer may have already or could possibly spread to other organs, such as the bones, liver, lungs, and brain. In order to determine that, further tests would be necessary.

How much cancer is in each node will also show on the results of the report. Cancer cells can range from small in size and few in number to large in size and many in number. This information may be reported as: 

• Microscopic (or minimal), meaning only a few cancer cells are in the node and that a microscope is needed to find them.
• Gross (also called significant or macroscopic), meaning there is a lot of cancer in the node and that it can be seen or felt without the use of a microscope.
• Extracapsular extension, meaning the cancer has spread (metastasized) outside the wall of the node.

Breast cancer treatment decisions and prognosis (outlook) can be affected by the lymph node status. If there is cancer found in the lymph nodes, chemotherapy might be required in addition to surgery. This is because chemotherapy can attack cancer cells throughout the lymph system. Patients who have negative results often have a greater chance of a full and long-lasting recovery than patients who have positive results. This is why doing self-exams and getting your regular mammograms can be helpful in finding breast cancer early. The earlier it is found, the less chance there is of it spreading to the lymph nodes.

90,000 Lymph nodes – what it is, function, location.

What analysis is taken from a person in the first place to determine whether he is healthy or not? Blood.

And imagine if there were still a simple and painless analysis of the contents of the lymph node. Then we would know everything about which the blood is silent! After all, all the “garbage” that is in the body is delivered to the lymph node: toxins, viruses, bacteria, fungi, parasites and even cancer cells. Here, all this murderous cocktail is completely destroyed.

Lymph nodes are our main defenders that protect our health, beauty, youth.

What do you know about lymph nodes?

When was the last time you checked yours?

What do you do to ensure that they can work smoothly?

If these simple questions baffled you, read this article and fill in the blanks.

Contents of the article

What are lymph nodes

Lymph is a devoted partner of blood, without which it simply would not exist.The life of each of our cells depends on the well-coordinated work of these two hard workers.

Blood delivers gases, nutrients and water to the cell. Lymph, washing the cell, “sucks” from it all unnecessary and harmful and sends it through its channels for cleaning and removal from the body.

Just imagine how many different “garbage” is formed in the human body every day: dead cells, corpses of viruses and bacteria, all kinds of toxins that have penetrated with food and air – a multi-billion dollar army!

And all this is pumped out of the cells by lymph.It catches all the “garbage” and drives it along its own paths.

Like the circulatory system, the lymphatic system has its own extensive “transport network” to which every cell of our body is “connected”. This network consists of vessels, capillaries, ducts, and trunks. And a very special, unique role in this biological “sewage” is assigned to the lymph nodes – a kind of sedimentation tanks.

It is in the nodes that all the “dirt” accumulated in the body is neutralized and eliminated: toxins, dead cells, corpses of viruses, bacteria, fungi, parasites, cells of malignant tumors.All this is filtered, like sewerage streams in sedimentation tanks. And special cells, lymphocytes, which are formed in the lymph nodes, are fighting all pathogens – our main defenders.

Lymph node functions

1. Barrier-protective

   Defense cells are formed in the lymph nodes: lymphocytes, phagocytes, antibodies. The lymph nodes capture harmful agents from the lymph and “digest” them. In particular, they prevent the proliferation of cancer cells, protect the body from the penetration of infectious agents.Lymph nodes are also responsible for the immune response to antigens.

2. Hematopoietic

   After passing through the nodes-“sedimentation tanks”, the lymph flows into the bloodstream, clean and enriched with lymphocytes. Lymphocytes, entering the systemic circulation, are carried with the bloodstream to all tissues and organs, where they perform their protective functions.

3. Drainage

   Nodes are involved in the outflow of fluid.They collect lymph from the vessels that come from the tissues. If this function is impaired, excess fluid accumulates in the tissues, and edema occurs.

4. Depositing

   The node acts as a temporary storage for lymph. A certain amount of lymph is retained in the lymph node and is turned off from the lymph flow. Why is this needed? For example, a lymph node is able to provide emergency unloading of the bloodstream in conditions of venous stasis, for this it can increase by 40-50%.

5. Exchange

   Nodes are involved in the metabolism: proteins, fats, carbohydrates, etc.

   And more about the daily feminine.

   Not only your health depends on the full functioning of the lymph nodes, but also your appearance, beauty and youth.

   When the lymph nodes cannot cope with all the “garbage” that gets into them with the lymph, they become clogged and inflamed.

   • Swollen hands – a sign of blockage of the axillary nodes, because of it, fluid does not leave the upper limbs.
   • Elephant legs means problems with the popliteal and inguinal lymph nodes, due to a violation of their drainage functions, the fluid cannot rise from the legs.
   • Swollen eyes – evidence that the submandibular and parotid lymph nodes cannot cope with their task.

Anatomy of the lymph nodes

Lymph nodes only seem small and insignificant.There are up to 1,000 of them in the human body, and together they make up about 1% of the body weight.

Most of them are located deep under the skin and even near the internal organs, so they cannot be felt. But some (under the jaw, in the groin, under the armpits) are palpable even in a healthy state.

The size of the lymph nodes is from 1 millimeter to 3 centimeters. Form – kidney-shaped, round, oval, ribbon-like. From the convex side of the node, the bringing lymphatic vessels enter it, and from the reverse side (from the so-called gate) the outgoing ones come out.

As a rule, 2-4 bringing vessels come to the node, and 1-2 outgoing vessels come out. That is, less lymph comes out than it comes in.

In addition, the lymph node communicates with the blood vessels. Arteries and nerves enter its gates, and veins exit.

The surface of the lymph node is covered with a connective tissue capsule. Under it is concentrated lymphoid tissue, which is saturated with many lymphocytes.

In the nodes, lymph slowly seeps through narrow slit-like spaces called sinuses.So she is cleansed of everything foreign.

Classification of lymph nodes

Lymph nodes are divided into several types according to different characteristics. Here are just a few of them:

1. By the depth of location: superficial (under the skin) and deep (on the surface of organs, on the walls of cavities, in the places of division of large blood vessels).
2. By location in the walls of the body (parietal) or inside its cavities (visceral).
3. By location in the gates of organs (organ) or between organs (interorgan).
4. By localization: several groups are distinguished depending on the location next to one or another organ / part of the body.

Location of lymph nodes in the human body

As a rule, lymph nodes are located in “flocks” near certain organs or parts of the body.

In each group of lymph nodes, lymph is collected from tissues and organs that are located nearby. Before entering the bloodstream, the lymph is sequentially filtered in several nodes, one after the other.It flows into the blood, already purified and enriched with lymphocytes.

Lumps in the neck, armpits and groin are most affected.

The main groups of lymph nodes on the human body:

• Lymph nodes of the head and neck

  This is a large and very important group.

  First, there is a brain next to them. The protection of brain tissues from the penetration of infections and pathological cells into them depends on the proper functioning of the cervical-head section of the lymphatic system.

  Secondly, the beauty of our face depends on the lymph nodes of the head and neck. They are responsible for the cleanliness of the head lymphatic basin, and, therefore, for the condition of the skin and soft tissues on the face. Some interruptions in the nodes – the lymph stagnates on the face as a “rotting swamp” – impurities burst outward with acne, rash, edema, bags under the eyes, folds, flews, double chin, sagging skin.

  Head lymph nodes:

  • parotid,
  • occipital,
  • mastoid (behind the ear),
  • submandibular,
  • chin,
  • facial.

  Neck lymph nodes:

  • front surface,
  • anterior deep (prelaryngeal, pretracheal, thyroid, etc.),
  • lateral superficial,
  • deep lateral (supraclavicular, retropharyngeal, nodes near the internal jugular vein).

  The easiest way to feel the submandibular lymph nodes, they are located on the left and right under the jaw.

  Unlike the rest of the body, the lymph on the face and neck moves from top to bottom. In the nodes, it is filtered, saturated with lymphocytes and, already pure and enriched, is sent into the bloodstream through the vein, which is located between the collarbones.

  As a rule, inflammation of the lymph nodes in the neck, near the ears, under the jaw is a reaction to colds.

• Axillary lymph node group

  Axillary lymph nodes are easy to find on your own.Their inflammation may indicate a disease of nearby organs.

  Especially the size of the axillary nodes should be monitored by women: their increase may indicate breast diseases. By the way, women have lymph nodes in the mammary glands themselves, but they are not as easy to detect on their own as axillary ones.

  Felt an enlarged knot under your armpits? Do not panic. This could be one of the following situations:

  • As a result of shaving, the skin has been damaged and an infection has penetrated.
  • You used a lot of deodorant on an unclean body: the pores, in which bacteria remained, were clogged, and the multiplication of microorganisms led to inflammation.
  • You are pregnant or breastfeeding.

• Inguinal lymph nodes

  Easily felt in the groin area. It is very important to monitor their condition as they are responsible for healthy fertility.

  Inguinal nodes are located close to the organs of the reproductive system and neutralize aggressors who come from the lower body. Lymph flows to the inguinal nodes from the legs, buttocks, abdominal wall (lower part), perineum, genitals.

  Inflamed lymph nodes in the groin swell, become the size of a bean and even a quail’s egg, pain when pressed.

• Popliteal lymph nodes

  Located behind the knee, in the popliteal fossa.

  The popliteal nodes are responsible for the outflow of lymph from the foot and lower leg. They protect the body from injuries and injuries to the legs, as they prevent the penetration of infection.

  Are your legs swollen below the knees? This indicates a blockage of the popliteal lymph nodes.

  Enlarged nodes in this area can be felt independently: they are located shallow under the skin.

  Usually popliteal lymph nodes enlarge due to some local infectious disease (for example, furunculosis) or bruises, broken legs.

• Chest nodes

  They are located deeply, it is impossible to grope them. Responsible for the internal organs.

  Divided into:

  • peristernal,
  • intercostal,
  • prevertebrates,
  • pericardial (near the heart),
  • upper diaphragmatic,
  • bronchopulmonary,
  • tracheobronchial,
  • peri-tracheal,
  • nodes of the mediastinum (parts of the chest cavity between the right and left pleura).

• Nodes of the abdominal cavity and abdomen

  They are located deeply and cannot be felt. They are divided into parietal (located in the lumbar region) and internal (gastric, hepatic, pancreatic, splenic, mesenteric, renal, iliac, etc.).

Causes of swollen lymph nodes

While the lymph uninterruptedly transports to the lymph nodes what it should, and the nodes cope with the load, the body is protected from everything harmful and foreign.

But if the amount of such “garbage” began to go off scale, then the nodes begin to work more actively, increase in size. And lymphocytes, despite their lightning-fast multiplication, may not be enough to neutralize all these “impurities”. Then the lymph node becomes inflamed.

The increase in nodes should be taken into consideration. This is the first signal that says that something is wrong in the body. “Red button”, which can light up as a result of some mild infectious disease, and as a result of a serious pathology.

For example, an increase in several groups of nodes at once is one of the symptoms of HIV.

The main causes of enlarged lymph nodes:

• infectious processes (especially acute upper respiratory tract infections),
• autoimmune diseases,
• tumors,
• diseases that are accompanied by metabolic disorders.

But with an increase in the lymph node, its inflammation does not necessarily develop.It occurs only if there are too many infectious agents, and not all of them die when they encounter lymphocytes.

It is worth sounding the alarm if the node has reached a huge size (up to a walnut), hurts, or the increase lasts too long.

Diseases of the lymph nodes

The lymph nodes have their own diseases, the so-called primary lesions of the lymph nodes.

But much more often, inflammation of the lymph node occurs as a secondary process, a reaction to some other infectious and inflammatory disease.And, as a rule, the hearth is somewhere nearby.

The infection struck the throat – the lymph nodes in the neck became inflamed.

Finger on hand festered – axillary lymph nodes were inflamed.

A genital infection has joined – the lymph nodes in the groin have increased.

Inflammation of the lymph node (lymphadenitis) is a reaction to a weakened immune system. And in the risk group, first of all, there are people who have lowered immune forces. And this is almost every person on the planet.

See how we live? We don’t understand what we eat, we don’t understand what we breathe, we experience constant stress, we have replaced sports with gadgets.We sit in our phones, bent over in three deaths and chewing some “yeshki”.

Where does strong immunity come from? Among other things, it is reduced by nervous disorders, lack of vitamins, hypothermia, long-term illness, anemia.

Symptoms of inflammation

What happens to the lymph nodes when they become inflamed:

• they increase in size,
• an enlarged node presses on adjacent tissues and organs, pain appears, it intensifies when touched,
• on the affected area, the skin may turn red, edema may occur.

With inflammation of the lymph nodes, the general state of health worsens. Appears:

• temperature,
• malaise,
• headache,
• decreased appetite.

In an acute form of inflammation, the lymph node may fester, nausea and severe headache appear. But such development is rare.

Diagnostics

Diagnosis of inflammation of the lymph nodes (lymphadenitis) usually consists of a blood test and hardware techniques: ultrasound, MRI, CT.In rare cases, a biopsy of the node is required – a puncture and collection of its contents for analysis.

What to do when the lymph nodes become inflamed

You will ask how to treat inflammation of the lymph nodes? The question itself is incorrect. Lymphadenitis is not an independent disease, but a reaction to infections and inflammations that have crept into the body. And it is not the nodes that should be treated, but the cause of their occurrence.

The lymph nodes themselves should be left alone. The main help in this case is not to harm.

No lymph nodes:

• warm up,
• massage,
• to crush.

Heat for knots is like a fire source for a powder keg. All the “dirt” will spread throughout the body so that it does not seem a little.

Inflamed lymph nodes need rest. Take care of creating the appropriate conditions.

It is possible that you will have to seek the help of physiotherapy.

If the temperature starts to rise, it means that the infection is progressing. Do not delay seeking medical attention. If it comes to purulent inflammation, even surgery may be required.

How to keep lymph nodes healthy

As such, there is no prevention of inflammation of the lymph nodes, and the best help for them is strong immunity.

We do not allow anything harmful and foreign into the body – we do not create an unbearable load for the lymph nodes.

We follow the general rules to strengthen the immune system, so that infections are kept by our side:

• physical activity,
• hardening,
• healthy food,
• fresh air,
• sufficient rest.

We also monitor healthy lymph flow. We do everything to keep the lymph clean and the lymph nodes to cope with their task.

What we do for delicate cleaning of lymph nodes and ducts:

• We remove excess liquid by mechanical cleaning. We dilute the lymph, help the lymph nodes to release toxins into the intestines. A proven option is licorice root + activated carbon.
• We move more: walk, run, swim, jump, play sports games.Muscles contract – lymph is pumped through the vessels.
• Beware of bruises and injuries. Women should especially protect their breasts. We refuse from “punitive” bras with underwire, which dig into areas of knot congestion.
• We perform special lymphatic drainage techniques. We accelerate and cleanse the lymph, increase the permeability of the lymphatic vessels, and activate microcirculation.

For lymphatic drainage exercises and the best techniques of self-massage – in the basic marathon “SmeloNET”.

Read the details of the marathon below and register.

Enlarged lymph nodes

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The structure of the lymphatic system

The lymphatic system consists of lymphatic vessels, lymph nodes and organs – the spleen and thymus gland.

A liquid circulates in the lymphatic vessels – lymph , which transports cells, proteins, nutrients and metabolic end products from tissues to large veins.

Lymphatic vessels merge into lymph nodes. Lymph nodes contain a large number of lymphocytes and act like filters to trap infectious agents such as bacteria and viruses.

Lymph nodes are usually grouped.There are large groups of lymph nodes in the armpits, on the sides of the neck, and in the groin.

If a focus of infection or inflammation forms in some place of the body, then the nearest lymph nodes enlarge and become painful. For example, in a person with tonsil inflammation, the cervical lymph nodes become enlarged. Lymph flows from the tonsils to the cervical lymph nodes, where the microorganisms that cause infection are destroyed, and their further spread throughout the body stops.

T and B cells

There are two types of lymphocytes: T un B cells

Like other blood cells, lymphocytes are formed in the bone marrow from special progenitor cells or stem cells. Young lymphocytes go through many stages of development until they become mature T or B lymphocytes. Both types of lymphocytes play an important role in recognizing and destroying the microorganisms that cause infection.

Usually, most of the lymphocytes circulating in the blood are T cells.They are responsible for recognizing and destroying altered body cells (more precisely, cells infected with viruses or bacteria).

B cells recognize ‘foreign’ cells and foreign bodies (eg bacteria that have entered the body). When B cells come into contact with a foreign protein (for example, on the surface of bacteria), they begin to produce antibodies that attach to the surface of the foreign cell and cause its death.

Lymph Nodes | Melanoma.no

Lymph nodes are small, round organs that serve as a natural biological filter, cleansing the body of harmful compounds. They are located along the lymphatic vessels and organs and together with them make up the lymphatic system – part of the immune system. The lymph nodes are the organs of lymphopoiesis and the formation of antibodies. They contain lymph, a clear liquid that carries immune cells fighting infection, as well as waste products of cells and tissues of the body.In a person with cancer, the lymph can also carry malignant cells that have splintered from the underlying tumor.

Lymph is filtered through lymph nodes that are located throughout the body and are connected to each other by lymphatic vessels. The lymphatic system is an integral part of the vascular system and is, as it were, an additional channel of the venous system, in close connection with which it functions and with which it has similar structural features (the presence of valves, the direction of lymph flow from tissues to the heart).Lymph node groups are located in the neck, armpits, chest, abdomen, and groin. Lymph nodes contain white blood cells (B-lymphocytes and T-lymphocytes) and other types of cells of the immune system. Lymph nodes trap bacteria and viruses, as well as some damaged and abnormal cells, helping the immune system to fight off disease.

Many types of cancer spread through the lymphatic system, and one of the first places where cancer cells settle is in nearby lymph nodes.

The sentinel lymph node is the first lymph node in the regional lymphatic basin through which lymph flows from the primary tumor, therefore, it is primarily affected by tumor cells. There can be more than one sentinel lymph node.

Sentinel lymph node biopsy (SLNB) is a procedure in which a sentinel lymph node is identified, then removed and examined for cancer cells.This intervention is applied to those patients who have already been diagnosed with cancer.
A negative SLNB result suggests that the tumor has not yet spread to nearby lymph nodes or other organs.

A positive SLNB result indicates that the cancer has spread to the sentinel lymph node and may be present in other nearby lymph nodes (called regional lymph nodes) and possibly other organs. This information can help the doctor determine the stage of the cancer (the extent to which the disease has spread in the body) and make an appropriate treatment plan.

What happens during SLNB?

First, the doctor determines the location of the sentinel lymph node (or nodes). To do this, the surgeon injects a radioactive substance or a special blue dye (or both) next to the tumor. The doctor then uses the device to look for lymph nodes that contain a radioactive substance, or looks for lymph nodes that are stained with blue dye. After the sentinel lymph node is located, the surgeon makes a small incision (about 1/2 inch) in the skin and removes the node.Next, the pathologist examines the sentinel node for the presence of tumor cells. If cancer is found, the surgeon decides to remove the additional lymph nodes immediately or during subsequent surgery. SLNB may be done on an outpatient basis or may require a short hospital stay.
A sentinel lymph node biopsy is usually performed at the same time as resection of the primary tumor. In some cases, surgery can be performed before or even after (depending on how damaged the lymphatic vessels are) the removal of the tumor.

What are the advantages of SLNB?

SNLB helps physicians pinpoint cancer stages and assess the risk of cancer cells spreading throughout the body. If the sentinel lymph node is negative for cancer, the patient can avoid more extensive lymph node surgery, which will reduce the potential complications associated with removing a large number of lymph nodes.

What is the potential harm to SLNB?

All lymph node resections, including SLNB, can have harmful side effects, although fewer lymph node removal is generally associated with fewer side effects, especially serious ones such as lymphedema (lymphostasis).Possible side effects include:

• Lymphedema or tissue swelling. During a lymph node resection, the lymphatic vessels are cut to and from the sentinel node or group of nodes. This disrupts the normal flow of lymph through the affected area, which can lead to abnormal accumulation of lymphatic fluid, which can provoke edema. Lymphostasis can cause pain or discomfort in the affected area, and the surrounding skin can become thickened or hard.The likelihood of developing lymphedema increases with the number of removed lymph nodes. The risk is reduced by resecting the sentinel lymph node alone. In the case of extensive removal of lymph nodes in the armpit or groin, the swelling can affect the entire arm or leg. In addition, there is an increased risk of infection in the affected area or limb.

It is extremely rare that chronic lymphostasis due to extensive removal of lymph nodes can provoke a cancer of the lymphatic vessels, called lymphangiosarcoma (Stewart-Trives syndrome):

• Seroma (lymphorrhea), a formation or lump caused by the accumulation of lymphatic fluid at the site of surgery …
• Numbness, tingling, swelling, bruising, or pain at the surgical site, and an increased risk of infection.
• Difficulty moving the affected part of the body.
• Skin or allergic reactions to blue dye used in SLNB.

False negative biopsy result – that is, tumor cells are not detected in the sentinel lymph node, even if they have already spread to regional lymph nodes or other body systems. A false negative biopsy result gives the patient and the doctor a false sense of confidence about the stage of the oncology spread in the patient’s body.

Is SLNB used for staging all types of cancer?

No. SLNB is most commonly used to diagnose breast cancer and melanoma. It is rarely used to stage penile cancer and endometrial cancer. However, this method is being investigated for other types of cancer, including cancer of the vulva and cervix, as well as colorectal cancer, cancer of the stomach, esophagus, head and neck, thyroid, and non-small cell lung cancer.

What research has shown on the use of SLNB in ​​melanoma?

Studies show that patients with melanoma who have undergone SLNB, which is found to be negative for cancer, and who have no clinical signs of cancer spreading to other lymph nodes, can avoid more extensive lymph node surgery during primary resection. tumors.A review of 71 studies with data from 25,240 patients showed that the risk of recurrent melanoma in regional lymph nodes in patients with negative SLNB was 5% or less.

During the procedure, a radioactive substance and / or blue dye is injected near the primary tumor. Further, the introduced material is determined visually and / or with the help of a device for determining the radioactivity. Once identified, the sentinel lymph node (s) is removed and examined for tumor cells. A sentinel lymph node biopsy may be done before or after removal of the primary tumor.

The results of a study of selective (selective) lymphadenectomy also confirmed the safety of SLNB in ​​patients with melanoma with positive sentinel lymph nodes and the absence of clinical signs of other lymph node involvement. This large clinical trial, involving more than 1,900 patients, compared the potential therapeutic benefits of SLNB plus immediate resection of the remaining regional lymph nodes (called radical lymphadenectomy or CLND) with SLND plus active surveillance, which included regular ultrasound of the remaining regional lymph nodes and radical lymph node dissection for detection of signs of metastasis of additional lymph nodes.After 43 months of follow-up, patients who underwent immediate radical lymphadenectomy did not have better melanoma-related survival compared to patients who underwent SLNB with CLND, performed only when signs of metastasis in accessory lymph nodes appeared (86% of participants in both groups did not die from melanoma over 3.5 years of follow-up).

December 15, 2020

Removal of lymph nodes in the axillary region – surgical treatment in Dnipro in the inpatient department Garvis

Lymph nodes are so-called accumulations of lymphatic tissues that are scattered throughout the body, the main function of which is to filter lymph and accumulate elements of the immune system designed to fight pathogens.

Unfortunately, both microbes and cancer cells can be fixed in the lymph nodes. To assess the stage of a cancerous tumor, it is very important to examine the lymph nodes for the presence of these cells.

Reasons for removal of lymph nodes in breast cancer

In breast cancer, oncology surgeons pay close attention to the following types of lymph nodes:

• cervical, supraclavicular and subclavian nodes;
• Axillary lymph nodes.

The axillary lymph nodes are characterized by the collection of lymph from some part of the thoracic region, from the mammary glands, upper limbs and shoulder, as well as from some parts of the abdominal cavity.

If we talk about malignant tumors of the mammary glands, then the lymph nodes enlarge only when the cancer cells repel from the original place of origin and enter the node. The body’s defenses with the help of the lymph nodes are trying to stop the process of the release of cancer cells further through the body.

An enlargement of the axillary lymph nodes is a sign that the tumor process is spreading.

A cancerous tumor of the mammary glands, metastasizing, first of all spreads through the lymphatic vessels. The immune system recognizes them as alien, and, with all its might, tries to fight them. If a large number of malignant elements are concentrated, immunity is suppressed, and then cancer cells begin to actively multiply. This is how a metastasis appears, which must be removed in order to stop the spread of the malignant tumor.

In invasive breast cancer situations, some axillary lymph nodes are often removed during mastectomy.

Surgery to remove the axillary lymph node

Surgical intervention, during which the lymph node is removed under the armpit, is called lymphadenectomy.

Nowadays, there are several methods of removing a lymph node under the armpit for cancer:

• Axillary lymphadenectomy. During this operation, the surgeon excises a certain amount of tissue in which the lymph nodes are located.To assess the condition of the lymph nodes, in most cases, it is enough to remove about a dozen nodes. All affected lymph nodes must be removed. Depending on the anatomical features of the patient, the number of nodes in the axillary region is different for everyone: some will have 7, and some will have 27. In a traditional operation to remove a lymph node under the armpit, the lymph nodes of the first (below the lower edge of the pectoral muscle) and the second (under the pectoralis minor) level. Lymphadenectomy is performed during the mastectomy or through a separate surgical incision after the tumor has been removed.
• Sentinel lymph node removal in breast cancer. Sentinel lymph nodes are the nodes that are the first to respond to the entry of cancer cells into them. The surgeon finds lymph nodes closer to the tumor and removes them. This operation, today, is a worthy alternative to traditional axillary lymphadenectomy. In order not to remove more than a dozen nodes, one or more lymph nodes are removed, which are likely to be affected by cancer cells. Then they are sent for histological examination.

Contraindications for removal of axillary lymph nodes in cancer

There are some contraindications to the removal of lymph nodes under the armpit:

• Unable to completely remove the tumor. These are situations when cancer is diagnosed at an advanced stage and the tumor has managed to affect other tissues and organs.
• General grave condition of a person: pathology of the heart and blood vessels, renal-hepatic failure, impaired blood circulation in the brain.

The listed reasons can be an obstacle not only to the removal of lymph nodes, but also to breast surgery in general.

Many years of experience and work experience of the specialists of the clinic “Garvis” guarantees high quality of operations to remove axillary lymph nodes. The use of the most modern methods of surgical intervention allows us to provide highly qualified surgical care to patients.

Sign up for a consultation by phones: (056) 7941020; (095) 2831020, (067) 3531020 or using the registration form on our website

Stomach cancer – prevention, stages, symptoms and treatment methods

Introduction

Digestion process

The stomach is located in the upper part of the abdominal cavity.It plays a critical role in digestion. Once swallowed, food travels down the muscle tube (esophagus) that connects the throat to the stomach. When it enters the stomach, food mixes – gastric juice is produced, which helps to grind it. The lump is then transferred to the small intestine for further digestion.

Types of stomach cancer

Stomach cancer begins when healthy tissue cells change and grow uncontrollably. It is necessary to distinguish between cancerous and benign tumors.Cancer (malignant) can grow, capturing neighboring organs and systems. Benign – grows, but does not spread to other tissues.

The main form of gastric cancer is adenocarcinoma. This means that the neoplasm has developed in the glandular tissue lining the inside of the stomach. Other cancers include lymphoma, gastric carcinoma, and neuroendocrine tumors, but these are rare.

Stages

The stage determines the location of the tumor, its prevalence, as well as its effect on the body as a whole.Physicians may need information based on tissue samples obtained during surgery, so staging usually continues until all tests are performed. This information helps the doctor determine which treatment is optimal and predict the possibility of recovery.

Classification system for adenosarcoma (most common gastric cancer) TNM:

• Tumor (T): Prevalence of neoplasm in the stomach wall.
• Lymph Nodes (N): The extent of the tumor to the lymph nodes.
• Metastases (M): Prevalence of the oncological process to other organs.

The results are pooled to determine the stage of cancer for each patient. There are 5 stages: stage 0 (zero), which is non-invasive ductal carcinoma in situ (PCIS), and stages I through IV (1 through 4).

Let’s take a closer look at each element of the TNM system for stomach cancer:

Tumor (T)

In the TNM system, the letter T plus a letter or number (from 0 to 4) is used to describe how far the tumor has grown.The size of the formation is measured in centimeters (cm).

Stages are also subdivided into smaller subgroups to help further characterize the tumor.

TX: Neoplasm is not evaluated.

T0 (T plus zero): No tumor data available.

Tis: This stage describes carcinoma in situ. Cancer is found only in cells on the surface of an inner layer called the epithelium. The process does not affect other layers of the stomach.

T1: The tumor has grown into its own lamina, muscle and submucosal layers (inner layer of the wall).

T1a: The tumor has grown into the lamina propria or muscularis.

T1b: The tumor has grown into the submucosa.

T2: The tumor has grown into the muscle layer of the stomach.

T3: The tumor has grown through all layers of muscle tissue into the connective tissue outside the stomach. It does not touch the mucous membrane or serous membrane of the peritoneum.

T4: The tumor has grown through all layers of muscle tissue into the connective tissue outside the stomach. The tumor has also grown into the mucous membrane, serous membrane, or organs surrounding the stomach.

T4a: The neoplasm has spread to the serous layer.

T4b: The neoplasm has grown into the organs surrounding the stomach.

Lymph nodes (N)

N in the TNM system means lymph nodes. These are small, bean-shaped organs that help fight off infections. Lymph nodes in the abdomen are called regional, and in other organs, distant lymph nodes. The overall prognosis for cancer patients is based on how many regional lymph nodes have pathological signs.

NX: Regional lymph nodes cannot be scored

N0 (N plus zero): The cancer has not spread to regional lymph nodes.

N1: The process is located in 1-2 regional lymph nodes.

N2: In 3-6 regional lymph nodes.

N3: In 7 or more lymph nodes.

N3a: In 7-15 regional lymph nodes.

N3b: In 16 or more regional lymph nodes.

Metastases (M)

The letter M in the TNM system means tumor growth into other (often adjacent) organs.This is called distant metastases.

MX: Cannot be estimated.

M0 (M plus zero): The oncological process has not spread to other parts of the body.

M1: Cancer has invaded other organs.

Doctors stage cancer by combining T, N, and M classifications.

Stage 0: Also called carcinoma in situ. The tumor is located only on the surface of the epithelium, without growing into other layers of the stomach. This is considered an oncological process at the initial stage (Tis, N0, M0).

Stage IA: The cancer has grown into the inner layers of the stomach wall, without spreading to the lymph nodes and other organs (T1, N0, M0).

Stage IB: Stomach cancer is stage IB if one of 2 conditions is met:

• The tumor has grown into the inner layers of the stomach wall. It only spreads to 1-2 lymph nodes (T1, N1, M0).
• The cancer has grown into the outer muscle layers of the stomach wall, but has not spread to the lymph nodes or other organs (T2, N0, M0).

Stage IIA: Stomach cancer belongs to stage IIA when one of the following conditions is met:

• The neoplasm has grown into the inner layers of the stomach wall.It has spread to 3-6 lymph nodes, but nowhere else (T1, N2, M0).
• Cancer has grown into the outer muscle layers of the stomach wall. It has spread to 1-2 lymph nodes, but nowhere else (T2, N1, M0).
• The oncological process passes through all layers of muscle tissue into the connective tissue outside the stomach. It has not passed into the peritoneal mucosa or serosa and has not spread to the lymph nodes or surrounding organs (T3, N0, M0).

Stage IIB: Stomach cancer is stage IIB when one of the following conditions is met:

• The cancer has grown into the inner layers of the stomach wall.It has spread to 7-15 lymph nodes, but nowhere else (T1, N3a, M0).
• Oncology has an invasion of the outer muscle layers of the stomach wall. Involves 3-6 lymph nodes, but nothing else (T2, N2, M0).
• The oncological process passed through all layers of muscle tissue into the connective tissue outside the stomach, but did not germinate into the peritoneal mucosa or into the serous membrane. It has spread to 1-2 lymph nodes, but nowhere else (T3, N1, M0).
• Cancer has grown through all layers of muscle tissue into the connective tissue outside the stomach.It has grown into the peritoneal mucosa or serous membrane without invading the lymph nodes or surrounding organs (T4a, N0, M0).

Stage IIIA: Stomach cancer is stage IIIA when one of the following conditions is met:

• The tumor has grown into the outer muscle layers of the stomach wall. It has spread to 7-15 lymph nodes, but not to other organs (T2, N3a, M0).
• The cancer has passed through all layers of muscle tissue into the connective tissue outside the stomach, but has not grown into the peritoneal mucosa or serosa.It has spread to 3-6 lymph nodes, but not to other organs (T3, N2, M0).
• The oncological process invaded all layers of muscle tissue into the connective tissue outside the stomach. The tumor has grown into the peritoneal mucosa or serous membrane and has spread to 1-2 lymph nodes, but not to other organs (T4a, N1, M0).
• The cancer has grown through all layers of muscle tissue into the connective tissue outside the stomach and into adjacent organs or structures. It has not spread to lymph nodes or distant parts of the body (T4b, N0, M0).

Stage IIIB: Stomach cancer is stage IIIB if one of the following conditions is met:

• The oncological process has invaded the inner layers of the stomach wall or the outer muscle layers of the stomach wall. It has spread to 16 or more lymph nodes, but not to distant parts of the body (T1 or T2, N3b, M0).
• The tumor has grown through all layers of muscle tissue into the connective tissue outside the stomach, but has not spread to the peritoneal mucosa or serosa. It has spread to 7-15 lymph nodes, but without invasion of adjacent organs (T3, N3a, M0).
• The neoplasm has passed through all layers of muscle tissue into the connective tissue outside the stomach, has grown into the mucous membrane of the peritoneum or into the serous membrane. The process has spread to 7-15 lymph nodes, but nowhere else (T4a, N3a, M0).
• Cancer has grown through all layers of muscle tissue into connective tissue outside the stomach, into adjacent organs or structures. It has spread or has not spread to 1-6 lymph nodes, but not to distant parts of the body (T4b, N1 or N2, M0).

Stage IIIC: Stomach cancer is stage IIIC when one of the following conditions is met:

• The malignant process has affected all layers of muscle tissue, connective tissue outside the stomach, sometimes invading the peritoneal mucosa or serous membrane.It has spread to 16 or more lymph nodes, but not to distant parts of the body (T3 or T4a, N3b, M0).
• The tumor has grown through all layers of muscle tissue into the connective tissue outside the stomach, as well as adjacent organs. It has spread to 7 or more lymph nodes, but not to other parts of the body (T4b, N3a or N3b, M0).

Stage IV: Stage IV gastric cancer describes cancer of any size that has spread to distant parts of the body other than the area around the stomach (any T, any N, M1).

Relapse

Cancer relapse is the return of oncology after treatment. Local (regional) relapse reappears in the same place. Distant metastases can also form. In case of relapse, you will need to pass all tests again to determine its degree.

Japanese classification system

In Japan, there is another method for staging stomach cancer, based on the location of the lymph nodes around the stomach containing cancer cells. Surgery for gastric cancer can be characterized using the Japanese system.The type of surgery is determined by which lymph nodes are removed besides the stomach. D0: Lymph nodes not removed

D1: Lymph nodes closest to the stomach removed.

D2: Lymph nodes removed in a wider area.

Information about the stage of the cancer will help your doctor recommend a specific treatment plan.

Symptoms

Oncology is not detected at an early stage, as it does not cause any specific symptoms. Following are the symptoms of stomach cancer.

• Indigestion or heartburn
• Abdominal pain and discomfort
• Nausea and vomiting, particularly vomiting of solid food shortly after eating
• Diarrhea or constipation
• Bloating after eating
• Loss of appetite
• Feeling like eating gets stuck in the throat while eating

Symptoms of common cancer include:

• Weakness and fatigue
• Bloody vomiting and blood in the stool
• Unexplained weight loss

It is important to remember that complaints can also be caused by many other diseases in particular a stomach virus or ulcer.

Treatment Methods

“Standard of Care” refers to the best known treatments. Clinical trials are also recommended as cancer care. They help test a new approach to treatment. Doctors want to know if this treatment is safe, effective, and possibly more acceptable than the standard treatment. Clinical trials can test a drug novelty, a combination of proven techniques, or dosage variations of standard drugs or other treatments.Clinical trials are an option for cancer care at every stage of the process. Your doctor can help you consider all your therapy options.

Treatment review

The interdisciplinary team draws up an overall treatment plan. In case of stomach cancer, such teams may include the following doctors:

• Gastroenterologist – specializes in the gastrointestinal tract, in particular, the stomach and intestines;
• Surgeon or oncologist surgeon – specializes in the treatment of cancer with surgery;
• Oncologist – specializing in the treatment of cancer with medication;
• Radiology oncologist – specializing in the treatment of cancer with radiation therapy;
• Histologist – specializes in the interpretation of laboratory tests and the assessment of cells, tissues and organs for the diagnosis of disease;
• Radiologist – Specializes in the use of imaging techniques to diagnose disease.

Treatment of stomach cancer consists of surgery, radiotherapy, chemotherapy, targeted therapy or immunotherapy. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible negative reactions of the body, personal preferences, and the presence of chronic pathology. For the treatment of oncology, a combination of different techniques is most often recommended. Treatment of a tumor can be complicated due to the fact that it is often found only in the latter stages.

Take the time to explore all the treatment options and be sure to ask questions about anything you don’t understand. Talk to your doctor about the purpose of each therapy and what to expect during your treatment. These conversations are called “joint decision making”.

Surgical treatment

This is the elimination of the neoplasm of the adjacent healthy tissue using surgery. The type of operation depends on the stage of the oncological process.

For very early stage cancers (T1a), some doctors may recommend a nonsurgical treatment called endoscopic mucosal resection.In the initial stages (stage 0 or stage I), when the cancer is still only in the stomach, surgery is used to cut off the portion of the stomach containing the cancer and adjacent lymph nodes. This is called subtotal or partial gastrectomy. In a partial gastrectomy, the surgeon sutures a small portion of the stomach into the esophagus or small intestine.

If cancer has grown into the outer stomach wall with or without lymph nodes, surgery plus chemotherapy or chemotherapy with radiotherapy can be used.The surgeon can perform subtotal gastrectomy or complete gastrectomy, that is, removal of the entire stomach. In a total gastrectomy, the surgeon connects the esophagus directly to the small intestine.

Gastrectomy is a major surgical procedure with unpleasant consequences. After this surgery, the patient is only allowed to eat a small amount of food at a time. A common side effect is a group of symptoms called “dumping syndrome,” including seizures, nausea, diarrhea, and dizziness after eating.This happens when food gets into the small intestine too quickly. The doctor can suggest ways to avoid the symptom complex and prescribe medications to control them. Symptoms usually diminish or disappear after a few months, but in some people they come on all the time. Patients who have had their entire stomach removed may need regular injections of vitamin B12 as they are no longer able to receive it through the stomach.

Regional lymph nodes are often removed during surgery because cancer may have spread to them.This is called a lymphadenectomy.

Radiation therapy

This is the use of high-energy X-rays or other particles to destroy cancer cells. The therapy regimen consists of several procedures carried out over a certain period of time. Patients with stomach cancer are prescribed external radiation therapy, when radiation comes from a device outside the body. Radiation therapy may be given before surgery to shrink a tumor or after surgery to kill any remaining cancer cells.

Side effects from radiation therapy include fatigue, mild skin reactions, indigestion and loose stools. Most of the side effects disappear shortly after treatment ends, but long-term effects are also possible.

Drug therapy

Systemic therapy is the injection of a drug into the bloodstream to destroy cancer cells.

Common systemic treatments include inserting an intravenous (IV) catheter into a vein using a needle or swallowing (oral) a tablet form of the drug.

For gastric cancer, the following types of systemic therapy are used:

• Chemotherapy
• Targeted therapy
• Immunotherapy

Depending on a number of factors, the patient is recommended either one type of systemic therapy or a combination of several types at the same time. They can also be part of a treatment plan that includes surgery and / or radiation therapy.

It is also important to tell your doctor if you are taking other drugs or dietary supplements.Herbal medicines, dietary supplements, and other medications interact with cancer drugs.

Chemotherapy is the use of drugs that destroy tumor cells, preventing them from growing and dividing.

The chemotherapy regimen (or scheme) usually consists of several cycles of treatments. They are carried out for a certain period of time. At the same time, the patient can receive 1 drug or a combination of different drugs.

The goal of chemotherapy is to destroy cancer cells left over from surgery, slow the growth of tumor cells, or reduce cancer-related symptoms.It can also be combined with radiation therapy. Side effects of chemotherapy depend on the individual characteristics of the organism, the drug dosage. Fatigue, severe weakness, risk of infection, dyspepsia, baldness, loss of appetite may occur.

Targeted therapy is treatment that targets specific genes, proteins, or the tissue environment of a cancer that promotes cancer growth and survival. Targeted therapy blocks the growth and spread of cancer cells while limiting damage to healthy cells.

Not all tumors have the same target. To develop the most effective treatment, your doctor will do tests to identify genes, proteins, and other factors in your tumor.

The following targeted therapy is used in the treatment of gastric cancer:

• HER2 targeted therapy. Some cancers can make too much of a protein called epidermal growth factor receptor 2 (HER2). This type of cancer is called HER2-positive cancer.
• Anti-angiogenic therapy.Aimed at stopping angiogenesis, that is, the process of creating new blood vessels. For the tumor to develop, nutrients are needed from the blood vessels. Therefore, the goal of anti-angiogenic therapy is to “deplete” the tumor.

Immunotherapy

Biological Therapy (another name) is designed to enhance natural defenses against cancer. It uses substances produced by the body or produced in a laboratory to improve, direct or restore the function of the immune system.

Different types of immunotherapy can cause different negative reactions. Common side effects include skin reactions, flu-like symptoms, diarrhea, and weight changes.

Physical, emotional and social consequences of cancer

Cancer and its treatments cause physical symptoms and side effects, as well as emotional, social and financial consequences. Managing all of these effects is called palliative or supportive care. This is an important part of your treatment, just as important as therapy to slow, stop, or eliminate cancer.

Palliative care aims to improve well-being during treatment by managing symptoms and supporting the non-medical needs of patients and their families. Anyone, regardless of age, type and stage of cancer, can receive such help. It is most effective when started as soon as the disease is diagnosed.

Palliative care is very diverse and often includes medication, dietary changes, relaxation techniques, emotional and spiritual support, and other treatments (chemotherapy, surgery, or radiotherapy).

Metastatic gastric cancer

When a tumor spreads to another part of the body, beyond the organ in which it originated, doctors call it metastatic cancer. Specialists have different views on the optimal standard treatment plan. Clinical trials can also be considered as a treatment option.

The goal of treatment at this stage is usually to prolong the patient’s life and eliminate symptoms, since metastatic gastric cancer is considered incurable.Any treatment, including chemotherapy or radiation therapy, is considered palliative. The main type of cancer care is chemotherapy. Importantly, research has shown that using palliative chemotherapy can improve both quality and life expectancy.

Remission and the possibility of recovery

This is a condition in which cancer cannot be detected in the body, and its symptoms are also absent.

Remission can be temporary or permanent. This uncertainty is causing many anxiety about the possible return of cancer.In many cases, remission is temporary, so it is important to discuss with your doctor the likelihood of the oncological process returning. Understanding the risk of recurrence and treatment options will help you feel more prepared.

If cancer comes back after initial treatment, it is called recurrent. May reappear in the same place (local), nearby (regional) or elsewhere (distant). After testing, you should discuss further cancer care with your doctor.The treatment plan often includes the above treatments, such as surgery, chemotherapy, and radiation therapy, but they can be used in other combinations or at different intensities. Sometimes, if the size of the recurrent tumor is small or its spread is limited, that is, with a localized recurrence, you may be offered surgical treatment.

If treatment fails

Cancer is not always curable. If the disease cannot be cured or controlled, the disease is called progressive or terminal disease.

Such a diagnosis is stressful and it is very difficult for many to discuss advanced cancer. It is important to speak openly and honestly with the healthcare team, explaining your feelings, preferences and fears. The medical team has special skills, experience and knowledge to support patients and their families and is always ready to help.

Risk factors and prevention

These are all things that increase the likelihood of developing cancer in a person. And although risk factors often affect the development of the disease, most of them do not directly cause cancer.Knowing your risk factors and discussing them with your doctor can help you make more informed lifestyle and health care choices.

The following factors increase the risk of developing cancer:

1. Age. Neoplasm most often occurs in people over 55 years old. Most patients diagnosed with stomach cancer are over 60-70 years old.
2. Pol. Men are twice as likely to develop cancer.
3. Bacteria. A fairly common bacterium called Helicobacter pylori, or H.pylori, causes inflammation and stomach ulcers. It is also considered one of the main causes of the oncological process. There is a test for H. pylori and the infection can be treated with antibiotics.
4. Family history / genetic predisposition. People with a parent, child, or sibling with cancer have a higher risk of the disease. Certain hereditary genetic disorders, such as hereditary diffuse stomach cancer, Lynch syndrome, hereditary breast and ovarian cancer, and familial adenomatous polyposis, increase the risk of developing a tumor.
5. Race / Ethnicity. Cancer is more common in blacks, Hispanics, and Asians than in whites.
6. Diet. A diet high in salt is associated with an increased risk of cancer. This includes foods preserved by drying, smoking, salting or pickling, and foods that are high in salt. Eating fresh fruits and vegetables can help reduce risk.
7. Previous surgery or health condition.People who have had stomach surgery, pernicious anemia, or achlorhydria have an increased risk of developing cancer. Pernicious anemia is a significant decrease in the number of red blood cells caused by the stomach not being able to properly absorb vitamin B12. Chlorhydria is a lack of hydrochloric acid in gastric juice.
8. Professional factors. Exposure to certain types of dust and vapors increases the risk of pathology.
9. Tobacco and alcohol. Tobacco use and alcohol abuse can increase the risk of stomach cancer.
10. Obesity. Being overweight increases the risk of developing cancer in men. It is unclear whether obesity increases a woman’s risk of developing stomach cancer.

Follow-up and follow-up

Treatment for people diagnosed with cancer does not end once active therapy is complete. Your doctors will continue to check for cancer recurrence, monitor any possible side effects, and monitor your overall health. This is called follow-up.It includes regular medical check-ups and medical tests. Doctors strive to track recovery in the months and years to come.

Relapse control

The purpose of follow-up is to control relapse. The disease recurs because small areas of undetected cancer cells may remain in the body. Over time, these cells can grow until they appear on test results or cause signs and symptoms. During follow-up, a physician familiar with your medical history may provide you with personal information about your risk of recurrence.Your doctor will ask specific health questions. Some may need blood tests or imaging tests as part of regular follow-up, but follow-up recommendations depend on several factors, including the type and stage of the cancer initially diagnosed and the type of treatment given.

Control of long-term and delayed side effects

People who have experienced treatment are often surprised that some side effects may persist after a period of treatment.These are long term side effects. Other side effects, called delayed ones, can develop months or even years later. Long-term and delayed effects can include physical and emotional changes.

How to disperse lymph stagnation at home

Light massage can improve lymph drainage
Photo: pixabaycom

Manual lymphatic drainage helps to flush out toxins, improve blood circulation and strengthen immunity.

Help yourself

Introduced by Emil Vodder , the lymphatic massage method helps to reduce swelling and improve your health. The lymphatic fluid dispersed by hand movements quickly removes toxins and waste products, absorbs fats and maintains fluid balance in the body.

One of the features of manual lymphatic drainage is that you can do it yourself. But, this method may be contraindicated for those who suffer:

• chronic heart failure;

• kidney problems;

• infectious diseases;

• thrombosis;

• cancer.

Light arm movements

Lymphatic massage is done smoothly. A light touch is enough to stimulate the flow of fluid through the lymphatic system.

Hard massaging can damage the lymph fibers, which are restored within 24 hours. Avoid massaging areas of the body with swollen skin, redness. Exposure to them can spread the inflammatory process.

How to prepare the lymph nodes for massage (you can do these movements just to stretch the lymph):

• Place your index and middle fingers on either side of your neck, just above your collarbone. Gently slide your fingers towards the center of the collarbone and back to activate the supraclavicular knot.

• Place the palms of each hand on either side of the neck below the ears.The tonsils and cervical lymph nodes are located here. Swipe your palms down and then up again to activate them.

• Place your hands near the hairline along the back of your head, then gently slide them along your neck to your spine to prepare the nape nodes.