Anatomy, Head and Neck, Lymph Nodes – StatPearls

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.

StatPearls [Internet].

Show details

Search term

Antony Koroulakis; Zohaib Jamal; Manuj Agarwal.

Author Information and Affiliations

Last Update: December 11, 2022.

Introduction

The head and neck, as a general anatomic region, is characterized by a large number of critical structures situated in a relatively small geographic area. It is inclusive of osseous, nervous, arterial, venous, muscular, and lymphatic structures. Lymphadenopathy is a significant clinical finding associated with acute infection, granulomatous disease, autoimmune disease, and malignancy. The involvement of specific nodal groups is an indicator of pathologically-affected organs and tissues, especially in the context of malignancy. As such, intimate knowledge of the anatomic relationships of the lymphatic nodal levels and the structures they drain is critical in the delivery of appropriate therapy in many patients with cancers of the head and neck. This knowledge is especially crucial in guiding the approach to proper locoregional therapy, whether by surgery or irradiation. A detailed understanding of the principle lymphatic nodal levels of the neck is required, including their anatomical configuration and boundaries, patterns of drainage, and risk of metastatic involvement in the context of malignancy.

Blood Supply and Lymphatics

The head and neck contains a rich and elaborate lymphatic network of more than 300 nodes and their intermediate channels. Aponeuroses bind them together with the muscles, nerves, and vessels of the head and neck. These lymphatic chains are strongly lateralized and typically do not directly communicate between left and right in the absence of a pathologic process. This lymphatic drainage originates at the base of the skull, then proceeds to the jugular chain adjacent to the internal jugular vein. From there it moves into the spinal accessory chain adjacent to the spinal accessory nerve, or cranial nerve XI, and then meets the supraclavicular chain. The lymphatics then drain on both sides. On the left side, they drain either directly into the vasculature via the jugulo-subclavian venous confluence or directly into the thoracic duct. On the right side, they flow directly into the lymphatic duct. Conversely, most structures drain ipsilaterally, except in the case of structures situated at the anatomic midlines. These include the nasopharynx, pharyngeal wall, base of the tongue, soft palate, and larynx. The lymph nodes of the neck are further classified by level. These levels are Ia, Ib, II, III, IV, V, VI, VII, VIII, IX, X. [1][2][3][4][5]

Level Ia: Submental Group

• Anatomy

  • Level I nodes are those bounded by the mandible superiorly and laterally and by the hyoid bone inferiorly. Level Ia contains the submental nodal group, bounded superiorly by the symphysis menti and inferiorly by the hyoid bone. It is bounded anteriorly by the platysma muscle, posteriorly by the mylohyoid muscles, laterally by the anterior belly of the digastric muscle, and medially by the virtual anatomic midline. These boundaries form a triangular region also termed the submental triangle.

• Drainage

  • This group drains the skin of the mental region, or chin, the mid-lower lip, the anterior portion of the oral tongue, and the floor of the mouth.

• Associated primary malignancies

  • These nodes most often contain metastatic deposits from malignancies of the floor of the mouth, anterior oral tongue, mandibular alveolar ridge, and lower lip.

Level Ib: Submandibular Group

• Anatomy

  • Level Ib contains the submandibular nodal group, bounded superiorly by the mylohyoid muscle and inferiorly by the hyoid bone. It is bounded anteriorly by the symphysis menti, posteriorly by the posterior edge of the submandibular gland, laterally by the inner surface of the mandible, and medially by the digastric muscle. These boundaries form a triangular region also termed the submandibular triangle.

• Drainage

  • They drain the efferent lymphatics from level Ia, the lower nasal cavity, both the hard and soft palates, and both maxillary and mandibular alveolar ridges. They also drain them from the skin and mucosa of the cheek, both upper and lower lips, the floor of the mouth, and the anterior oral tongue.

• Associated primary malignancies

  • These nodes most often contain metastatic deposits from malignancies of the oral cavity, anterior nasal cavity, soft-tissues of the mid-face, and submandibular gland.

Level II: Upper Jugular Group

• Anatomy

  • Level II represents the beginning of the jugular chain. It contains the upper jugular nodal group, adjacent to the top third of the internal jugular vein (IJV) and upper spinal accessory nerve. It is bounded superiorly by the insertion of the posterior belly of the digastric muscle into the mastoid process, and inferiorly by the caudal border of the hyoid bone or alternatively, as a surgical landmark, the carotid bifurcation. It is bounded anteriorly by the posterior edge of the submandibular gland, posteriorly by the posterior edge of the sternocleidomastoid muscle (SCM), laterally by the medial surface of the SCM, and medially by the internal carotid artery and scalenus muscle.

• Drainage

  • This group drains the efferent lymphatics of the face, parotid gland, level Ia, level Ib, and retropharyngeal nodes. It receives direct drainage from the nasal cavity, the entire pharyngeal axis, larynx, external auditory canal, middle ear, and the sublingual and submandibular glands.

• Associated primary malignancies

  • These nodes most often contain metastatic deposits from malignancies of the nasal and oral cavities, nasopharynx, oropharynx, hypopharynx, larynx, and major salivary glands. It is the most commonly involved nodal level. [6][7][8][9][10]

Level III: Middle Jugular Group

• Anatomy

  • Level III contains the middle jugular nodal group, adjacent to the middle third of the IJV. It is bounded superiorly by the caudal border of the hyoid bone, and inferiorly by the caudal edge of the cricoid cartilage or alternatively, as a surgical landmark, the plan where the omohyoid muscle crosses the IJV. It is also bounded anteriorly by the anterior edge of the SCM, or the posterior third of the thyrohyoid muscle, and posteriorly by the posterior border of the SCM. Finally, it is bordered laterally by the medial surface of the SCM, and medially by the internal carotid artery and scalenus muscle.

• Drainage

  • This group drains the efferent lymphatics from level II and level V, and partially from the retropharyngeal, pretracheal, and recurrent laryngeal nodes. It receives direct drainage from the base of the tongue, tonsils, larynx, hypopharynx, and thyroid gland.

• Associated primary malignancies

  • These nodes most often contain metastatic deposits from malignancies of the oral cavity, nasopharynx, oropharynx, hypopharynx, and larynx.  [11][12][13][14][15]

Level IVa: Lower Jugular Group

• Anatomy

  • Level IVa contains the lower jugular nodal group adjacent to the inferior third of the IJV. It is bounded superiorly by the caudal border of the cricoid cartilage, and inferiorly by a virtual level two centimeters superior to the sternoclavicular joint, based off surgical conventions of level IVa dissection. It is bounded anteriorly by the anterior edge of the SCM (more superiorly) and the body of the SCM (more inferiorly), and posteriorly by the posterior edge of the SCM (more superiorly) and the SM(more inferiorly. This group is also laterally bound by the medial edge of the SCM (more superiorly) and the lateral edge of the SCM (more inferiorly). Finally, it is medially bordered by the medial edge of the common carotid artery, the medial edge of the thyroid gland and scalenus muscle (more superiorly), and the medial edge of the SCM (more inferiorly).

• Drainage

  • This group drains the efferent lymphatics from levels III and V, and partially from the retropharyngeal, pretracheal, and recurrent laryngeal nodes. It receives direct drainage from the larynx, hypopharynx, and thyroid gland.

• Associated primary malignancies

  • These nodes most often contain metastatic deposits from malignancies of the hypopharynx, larynx, thyroid, cervical esophagus, and rarely, the anterior oral cavity. Deposits from the anterior oral cavity can manifest without proximal nodal involvement.

Level IVb: Medial Supraclavicular Group

• Anatomy

  • This nodal group is a continuation of level IVa to the superior edge of the sternal manubrium. It is bounded anteriorly by the deep surface of the SCM. Posteriorly, it is bound by the anterior edge of the scalenus muscle (more superiorly) and the lung apex, brachiocephalic vein, and artery on the right, as well as the common carotid and subclavian arteries on the left (more inferiorly). It is bounded laterally by the lateral edge of the scalenus muscle, and medially by the medial border of the common carotid artery which is also adjacent to level VI.

• Drainage

  • This group drains the efferent lymphatics from levels IVa and Vc, and partially from the pretracheal and recurrent laryngeal nodes. It receives direct drainage from the larynx, trachea, hypopharynx, esophagus, and thyroid gland.

• Associated primary malignancies

  • These nodes most often contain metastatic deposits from malignancies of the hypopharynx, subglottic larynx, trachea, thyroid, and cervical esophagus.

Level Va and Vb: Posterior Triangle Group

• Anatomy

  • These nodal groups are contained with the posterior triangle. They are situated posteriorly to the SCM, and adjacent to the inferior portion of the spinal accessory nerve and transverse cervical vessels. It is bounded superiorly by the superior edge of the hyoid bone and inferiorly by a virtual plane crossing the transverse vessels. It is bound anteriorly by the posterior margin of the SCM, and posteriorly by the anterior border of the trapezius muscle. It is also bound by the platysma muscle and skin laterally, and by the levator scapulae (more superiorly) and scalenus muscle (more inferiorly) medially. A virtual plane at the inferior edge of the cricoid cartilage divides this group into upper, or Va, and lower, or Vb, posterior triangles.

• Drainage

  • These nodal groups drain the efferent lymphatics from the occipital, retro-auricular, occipital, and parietal scalp nodes. It receives direct drainage from the skin of the lateral and posterior neck and shoulder, the nasopharynx, oropharynx, and thyroid gland.

• Associated primary malignancies

  • These nodes most often contain metastatic deposits from malignancies of the nasopharynx, oropharynx, and thyroid.

Level Vc: Lateral Supraclavicular Group

• Anatomy

  • This nodal group is a continuation of levels Va and Vb; it contains the lateral supraclavicular group. It is bounded superiorly by a virtual plan crossing the transverse vessels, and inferiorly by a virtual plan 2 cm superior to the sternoclavicular join. It is also bounded anteriorly by the skin and posteriorly by the anterior border of the trapezius muscles (more superiorly) and the serratus anterior (more inferiorly). Laterally, it is bounded by the trapezius muscle (more superiorly) and the clavicle (more inferiorly). Medially, it is bordered by the scalenus muscle and lateral edge of the SCM, and is directly adjacent to the lateral edge of level IVa.

• Drainage

• Associated primary malignancies

Level VI: Anterior Compartment Group

The anterior compartment contains this nodal group, which is symmetric about the anatomic midline. It is also further subdivided into the superficially-located anterior jugular nodes, or level VIa, and the deeper pre-laryngeal, pre-tracheal, and para-tracheal (recurrent laryngeal) nodes, or level VIb. Level VIa

Level VIb

• Anatomy

  • Level VIb is bounded superiorly by the superior edge of the thyroid cartilage and inferiorly by the superior border of the sternal manubrium. It is also bounded anteriorly by the posterior margin of the infrahyoid muscles, and posteriorly by the anterior larynx, thyroid gland, and trachea at the midline, the pre-vertebral muscles on the right, and the esophagus on the left. This group is bordered laterally by the common carotid artery and medially by the lateral aspects of the trachea and esophagus.

• Drainage

  • Level VIb drains the efferent lymphatics from the anterior floor of the mouth, tip of the oral tongue, lower lip, thyroid gland, glottic and supraglottic larynx, hypopharynx, and cervical esophagus.

• Associated primary malignancies

  • These nodes most often contain metastatic deposits from malignancies of the lower lip, oral cavity (floor of the mouth and anterior oral tongue), thyroid, glottic and subglottic larynx, the apex of the piriform sinus, and the cervical esophagus.  [16][17]

Level VII: Prevertebral Compartment Group, including Levels VIIa and VIIbLevel VIIa: Retropharyngeal Nodes

• Anatomy

  • These nodes are contained in the retropharyngeal space. They are divided into medial and lateral subgroups. The lateral groups are bounded superiorly by the superior edge of the C1 vertebral body, or the hard palate, and inferiorly by the superior edge of the body of the hyoid bone. Anteriorly, they are bounded by the posterior edge of the superior/middle pharyngeal constrictor muscles. They are bordered posteriorly by the longus capitis and longus colli muscles, laterally by the medial edge of the internal carotid artery, and medially by a virtual line parallel to the lateral edge of the longus capitis muscle. The medial groups are approximated at the midline and not well-defined.

• Drainage

  • These nodes drain the efferent lymphatics from the nasopharynx, eustachian tube, and soft palate.

• Associated primary malignancies

  • These nodes most often contain metastatic deposits from malignancies of the nasopharynx, pharyngeal wall, and oropharynx including tonsillar fossa and soft palate.

Level VIIb: Retrostyloid Nodes

• Anatomy

  • These nodes are contained in the fatty space surrounding the large vessels of the neck leading to the jugular foramen. They are the superior continuation of level II. Level VIIb is bounded superiorly by the jugular foramen at the base of skull, and inferiorly by the inferior edge of the lateral process of the C1 vertebral body, the superior boundary of level II. These nodes are bounded anteriorly by the posterior edge of the prestyloid parapharyngeal space, and posteriorly by the C1 vertebral body and base of skull. Finally, they are bordered laterally by the styloid process and deep parotid lobe, and medially by the medial edge of the internal carotid artery.

• Drainage

• Associated primary malignancies

  • These nodes most often contain metastatic deposits from malignancies of the nasopharynx and anywhere in the head and neck resulting in significant infiltration of upper-level II nodes causing via retrograde flow.

Level VIII: Parotid Group

• Anatomy

  • This group includes the subcutaneous pre-auricular, superficial and deep intraparotid, and subparotid nodes. It is bounded superiorly by the zygomatic arch and external auditory canal, and inferiorly by the mandibular angle. This group is bounded anteriorly by the posterior edge of the mandibular ramus, the posterior edge of the masseter muscle (more laterally), and medial pterygoid muscle (medially). It is also bordered posteriorly by the anterior edge of the SCM (more laterally) and posterior belly of the digastric muscle (more medially). These nodes are bordered laterally by superficial muscular aponeurotic system (SMAS) layer within the subcutaneous tissues, and medially by the styloid process and muscle.

• Drainage

  • These nodes drain the efferent lymphatics from the frontal and temporal skin, eyelids, conjunctivae, auricles, external acoustic meatus, tympanum, nasal cavities, the root of the nose, nasopharynx, and the eustachian tube.

• Associated primary malignancies

  • These nodes most often contain metastatic deposits from malignancies of the previously named draining structures, as well as the orbit, external auditory canal, and parotid gland.[18]

Level IX: Buccofacial group

• Anatomy

  • This group contains the malar and the buccofacial nodes. These are superficial nodes surrounding the facial vessels on the external surface of the buccinator muscle. It is bounded superiorly by the inferior edge of the orbit and inferiorly by the inferior border of the mandible. It is also bounded anteriorly by the SMAS layer within the subcutaneous tissue, and posteriorly by the anterior edge of the masseter muscle and the corpus adiposum buccae. The lateral border is the SMAS layer, and the medial border is the buccinator muscle.

• Drainage

  • These nodes drain the efferent vessels of the nose, eyelids, and cheek.

• Associated primary malignancies

  • These nodes most often contain metastatic deposits from malignancies of the facial skin, nose, and buccal mucosa, as well as the maxillary sinus if invading soft tissues of the cheek.

Level X: Posterior Skull Group, including Levels Xa and Xb

Level Xa: Retroauricular and Subauricular Nodes

• Anatomy

  • This group includes superficial nodes on the mastoid process. It is bounded superiorly by the superior edge of the external auditory canal, and inferiorly by the mastoid tip. It is also bounded anteriorly by the anterior edge of the mastoid (inferiorly) and posterior edge of the external auditory canal (superiorly), and posteriorly by the posterior edge of the SCM. This group is bordered laterally by subcutaneous tissue, and medially by the splenius capitis muscles (inferiorly) and the temporal bone (superiorly).

• Drainage

  • These nodes drain the efferent vessels from the posterior auricular surface, external auditory canal, and adjacent scalp.

• Associated primary malignancies

Level Xb: Occipital Nodes

• Anatomy

  • This group is the superior and superficial continuation of level Va. It is bounded superiorly by the external occipital protuberance, and inferiorly by the superior border of level V. It is also bounded anteriorly by the posterior edge of the SCM, which is the posterior border of level Xa, and posteriorly by the anterior/lateral side of the trapezius muscle. Finally, this group is bordered laterally by subcutaneous tissues, and medially by the splenius capitis muscle.

• Drainage

• Associated primary malignancies

Clinical Significance

The lymphatic drainage of the head and neck is unique. Its remarkably well-delineated and characterized anatomic subgroups are closely associated with draining anatomic structure. These, in turn, are related to malignant neoplasms arising from specific anatomic structures. Intimate knowledge of this network allows the surgeon to complete an oncologically-appropriate dissection. It also helps the radiation oncologist appropriately treat elective nodal levels to reduce recurrence, and the primary care physician to guide the path to the necessary work up.

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

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

Lymph nodes of the neck; Posterior view, Afferent vessel to deep cervical glands, Afferent vessels of retropharyngeal glands, Retropharyngeal glands, Glandular nodule, Gland of deep cervical chain, Efferent vessels of retropharyngeal glands. Contributed (more…)

Figure

Lymph nodes of the arm, Deltoid pectoral glands, Axillary glands, Supratrochlear gland. Contributed by Gray’s anatomy Plates

Figure

Mediastinal lymph nodes. Image courtesy S Bhimji MD

Figure

Station for cervical lymph nodes. Contributed by Shekhar Gogna MD

References

1.

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]

2.

Biau J, Lapeyre M, Troussier I, Budach W, Giralt J, Grau C, Kazmierska J, Langendijk JA, Ozsahin M, O’Sullivan B, Bourhis J, Grégoire V. Selection of lymph node target volumes for definitive head and neck radiation therapy: a 2019 Update. Radiother Oncol. 2019 May;134:1-9. [PubMed: 31005201]

3.

Chone CT, Crespo AN, Rezende AS, Carvalho DS, Altemani A. Neck lymph node metastases to the posterior triangle apex: evaluation of clinical and histopathological risk factors. Head Neck. 2000 Sep;22(6):564-71. [PubMed: 10941157]

4.

Lindberg R. Distribution of cervical lymph node metastases from squamous cell carcinoma of the upper respiratory and digestive tracts. Cancer. 1972 Jun;29(6):1446-9. [PubMed: 5031238]

5.

Vauterin TJ, Veness MJ, Morgan GJ, Poulsen MG, O’Brien CJ. Patterns of lymph node spread of cutaneous squamous cell carcinoma of the head and neck. Head Neck. 2006 Sep;28(9):785-91. [PubMed: 16783833]

6.

Ishikawa M, Anzai Y. MR imaging of lymph nodes in the head and neck. Neuroimaging Clin N Am. 2004 Nov;14(4):679-94. [PubMed: 15489148]

7.

Ho FC, Tham IW, Earnest A, Lee KM, Lu JJ. Patterns of regional lymph node metastasis of nasopharyngeal carcinoma: a meta-analysis of clinical evidence. BMC Cancer. 2012 Mar 21;12:98. [PMC free article: PMC3353248] [PubMed: 22433671]

8.

Candela FC, Kothari K, Shah JP. Patterns of cervical node metastases from squamous carcinoma of the oropharynx and hypopharynx. Head Neck. 1990 May-Jun;12(3):197-203. [PubMed: 2358329]

9.

Candela FC, Shah J, Jaques DP, Shah JP. Patterns of cervical node metastases from squamous carcinoma of the larynx. Arch Otolaryngol Head Neck Surg. 1990 Apr;116(4):432-5. [PubMed: 2317325]

10.

Hicks WL, Kollmorgen DR, Kuriakose MA, Orner J, Bakamjian VY, Winston J, Loree TR. Patterns of nodal metastasis and surgical management of the neck in supraglottic laryngeal carcinoma. Otolaryngol Head Neck Surg. 1999 Jul;121(1):57-61. [PubMed: 10388879]

11.

Shah JP, Candela FC, Poddar AK. The patterns of cervical lymph node metastases from squamous carcinoma of the oral cavity. Cancer. 1990 Jul 01;66(1):109-13. [PubMed: 2354399]

12.

Montero PH, Patel SG. Cancer of the oral cavity. Surg Oncol Clin N Am. 2015 Jul;24(3):491-508. [PMC free article: PMC5018209] [PubMed: 25979396]

13.

Farmer RW, McCall L, Civantos FJ, Myers JN, Yarbrough WG, Murphy B, O’Leary M, Zitsch R, Siegel BA. Lymphatic drainage patterns in oral squamous cell carcinoma: findings of the ACOSOG Z0360 (Alliance) study. Otolaryngol Head Neck Surg. 2015 Apr;152(4):673-7. [PMC free article: PMC4399646] [PubMed: 25749001]

14.

Woolgar JA. Histological distribution of cervical lymph node metastases from intraoral/oropharyngeal squamous cell carcinomas. Br J Oral Maxillofac Surg. 1999 Jun;37(3):175-80. [PubMed: 10454023]

15.

Shah JP. Patterns of cervical lymph node metastasis from squamous carcinomas of the upper aerodigestive tract. Am J Surg. 1990 Oct;160(4):405-9. [PubMed: 2221244]

16.

Chung EJ, Kim GW, Cho BK, Park HS, Rho YS. Pattern of lymph node metastasis in hypopharyngeal squamous cell carcinoma and indications for level VI lymph node dissection. Head Neck. 2016 Apr;38 Suppl 1:E1969-73. [PubMed: 26835610]

17.

Chung EJ, Lee SH, Baek SH, Park IS, Cho SJ, Rho YS. Pattern of cervical lymph node metastasis in medial wall pyriform sinus carcinoma. Laryngoscope. 2014 Apr;124(4):882-7. [PubMed: 23832757]

18.

Chisholm EJ, Elmiyeh B, Dwivedi RC, Fisher C, Thway K, Kerawala C, Clarke PM, Rhys-Evans PH. Anatomic distribution of cervical lymph node spread in parotid carcinoma. Head Neck. 2011 Apr;33(4):513-5. [PubMed: 20652975]

Disclosure: Antony Koroulakis declares no relevant financial relationships with ineligible companies.

Disclosure: Zohaib Jamal declares no relevant financial relationships with ineligible companies.

Disclosure: Manuj Agarwal declares no relevant financial relationships with ineligible companies.

Copyright © 2023, StatPearls Publishing LLC.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4. 0 International (CC BY-NC-ND 4.0)
(
http://creativecommons.org/licenses/by-nc-nd/4.0/
), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

Bookshelf ID: NBK513317PMID: 30020689

Lymph Nodes & Cancer | What are Lymph Nodes?

• What is the lymph system?
• Cancer in the lymph nodes
• Effects of removing lymph nodes

What is the lymph system?

The lymph (or lymphatic) system is a part of your body’s immune system. It includes a network of lymph vessels and lymph nodes. Lymph vessels are a lot like the veins that collect and carry blood through the body. But instead of carrying blood, these vessels carry the clear watery fluid called lymph. Lymph fluid also contains white blood cells, which help fight infections.

Lymph fluid would build up and cause swelling if it were not drained in some way. Lymph vessels draw up the lymph fluid from around the cells to send it towards the chest. There, lymph fluid collects into a large vessel that drains into a blood vessel near the heart.

Lymph nodes and what they do

Lymph vessels send lymph fluid through nodes throughout the body. Lymph nodes are small structures that work as filters for foreign substances, such as cancer cells and infections. They contain immune cells that can help fight infection by attacking and destroying germs that are carried in through the lymph fluid. Lymph nodes are located in many parts of the body, including the neck, armpit, chest, abdomen (belly), and groin. They contain immune cells that can help fight infection by attacking and destroying germs that are carried in through the lymph fluid.

There are hundreds of lymph nodes throughout the body. Each lymph node filters the fluid and substances picked up by the vessels that lead to it. Lymph fluid from the fingers, for instance, works its way toward the chest, joining fluid from the arm. This fluid may filter through lymph nodes at the elbow, or those under the arm. Fluid from the head, scalp, and face flows down through lymph nodes in the neck. Some lymph nodes are deep inside the body, such as between the lungs or around the bowel, to filter fluid in those areas.

Swollen lymph nodes

When there’s a problem, such as infection, injury, or cancer, lymph nodes in that area may swell or enlarge as they work to filter out the “bad” cells. Swollen lymph nodes (lymphadenopathy) tell you that something is not right, but other symptoms help pinpoint the problem. For instance, ear pain, fever, and enlarged lymph nodes near your ear are clues that you may have an ear infection or cold.

Some areas where lymph nodes commonly swell are in the neck, groin, and underarms. In most cases, only one area of nodes swells at a time. When more than one area of lymph nodes is swollen it’s called generalized lymphadenopathy. Some infections (such as strep throat and chicken pox), certain medicines, immune system diseases, and cancers like lymphoma and leukemia can cause this kind of swelling. Your health care provider will look for more information to figure out the cause of the swelling. Lymph node swelling is often caused by something other than cancer.

Cancer in the lymph nodes

Cancer can appear in the lymph nodes in 2 ways: it can either start there or it can spread there from somewhere else.

Cancer that starts in the lymph nodes is called lymphoma. You can read more about lymphoma in Hodgkin Lymphoma and Non-Hodgkin Lymphoma.

More often, cancer starts somewhere else and then spreads to lymph nodes. That is the focus of this section.

How does cancer spread to lymph nodes?

Cancer can spread from where it started (the primary site) to other parts of the body.

When cancer cells break away from a tumor, they can travel to other areas through either the bloodstream or the lymph system. If they travel through the lymph system, the cancer cells may end up in lymph nodes. Most of the escaped cancer cells die or are killed before they can start growing somewhere else. But one or two might settle in a new area, begin to grow, and form new tumors. This spread of cancer to a new part of the body is called metastasis.

In order for cancer cells to spread to new parts of the body, they have to go through several changes. They must become able to break away from the original tumor and attach to the outside wall of a lymph or blood vessel. Then they must move through the vessel wall to flow with the blood or lymph to a new organ or lymph node.

When cancer does spread to lymph nodes, it usually spreads to nodes near the tumor itself. These are the nodes that have been doing most of the work to filter out or kill the cancer cells.

How is cancer in lymph nodes found?

Normal lymph nodes are tiny and can be hard to find, but when there’s infection, inflammation, or cancer, the nodes can get larger. Those near the body’s surface often get big enough to feel with your fingers, and some can even be seen. But if there are only a few cancer cells in a lymph node, it may look and feel normal. Lymph nodes deep in the body cannot be felt or seen. So doctors may use scans or other imaging tests to look for enlarged nodes that are deep in the body. Often, enlarged lymph nodes near a cancer are assumed to contain cancer.

The only way to know whether there is cancer in a lymph node is to do a biopsy. Doctors may remove lymph nodes or take samples of one or more nodes using needles. The tissue that’s removed is looked at under the microscope by a pathologist (a doctor who diagnoses illness using tissue samples) to find out if there are cancer cells in it. The pathologist prepares a report, which details what was found. If a node has cancer in it, the report describes what it looks like and how much was seen.

When a surgeon operates to remove a primary cancer, they may remove one or more of the nearby (regional) lymph nodes as well. Removal of one lymph node is considered a biopsy, but when many lymph nodes are removed, it’s called lymph node dissection. When cancer has spread to lymph nodes, there’s a higher risk that the cancer might come back after surgery. This information helps the doctor decide whether more treatment, like chemo, immunotherapy, targeted therapy or radiation, might be needed after surgery.

What does it mean if there’s cancer in my lymph node?

If cancer is found in one or more lymph nodes, it could mean that more tests are needed to know how far the cancer has spread. This information is used to determine the stage of your cancer and the best treatment options.

For more information on staging, see Cancer Staging, or find your cancer type for more detailed information.

Effects of removing lymph nodes

When lymph nodes are removed, it can leave the affected area without a way to drain off the lymph fluid. Many of the lymph vessels now run into a dead end where the node used to be, and fluid can back up. This is called lymphedema, which can become a life-long problem. The more lymph nodes that are removed, the more likely it is to occur. To learn more about what to look for, ways reduce your risk, and how to manage this side effect, see Lymphedema.

Removing lymph nodes during cancer surgery is highly unlikely to weaken a person’s immune system, since the immune system is large and complex and is located throughout the body.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

American Joint Committee on Cancer. AJCC Cancer Staging Manual, 8th ed. New York: Springer 2017: 715-725.

Liao S, von der Weid PY. Lymphatic system: an active pathway for immune protection. Semin Cell Dev Biol. 2015;38:83–89.

National Institute of Allergy and Infectious Diseases. Overview of the Immune System. Updated December 30, 2013. Accessed at https://www.niaid.nih.gov/research/immune-system-overview on February 23, 2021. 

Last Revised: March 2, 2021

American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.

Neck Soft Tissue MRI

MRI Center – Lymph Node MRI

Neck Soft Tissue Examination

A key part of the peripheral immune system consists of the lymph nodes. When metabolic / autoimmune pathologies occur, neoplasms occur, infection appears, lymph nodes increase in size. This process belongs to the general medical signs.

Such changes entail a variety of procedures and therapeutic examinations. The best way to examine this organ is tomography of the lymph nodes.

Lymph node MRI price in Moscow

org/Product”>

Survey	PROMOTION PRICE! Find out the end date of the promotion by calling the medical center
Neck soft tissue MRI (lymph nodes)	5 600

Why MRI of lymph nodes is necessary

MRI of the lymph nodes is the most advanced diagnostic method that reveals inconsistencies in the body. The display is based on a magnetic field combined with radio frequency pulses.

The positive aspect of this research method is its harmlessness and information content. During the examination, patients are spared from contact with highly radioactive substances, as well as from the perception of harmful radiation. The image quality factor makes it possible to recognize even the slightest modifications in the depicted organ.

Using only MRI of the lymph nodes, doctors can make a qualitative assessment of the state of the entire lymphatic system, as well as its individual elements

Indications for MRI of the lymph nodes

Lymph nodes in the human body perform the work of filtering of natural origin. Lymph flows through these filters, and they also trap all kinds of cells of the wrong composition.

MRI of the lymph nodes is usually done if:

• Immunity is impaired due to various diseases.
• There is an assumption of infectious diseases. This includes special diseases (tuberculosis or HIV).
• Symptoms are present that suggest the presence of metastases or tumors in the lymph nodes.

An appointment for MRI of the lymph nodes is issued if the patient has:

• As a result of infection, the lymph nodes have changed in size.
• If the size of the lymph nodes has changed for unknown reasons.
• Lymph nodes are enlarged on one side.
• The patient has already recovered, and the lymph nodes continue to grow.
• Lymph nodes have become larger. At the same time, the patient’s body temperature is elevated, the patient feels pain, there is a violation of swallowing functions.

For a more effective diagnosis, the patient may be offered an MRI with contrast. This research method consists of introducing a contrast agent into the body by injection. This drug accumulates in the organ being examined.

Soft tissues of the neck

MRI of the soft tissues of the neck

From an anatomical point of view, the neck area is subject to the greatest load. It contains many organs that fit tightly to each other in a limited space. These organs belong to different systems such as nervous, circulatory, digestive, endocrine, lymphatic. Therefore, with the help of MRI of the soft tissues of the neck organs, it is possible to examine various changes in the structures (larynx, lymph nodes, thyroid gland, salivary glands).

Neck MRI is prescribed if there are suspicions of diseases of the vascular system, endocrine anomalies, when the salivary glands or the thyroid gland are inflamed. Also, tomography helps to identify tumors and metastases in the neck.

Where to get an MRI of lymph nodes in Moscow

If you need to diagnose lymph nodes, please contact our medical center located near the metro station. Experienced doctors work on high-precision equipment. Therefore, you will have an MRI in comfort, and the results of the study will be informative and accurate. With us you will feel safe!

Appointment by phone: +7 (495) 783-02-05, +7-985-256-02-03

Address: Moscow, st. Zagoryevskiy proezd, 1

Lymphadenopathy (enlarged lymph nodes) – symptoms and treatment

What are lymph nodes

The lymphatic system is part of the vascular system, similar to a second bloodstream. It consists of capillaries, vessels and ducts through which lymph flows – a transparent viscous liquid with a large number of immune cells.

The lymphatic system is connected with the circulatory system. The task of the lymph is to take excess proteins, salts, water, toxins, cellular debris, pathogens and metabolic products from the tissues, and then send them to the blood for further utilization by the organs of the excretory system.

The lymphatic system includes the lymphatic vessels, the spleen, and the lymph nodes, which are small collections of lymphoid tissue. They filter the lymph and fight pathogens.

The lymphatic system includes the lymphatic vessels, spleen and lymph nodes

Lymph nodes are peripheral and deep.

Peripheral lymph nodes:

• occipital,
• behind the ear,
• front ear,
• chin pads,
• rear neck,
• front neck,
• submandibular,
• supraclavicular,
• jugular,
• axillary,
• cubital (elbow),
• inguinal,
• popliteal.

Peripheral lymph nodes close to the surface of the skin and can be felt

Deep lymph nodes are located in the chest and abdominal cavities, as well as in the muscle tissue of the thigh.

There are about 500 lymph nodes in the human body.

Lymph nodes are needed to protect the body from the spread of pathogens. Each lymph node plays the role of a “customs” – it passes lymph through itself, but recognizes and retains bacteria, viruses, fungi, toxins, as well as damaged and mutated cells that migrate through the lymphatic vessels from various organs and tissues.

To neutralize pathogens, each lymph node contains clusters of lymphocytes and macrophages – immune cells that quickly destroy harmful atypical cells and microorganisms.

Also in the lymph nodes, the maturation and preparation of lymphocytes for the destruction of foreign proteins and cells occurs.

In the lymph node there are clusters of lymphocytes and macrophages that destroy atypical cells and microorganisms

If there are too many pathogens, the lymph nodes may not be able to cope with the load and increase in size. Doctors call this condition lymphadenopathy .

ICD-10 code for lymphadenopathy – R59 (“Swollen lymph nodes”).

Causes of lymphadenopathy

As a rule, lymphadenopathy is secondary. It does not arise by itself, but as a symptom and consequence of various pathologies.

Causes of lymphadenopathy can be infectious and non-infectious .

When infected, the lymphatic system reacts to the invasion and stimulates the production of protective immune cells – lymphocytes and macrophages, which are needed to destroy foreign microorganisms. Due to the growth in the number of immune cells, the lymph nodes increase in size.

Infection of the lymph node can also lead to lymphadenopathy. In this case, the lymph node not only enlarges, but also becomes inflamed – and lymphadenitis develops.

In non-infectious lymphadenopathy, enlarged lymph nodes can be caused by the growth of tumor cells, as well as autoimmune diseases.

Lymphadenopathy in viral and bacterial infections

Most often, swollen lymph nodes are associated with infectious diseases.

The most common cause of enlargement of peripheral lymph nodes is acute respiratory diseases (ARI) viral and bacterial nature.

For example, lymph nodes often ‘swell’ in acute tonsillitis, also called tonsillitis. Streptococci, staphylococci, pneumococci, adenoviruses, influenza virus and other infectious agents can provoke tonsillitis. Lymphadenopathy caused by acute respiratory infections, as a rule, affects only the posterior cervical or submandibular lymph nodes.

Most often, swollen lymph nodes are associated with infectious diseases.

The posterior cervical lymph nodes are most often enlarged in acute respiratory infections

Deep lymph nodes increase if the infection has penetrated into the internal organs. With intestinal infections, the mesenteric lymph nodes located in the abdominal cavity, next to the intestines, may increase, and with pneumonia, the lymph nodes of the chest cavity and mediastinum.

In some cases, for example, when infected with the Epstein-Barr virus, which leads to the development of infectious mononucleosis, both peripheral and deep lymph nodes, as well as the spleen (it is also part of the lymphatic system), are significantly enlarged.

With HIV infection, generalized lymphadenopathy is observed – almost all lymph nodes are enlarged at once.

Lymph nodes can also increase in size with diphtheria, chicken pox, tuberculosis, hepatitis, toxoplasmosis, venereal diseases and many other infections.

It is impossible to determine which particular pathogen has entered the body by swollen lymph nodes. However, the general complaints of the patient, as well as an examination of enlarged lymph nodes, will help the doctor narrow the area of ​​diagnosis, identify the source of infection and make a diagnosis.

Lymphadenopathy in autoimmune diseases

Lymphadenopathy often occurs in association with systemic autoimmune diseases, such as systemic lupus erythematosus, Still’s disease, or rheumatoid arthritis.

In autoimmune disorders, the immune system mistakenly perceives its own cells as pathogenic and begins to destroy them. Lymph nodes and the spleen are actively involved in this process and increase in size due to the heavy load.

Lymphadenopathy in malignant neoplasms

Lymphadenopathy occurs when cancer cells separated from the main tumor enter the lymphatic system and settle in the lymph node.

Accumulating, such cells begin to form metastases – distant secondary foci of a malignant tumor. With the development of a malignant process, the lymph nodes increase in size and become hard. Gradually, they cease to cope with cancer cells and begin to pass them further along the lymphatic system to the next lymph nodes.

All malignant tumors metastasize to lymph nodes.

In addition, there is a separate type of tumor that initially affects the lymphatic system – they are called lymphomas.

Types of lymphadenopathy

Lymphadenopathy is distinguished by the cause of occurrence, prevalence, duration and nature of the course.

Due to occurrence:

• infectious;
• non-infectious.

Involvement of the tumor process:

• tumor;
• non-tumor.

By prevalence:

• localized form – lymph nodes are enlarged only in one part of the body;
• common form – lymph nodes are enlarged in two or more parts of the body.

Duration:

• short – less than 2 months;
• long, or protracted – lasts more than 2 months.

Downstream:

• acute – short-lived, occurred together with any acute pathology;
• chronic – prolonged, persists due to chronic pathology or for no apparent reason;
• recurrent – exacerbates with a certain frequency against the background of a chronic disease or for no apparent reason.

Symptoms of lymphadenopathy

Lymphadenopathy is accompanied by an increase in lymph nodes. In classical lymphadenopathy, the nodes are soft in texture, sometimes slightly painful. In size, the affected lymph node may resemble a bean – it is about 2 cm.

In most cases, patients do not pay attention to enlarged lymph nodes, they are only concerned about the manifestations of the underlying disease. For example, with acute respiratory infections, it can be a sore throat, sore throat, cough, runny nose, fever, chills, a general feeling of malaise.

However, in some cases, an increase in lymph nodes is a symptom of a serious pathology.

An enlarged axillary lymph node in a woman may be a sign of breast cancer.

With the development of lymphoma or the spread of tumor cells (metastasis), the lymph nodes enlarge for no apparent reason and become dense, even hard.

In breast cancer, nearby lymph nodes are enlarged

The patient may not notice enlargement of internal lymph nodes at all. In this case, complaints will primarily indicate the symptoms of the underlying disease, and lymphadenopathy will be detected only after ultrasound, CT or MRI of the corresponding part of the body.

Diagnosis of lymphadenopathy

Most often, patients do not notice lymphadenopathy and do not complain about it. It serves as a secondary symptom of various diseases.

For example, with acute respiratory infections, patients first of all mention sore throat, nasal congestion, cough, chills and other symptoms, but not an increase in submandibular lymph nodes – the therapist will pay attention to this during examination and palpation (palpation).

If a patient comes to a therapist with complaints of a “cold”, the doctor will first feel the neck and the area under the lower jaw – he will check the lymph nodes.

In intestinal infections, such as salmonellosis, the main symptoms are abdominal pain, vomiting, diarrhea, high fever. An increase in the abdominal lymph nodes, if any, will reveal only a hardware study.

However, in some cases, the appearance of an unusual “bump” under the armpit or in the groin may be the main complaint. In this case, the doctor will ask in detail about the symptoms and, focusing on the location of the enlarged lymph node, will begin to look for the cause of lymphadenopathy.

To assess the general condition of the patient, detect inflammatory processes and narrow the search area for pathology, a specialist can prescribe a general blood test and biochemistry, a urinalysis, and, if necessary, a set of tests for HIV, syphilis and hepatitis.

Clinical blood test with leukocyte formula and ESR (with microscopy of a blood smear in case of pathological changes) (venous blood)

430 ₽

33 Add to cart

Biochemistry 21 indicators ( extended)

3 690 ₽

Add to cart

Hospital complex

1 100 ₽

Add to cart

If the consistency of the lymph node is not soft, but elastic and hard, the doctor may suggest the development of a lymphoma or metastasis of any tumor. For example, a hard lymph node under the arm of a woman can be a sign of breast cancer.

If a malignant process is suspected, the therapist will refer the patient to an oncologist for an extended examination, including for the appointment of a biopsy – an analysis of the tissues of the lymph node for the presence of pathological changes and cancer cells.

To confirm the diagnosis, the doctor may prescribe a histological examination of the lymph nodes, which will reveal a malignant process, as well as recommend studies for a specific type of cancer.

Histological examination of lymph nodes (1-5 lymph nodes)

2 220 ₽

Add to cart

Histological examination of lymph nodes (more than 5 lymph nodes)

2 550 ₽

Add to cart

CA 15-3 glands)

630 ₽

Add to cart

Research breast punctate

550 ₽

Add to cart

Histological examination of the breast (biopsy material)

2 650 ₽

Add to cart

Treatment of lymphadenopathy

Lymphadenopathy is not considered an independent disease and does not require separate treatment. It occurs as a result of other diseases, and the main goal of therapy is to cure them, and in the case of autoimmune and some oncological diseases, to achieve a stable remission.

For a viral infection, the patient is prescribed antiviral drugs. If the causative agent of the infection is a bacterium, the doctor will give you a prescription for antibiotics.

Treatment of autoimmune diseases may be associated with the use of hormonal drugs and immunosuppressants – drugs that reduce the body’s immune response.

Oncological diseases are treated with the help of operations, chemical and radiation therapy.

If the cause of the enlarged lymph nodes is not established (idiopathic lymphadenopathy) and no diseases were found after the examination, the doctor may recommend a preventive visit every 3 months to observe and evaluate changes. Perhaps the disease proceeds in a latent form and it takes time to manifest itself.

Sequelae of lymphadenopathy

Lymphadenopathy is a clinical sign of many diseases and a signal of the body that something is wrong with health.

In advanced infectious diseases, the pathogen can enter the lymph node and lead to its inflammation – lymphadenitis . Pathology is manifested by severe pain in the lymph node, swelling, redness of the skin, and sometimes suppuration or tissue death (necrosis).

Tuberculous lymphadenitis.
Photo: Dr. J. S. Bhandari

Lymphadenitis can lead to blood poisoning – sepsis, as well as to the spread of infection throughout the body.

Moreover, swollen lymph nodes can be oncogenic in nature – be a sign of the spread of secondary foci of a cancerous tumor. For example, lymph nodes increase with the development of a malignant neoplasm – lymphoma, as well as with the spread of cancer cells of other tumors (metastases) through the lymphatic system.

Suspicion of lymphadenopathy is a reason to consult a doctor.

Oncological diseases in the early stages in most cases respond well to treatment. But if their beginning is missed, the malignant process may spread to other organs, and in this case, the treatment may be less effective.