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Where are nodes located. Understanding the Role of Lymph Nodes in Cancer: A Comprehensive Guide

by alexxlab

What is the lymph system? How do lymph nodes work? What happens when lymph nodes become swollen? Can cancer spread to lymph nodes? Get the answers to these questions and more in our detailed article.

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The Lymph System: Key Components and Functions

The lymph (or lymphatic) system is a crucial part of the body’s immune system. It includes a network of lymph vessels and lymph nodes. Lymph vessels are similar to veins, but they carry a clear, watery fluid called lymph instead of blood. Lymph fluid contains white blood cells that help fight infections.

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

Understanding Lymph Nodes

Lymph vessels send lymph fluid through lymph nodes throughout the body. Lymph nodes are small structures that act as filters, trapping foreign substances like cancer cells and infections. They contain immune cells that can attack and destroy germs carried in the lymph fluid.

There are hundreds of lymph nodes in the body, located in areas such as the neck, armpit, chest, abdomen, and groin. Each lymph node filters the fluid and substances picked up by the vessels leading to it. Lymph fluid from different parts of the body may flow through multiple lymph nodes before reaching the chest.

Swollen Lymph Nodes: Causes and Implications

When there’s a problem, such as an 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) indicate that something is not right, but other symptoms help identify the underlying issue.

Lymph node swelling is often caused by something other than cancer, such as infections, immune system diseases, or certain medications. Your healthcare provider will investigate further to determine the cause of the swelling.

Cancer and the Lymph System

Cancer can appear in the lymph nodes in two ways: it can either start there (lymphoma) or it can spread there from somewhere else.

When cancer cells break away from a tumor, they can travel to other areas through 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, but a few might settle in a new area and form new tumors, a process called metastasis.

Detecting Cancer in Lymph Nodes

Normal lymph nodes are tiny and hard to find, but when there’s an infection, inflammation, or cancer, the nodes can swell and become larger. Those near the body’s surface often get big enough to be felt, 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 check for changes in the lymph nodes that could indicate the presence of cancer.

The Importance of Lymph Nodes in Cancer Staging and Treatment

The extent of cancer spread to lymph nodes is a key factor in determining the stage of cancer and the appropriate treatment approach. Lymph node involvement can provide valuable information about the cancer’s behavior and help guide decisions on the best course of action.

In some cases, lymph nodes may need to be surgically removed and examined to assess the extent of cancer spread. This information is crucial for developing an effective treatment plan and understanding the prognosis for the individual patient.

Staying Informed and Seeking Medical Advice

Understanding the role of the lymph system and lymph nodes in cancer is important for anyone affected by the disease. If you have concerns about swollen lymph nodes or potential cancer spread, it’s essential to discuss them with your healthcare provider.

Your doctor can perform the necessary examinations and tests to determine the cause of any lymph node changes and develop an appropriate treatment plan if cancer is involved. Staying informed and proactive about your health can make a significant difference in the management and outcome of your condition.

Lymph Nodes and Cancer

What is the lymph system?

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

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

Lymph nodes and what they do

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

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

Swollen lymph nodes

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

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

Cancer in the lymph nodes

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

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

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

How does cancer spread to lymph nodes?

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

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

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

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

How is cancer in lymph nodes found?

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

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

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

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

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

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

Effects of removing lymph nodes

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

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

Axillary Nodes – Anatomy Pictures and Information

The axillary nodes are a group of lymph nodes located in the axillary (or armpit) region of the body. They perform the vital function of filtration and conduction of lymph from the upper limbs, pectoral region, and upper back.

The axillary lymph nodes are a group of twenty to thirty large lymph nodes located in the deep tissues in and around the armpit. These nodes are arranged into five distinct groups: pectoral (anterior), lateral, subscapular (posterior), central (intermediate), and subclavicular (medial). Continue Scrolling To Read More Below…

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Each group of lymph nodes receives lymph from a specific region of the body or from another group of lymph nodes.

  • The pectoral group consists of four or five large lymph nodes located at the superior border of the pectoralis major muscle. These lymph nodes receive lymph from afferent lymphatic vessels in the mammary and pectoral regions of the chest. Efferent lymphatic vessels from this group carry lymph to the central lymph nodes.
  • Bordering the lateral edge of the pectoral group is the lateral group. The lateral group consists of four to six lymph nodes clustered around the axillary vein. Lymph from lymph vessels in the upper limb (arm) feeds into the lateral group and is passed on to the central lymph nodes through efferent lymphatic vessels.
  • The subscapular group is found in the posterior of the axilla inferior to the scapula, or shoulder blade. Six to seven lymph nodes make up this group, which filters lymph from lymphatic vessels in the back of the neck and upper back. Efferent lymphatic vessels from this group carry lymph to the central lymph nodes.
  • The central nodes are a group of three to four lymph nodes embedded in the mass of adipose tissue in the base of the axilla. They further filter lymph that has already been filtered in the pectoral, lateral, and subscapular lymph nodes. Lymph from the central nodes is conducted through lymphatic vessels to the subclavicular nodes just below the clavicle, or collar bone.
  • The subclavicular nodes are six to twelve lymph nodes that perform the final round of lymph filtration before passing lymph on to the subclavian trunk.

Lymph is a class of extracellular fluid found in lymphatic vessels and formed from the interstitial fluids of the body. Interstitial fluid is another type of extracellular fluid found surrounding the cells of every tissue in the body. Blood plasma passing through capillaries in the tissues leaks through small gaps in the capillary walls and flows between the cells, forming interstitial fluid. Interstitial fluid plays a vital role in delivering water and nutrients to the tissues while picking up waste materials from the cells. Interstitial fluid also picks up debris from dead cells, viruses, bacteria, and possibly tumor cells. Lymphatic capillaries present in the tissues draw interstitial fluid into their lumens, where it becomes lymph. Lymph is then filtered by lymph nodes and returned to the bloodstream where it once again becomes blood plasma.

Lymph nodes are small organs in the lymphatic system. Their shape bears a resemblance to kidney beans. The exterior of each lymph node consists of a tough capsule made of dense fibrous connective tissue. Reticular tissue containing abundant lymphocytes and macrophages fills the interior of the lymph node. Lymph nodes serve as filters of the lymph that enters from several afferent lymph vessels. Reticular fibers in the reticular tissue work like a net to collect any pathogen or tumor cells in the lymph. The macrophages and T-lymphocytes then attack and kill these pathogens and tumor cells. Once the lymph has been filtered, it passes through efferent lymph vessels, which transport the filtered lymph out of the lymph node en route to the lymphatic ducts.

Lymph passes through several sets of lymph nodes to complete its filtration process, before flowing into larger lymphatic trunks. The subclavian trunks carry lymph from the axillary nodes through the torso to the left and right lymphatic ducts. Both lymphatic ducts return filtered lymph to the subclavian veins, where it becomes part of the blood plasma and returns to the heart for further circulation.

Lymph nodes Definition and Examples

Definition of lymph nodes

Lymph nodes definition

Lymph nodes are small, bean-shaped organs located in different parts of the body and act as “drainage points” throughout the lymphatic system. They store special cells (lymphocytes) that can trap cancer cells and bacteria traveling through the body in lymph. Each lymph node is an organized structure surrounded by a fibrous capsule and a substance of three major regions: (1) cortical, (2) paracortical, and (3) medullary. Lymph enters the lymph nodes at intervals in the lymphatic system to be filtered out of bacteria, antigens, and cancer cells prior to returning to the bloodstream. The human body has several lymph nodes that occur in clusters. They are located in the cephalic (mostly), thoracic, and inguinal regions. Etymology: from Latin lympha , meaning “water”, “water nymph”; Latin nodus, meaning “a knot”. Synonyms: lymph glands; lymphatic nodes; lymphoglandula; lymphonodular; lymphonodus.

Are lymph glands and nodes the same thing?

Lymph nodes are also referred to as lymph glands because they seem like a true gland. However, lymph nodes are not precisely glands. A true gland is defined as an infolding of an epithelial sheet specialized for secretion. Lymph nodes are masses of tissues in the lymphatic vessels where several immune cells are located. They are not mainly for secretion but to serve as filters of the body. The lymph passes through these “checkpoints” to be filtered for cells and other particles (antigens) designated for destruction.

Lymph node structure

A lymph node is a mass of tissue encased by a fibrous capsule, with a shape resembling a “bean”. The capsule is made up of reticular fibers of reticular connective tissue. It extends to the inside of the lymph node. These capsular extensions are referred to as “trabeculae” (singular: trabecula). Lymph nodes have substances, each consisting of three major tissue regions: (1) the cortical region (cortex), (2) the paracortical region (paracortex ), and (3) the medullary region (medulla). (Ref.1) These regions are made up of connective tissues wherein immune cells are enmeshed. The outermost region is the cortex whereas the innermost, the medulla. The paracortex surrounds the medulla. The presence of trabeculae divides these regions into lobules (also called nodules). The cortex contains the lymphoid follicles (i.e. masses of lymphoid tissue) that may be primary or secondary. The primary follicles contain mostly immature lymphocytes. The secondary follicles contain many B lymphocytes from the bloodstream that have entered the lymph node through the high endothelial venules in the paracortical region. The paracortex is the tissue region dominated mostly by mature T lymphocytes and dendritic cells. The high endothelial venules in this region also allows the entry of growth and regulatory factors for the maturation and the activation of the immune cells. (Ref.2) The medulla is largely composed of blood vessels, medullary sinuses, and the medullary cords. The medullary cords are a source of plasma cells. (Ref.1) The medulla also contains the macrophages, such as histiocytes (immobile macrophages), and reticular cells. A depression on the surface of the lymph node through which the efferent lymph vessel emerges from and the blood vessels enter and leave is referred to as “hilum”. The presence of the hilum makes the lymph node shaped like a “bean”.

To identify the different parts of the lymph node see the lymph node anatomy and histology diagram below. Also shown in the diagram is the direction of the lymph flow. Lymph enters the lymph node via the afferent lymphatic vessel. Next, it percolates through the substance of the lymph node through lymph node sinuses. In particular, it moves through a series of sinuses as follows: subcapsular sinus > trabecular sinuses > medullary sinuses. Lymph, then, leaves the lymph node via the efferent lymphatic vessel.

Lymph node structure. Credit: Chris Sullivan, CC BY-SA 4.0.

Lymph nodes function

The primary function of the lymph nodes is to filter out lymph that enters the lymphatic system. They remove bacteria and antigens from it. After this, lymph returns to the bloodstream. In the lymphatic system, the lymph nodes, together with the spleen, are its secondary lymphoid organs (SLO). Their role, which is to initiate an adaptive immune response, makes them a part of the immune system as well. In particular, B and T lymphocytes in the lymph nodes are involved in antibody responses and cell-mediated immune responses, respectively. The spleen, though, filters not the lymph but the blood cells.

The lymph nodes also act as the site where lymphocytes can be produced. Aside from the lymphocytes coming from the bloodstream, new lymphocytes are also produced within the lymph nodes. Thus, the lymph nodes can also be a source of lymphocytes apart from other organs of lymphoid tissues, such as spleen, thymus, and bone marrow.

Location of lymph nodes in the body

Lymph nodes, together with the lymph vessels, lymphoid tissues (organs), and lymph, comprise the lymphatic system. The human body typically has about 500 to 600 lymph nodes. They occur as clusters, such as the nodes under jaw (chin), in the neck area, thorax, underarm, and inguinal regions (groin). Based on their location, the lymph nodes are typified and named as follows:

Near or at the chin:

  • Mastoid lymph nodes
  • Occipital lymph nodes
  • Parotid lymph nodes

Near or at the neck area:

  • Deep anterior cervical lymph nodes
  • Deep lateral cervical lymph nodes
  • Jugulodigastric lymph node
  • Jugulo-omohyoid lymph node
  • Submandibular lymph nodes
  • Submental lymph nodes
  • Virchow’s node

At the thoracic region:

  • Pulmonary lymph nodes: subsegmental lymph nodes, segmental lymph nodes, lobar lymph nodes, interlobar lymph nodes, and hilar lymph nodes
  • Mediastinal lymph nodes: tracheal lymph nodes, esophageal lymph nodes, etc.

At the upper limbs:

  • Superficial lymph nodes: supratrochlear nodes, deltoideopectoral nodes
  • Deep lymph nodes: lateral nodes, anterior nodes, central nodes, and medial nodes

At the lower limbs:

  • Superficial inguinal lymph nodes
  • Deep inguinal lymph nodes
  • Popliteal lymph nodes

Swollen lymph nodes

During an infection, the immune cells in the lymph nodes multiply rapidly. Enlarged or swollen lymph nodes indicate heightened immune activity and the medical condition is referred to as lymphadenopathy. Other possible causes include autoimmune diseases, tumors, cancers, and drug reactions. Thus, treatment varies according to the cause of the enlargement. Swollen lymph nodes caused by infections and allergies are typically painful and reverts to normal size after the infection. Enlarged lymph nodes due to cancer are often painless and may be accompanied by other symptoms, depending on the clinical stage of the cancer.

Swollen lymph nodes armpit

Swollen axillary lymph nodes are common. They are usually caused by infections (bacterial, viral, or fungal). They can also be a manifestation of allergic reactions to chemicals, such as deodorants and antiperspirants. Swollen lymph nodes due to Infections and allergic reactions are often painful. When caused by infection, the condition may be accompanied by fever and swelling of the other lymph nodes.

Swollen lymph nodes in neck

Lymph nodes at the cervical region enlarge as the body fights off an infection. Common causes are ear infections, dental infections, tonsillitis, strep throat infection, and mumps. They are considered swollen when they are larger than 1 to 2 cm in size. (Ref.3)

Swollen lymph nodes in groin

Inguinal lymph nodes become swollen typically because of infection or injury at the lower body. Common examples are athlete’s foot, jock itch, genital infections, urinary tract infection (UTI), cellulitis, prostatitis, cystitis, and sexually transmitted infections.

Related terms

See also

References

  1. medullary cords. (n.d.). Retrieved from http://www.dentaldecks.com/wp-content/public/docs/15-16%20as%20card%205%20for%20web.pdf
  2. Kaldjian, E. P., Gretz, J. E., Anderson, A. O., Shi, Y., & Shaw, S. (2001). Spatial and molecular organization of lymph node T cell cortex: a labyrinthine cavity bounded by an epithelium-like monolayer of fibroblastic reticular cells anchored to basement membrane-like extracellular matrix. International Immunology, 13(10), 1243–1253. https://doi.org/10.1093/intimm/13.10.1243
  3. Kinman, T. (2012, July 19). What’s Causing This Lump on My Neck? Healthline; Healthline Media. https://www.healthline.com/health/neck-lump#pictures-of-neck-lumps
    ‌

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Lymph Node | British Society for Immunology

A number of specialised tissues are important for the proper functioning of the immune system. Among these are the lymph nodes, which provide an ideal environment for communication between immune cells. This environment is necessary for proper activation of the T and B cells (or lymphocytes) that are required for defence against many pathogens. A number of features of lymph nodes help them to perform their functions.
Lymph node location
The lymph nodes are strategically located at locations where they can be easily reached by immune cells travelling around the body. The exact total number of human nodes is not known, but each person is thought to have at least 500. Each lymph node is well-supplied by both lymphatic vessels and blood vessels, which allow lymphocytes to enter and exit. The nodes are contained within a tough capsule, and surrounded by specialised fatty deposits, both of which may give some physical protection.
Lymph node structure
Each human lymph node is up to 20mm in diameter, and is divided into compartments. Each compartment has important functions in enabling communication between lymphocytes. The outer layer (Cortex) contains the B-cell areas, or follicles. The middle layer (Paracortex) is mostly populated by T cells and dendritic cells (Figure 1). The paracortex also contains specialised blood vessels (high endothelial venules) through which many B and T cells enter the node. The lymph vessels enter the nodes at the outer edge, between the capsule and the cortex, and also penetrate deep within the nodes, via channels called conduits. T and B cells leave the node via “efferent” lymphatic vessels, found in the central “medullary” region. All these structures are maintained by a network of fibrous non-lymphoid cells that can also actively influence immune responses.

Figure 1. A slice through a lymph node, showing B and T cell  areas where lymphocytes are tightly packed (purple)

Co-ordinated movement of cells in lymph nodes

T cells enter the lymph nodes through high endothelial venules, and move around within the T-cell area, transiently interacting with large numbers of dendritic cells. They finally leave the node via the efferent lymphatic vessels. B cells enter by the same route and migrate through the T-cell area to the follicles, before finally leaving the node and re-entering the circulation. These migratory patterns give dendritic cells, T cells, and B cells many opportunities to interact. The appear to travel along the fibrous structural network that supports the node, further increasing their chances of interacting.

Responding to new infections

Lymph nodes are extremely important in responses to infections, especially those that an individual has not previously encountered. Proteins from the infecting micro-organism will reach dendritic cells in the lymph node, or will be carried to the lymph node by migrating dendritic cells. Protein fragments from the organism will be “presented” to T cells. The continual interactions between dendritic cells and T cell ensure that a T cell will soon be found that recognises the infection-derived protein fragment. This T cell will then divide and coordinate the immune response against the infection. Crucially, some of the dividing T cells’ daughters will travel to the B cell follicle and promote B-cell division and maturation, enabling the production of the antibodies that are essential for fighting many infections.

This article was updated by the author in January 2021

© The copyright for this work resides with the BSI

Groin Lymph Node Dissection | Fox Chase Cancer Center

Inguinal Lymph Node Dissection for Melanoma

An inguinal lymph node dissection (also known as a groin lymph node dissection) is the removal of lymph nodes and all tissue from the groin region that may contain tumors.

The human body contains lymph nodes in the neck, armpits, and inguinal region. Lymph nodes found in the groin are called inguinal nodes.

Melanoma can spread to the inguinal lymph nodes. If the nodes are enlarged and felt by yourself or your physician, or if nodes are found to harbor melanoma after a sentinel lymph node biopsy. 

If melanoma is found in a lymph node in this region, a lymph node dissection, or clearance within the groin, is recommended, with the goal of controlling the progression or return of the cancer. In general, if a patient is found to have melanoma within any lymph nodes, the recommended course of action is to remove them surgically.  You will see physical therapy prior to surgery in our preoperative lymphedema clinic and be instructed on exercises and measured for a compression garment.

Minimally Invasive Inguinal Lymph Node Dissection (MILND)

Fox Chase Cancer Center is one of only a few centers in the country that offers a minimally invasive approach to inguinal lymph node dissection.  This approach allows the procedure to be done through three small incisions, rather than a larger incision.  The incisions are lower in the leg, away from the groin crease with the hope of decreasing the risk of infection, postoperative complications, and less pain. The procedure takes about 1.5 hours to perform. 

What to Expect During a Lymph Node Groin Dissection

Before the surgery, your anesthesiologist will give you general anesthetic, so you will not be awake during the procedure. Once you are asleep, local anesthetic is injected into the area, to provide additional comfort after the procedure, which generally lasts 1-3 hours. During the operation, your surgeon will make an incision in the groin.  Staples or stitches are used to close the incision.

The intention of the operation is to remove all of the lymph nodes and associated tissue without causing damage to any nearby arteries, veins, and nerves. However, minor groin nerves exist that must be removed during the operation, which results in mild numbness in the upper thigh that is often permanent.

Sometimes, removal of the lymph nodes around the groin area, into the pelvis, is necessary. In order to do so a larger incision extending up toward the abdomen must be made. The muscles of the abdominal wall are opened for full visibility of the lymph nodes; this area is then repaired before closure of the surface wound.

Because any large wound produces fluid, a surgical drain (typically a soft, flexible silicone tube) is placed to collect the fluid. Homecare nurses will be arranged to check the drain and incision. You can expect the drain to remain in place for 3-4 weeks following the procedure.

Preparing for the Procedure

In addition to normal preparations for your surgery, you will also need to wear special stockings to prevent blood clots in the legs. Typically, an injection of heparin or clexane into the abdominal skin is performed to reduce the risk of blood clots.

After the Procedure

Your physician will keep you on bed rest 4-6 hours following surgery. You will likely stay in the hospital 1 or 2 nights and go home with the drain. Nursing staff will train you in the proper care and arrange for follow up before returning home. At the time of discharge, you will likely receive a prescription for pain medication. 

After 2-3 weeks, the stitches and/or staples will be removed. The scar in the groin will fade over time.

As with any surgical procedure, you will likely feel tired for a few weeks, and you should take a leave of 3-6 weeks from work to rest and heal. You should drive and resume normal activities once you feel fully in control again. Most patients do recover well from the procedure and resume all regular activities within 4-6 weeks.

After surgery, a pathologist will review and test the tissue that was removed from the groin. This detailed examination takes about 7-10 working days. The results will determine your follow-up care and whether further treatment is necessary.

Regular post-operative checks are recommended to check the healing progression and look for any signs of a possible melanoma recurrence. The surgery taken place will help to prevent the melanoma from progression in the groin area. However, because the melanoma could spread to other regions within the body, ongoing, regular follow up is recommended.

Possible Side Effects

Most patients recover from the surgery well without any major issues. Some common side effects, however, may include fluid collection in the groin and minor wound infection. These problems are simple to manage and do not typically require readmission to the hospital.  The most common side effect is lymphedema and this occurs in approximately 20% of patients.  If it occurs it can be months or years after the procedure. 

Below is a comprehensive listing of possible side effects in the early and later stages:

Common Side Effects

  • Numbness around the wound and in the upper thigh
  • Minor wound infection
  • Small amount of blood collection or lymph fluid collection (known as seroma)
  • Possible constipation if a more extensive procedure involving removal of the nodes in the pelvis is undertaken, making it uncomfortable to eat solids for 2-3 days following the procedure (fluids only may be recommended until the bowels function regularly again)
  • Prominent scar at site of incision
  • Numbness around wound and in the inner thigh
  • Small seroma (fluid collection) in wound
  • Lymphedema (swelling of the leg)

Less Common Side Effects

  • Excessive bleeding needing re-operation
  • Major wound infection requiring re-operation
  • Deep vein thrombosis (clots in the veins in the legs)
  • Pulmonary embolism (lung clots)
  • Damage to blood vessels and nerves supplying muscles
  • Chest infection
  • Large seroma (fluid collection) requiring repeated drainage or new drain insertion
  • Neuralgia in the leg or groin

Pay Attention to Your Lymph Nodes for Cancer Signs

Cancer isn’t always easy to detect, especially when most signs and symptoms don’t appear until the disease has progressed to a more advanced stage. However, particular organs in your body can be very telling, for example: your lymph nodes. 

Lymph nodes, which are also called lymph glands, are part of your immune system. When lymph nodes are enlarged or sensitive to the touch, it’s your body’s way of alerting that your body is fighting an infection. They can also be an early warning system for certain types of cancer, such as lymphoma, leukemia, and breast cancer.

What are Lymph Nodes?

Lymph nodes are your immune system’s first line of defense. These bean-shaped organs act as filters for lymph— a clear fluid circulating throughout your body, which brings nutrients to cells, and carries away bacteria and other waste. Your lymph nodes trap foreign particles like bacteria, viruses, and even cancer cells, ensuring that they are removed from the body. 

Clusters of lymph nodes are located in several areas of the body, including your:

  • jaws 
  • neck
  • upper chest 
  • under your arms
  • groin, on either side of the pubic bone.

After developing an illness or infection, you may have noticed “swollen glands” in your neck. If so, those are your lymph nodes working hard to defend your immune system from the waste products (such as bacteria and viruses) that your lymph system has detected.

How Lymph Nodes and Cancer are Related

Cancer can appear in lymph nodes either from spreading from the original location, or it can begin in the lymph nodes 

It is crucial to keep in mind that cancer in the lymph nodes does not necessarily mean you have lymph node cancer. Cancers that start elsewhere, for example, breast cancer, sometimes spread to the lymph nodes since lymph fluid carries cells around the body. Nodes can also show signs of change even if the cancer has not spread to other organs. For example, if you were diagnosed with breast cancer, then the breast cancer cells may have traveled to the lymph system, meaning you would only be treated only for breast cancer.

Cancer that starts in the lymph system cells, or lymphoma, is a type of blood cancer. Since lymph tissues are found throughout the body, lymphoma can begin almost anywhere. Many types of lymphoma exist. However, they are broadly categorized into two main types: Hodgkin lymphoma and non-Hodgkin lymphoma. 

Hodgkin and non-Hodgkin lymphomas involve different types of lymphocyte cells. Non-Hodgkin lymphoma is more common and will develop in lymph nodes anywhere in the body. Most cases of non-Hodgkin lymphoma are in an advanced stage when they are diagnosed.

Hodgkin lymphoma usually starts in the upper body, such as chest, armpits, or neck. However, Hodgkin lymphoma is often diagnosed early, making it considered very treatable cancer.

Lymph Node Screening

If you have a cancer diagnosis, it is likely tests will be run to see if the lymph fluid shows evidence of cancer cells. The results of a lymph node screening help your Rocky Mountain Cancer Centers oncologist identify what stage your cancer is in, and ultimately, assist him or her in determining the type and frequency of your cancer treatment.

A physical exam will also be performed. During this exam, your doctor will feel the lymph nodes close to the surface to check for soreness or swelling. However, many lymph nodes are too tiny or too deep in your body to be felt during a physical exam. Therefore, imaging technologies such as X-rays, MRIs, ultrasound, or CAT scans are also used to spot any enlargements or irregularities. A lymph node biopsy is also typically part of the diagnosis process. Your cancer surgeon will usually remove one or two of the nearby lymph nodes to see if they show any evidence of cancer.

Signs to Watch For

If you have swollen lymph nodes but don’t have any apparent illness, we encourage you to schedule your primary care physician for an exam. Especially if your lymph nodes feel hard to the touch, and that feeling doesn’t go away after two weeks or so. When any of the following symptoms accompany swollen lymph nodes, seek medical attention. These symptoms include:

  • Night sweats
  • Fatigue
  • Fever
  • Unexplained weight loss
  • Coughing, chest pain, or shortness of breath
  • Frequent or severe infections
  • Easy bruising or bleeding
  • Abdominal pain or swelling
  • Feeling full after eating just a small amount of food

If your doctor has indicated that you should have a lymph node screening and are located in Colorado, please find the RMCC location that is most convenient for you and call to request an appointment. Your primary care physician or oncologist should be able to recommend a screening provider near you if you are not located close to one of our cancer treatment centers. 

The Lymphatic System (for Parents)

What Is the Lymphatic System?

The lymphatic system is part of the immune system. It keeps body fluid levels in balance and defends the body against infections. Lymphatic (lim-FAT-ik) vessels, tissues, organs, and glands work together to drain a watery fluid called lymph from throughout the body.

What Does the Lymphatic System Do?

One of the lymphatic system’s major jobs is to drain extra

lymph(LIMF) fluid from body tissues and return it to the blood. Lymph contains white blood cells called lymphocytes (LIM-fuh-sites) and chyle (KYE-ul), which is made of fats and proteins from the intestines.

This is important because water, proteins, and other substances are always leaking out of tiny blood capillaries into the body tissues around them. If the lymphatic system didn’t drain it, this extra fluid would build up in the tissues and make them swell.

What’s in the Lymphatic System?

Organs and tissues that are part of the lymphatic system include:

  • bone marrow, the thick, spongy kind of jelly inside bones that makes many kinds of blood cells, including immune system cells
  • thymus gland, which makes immune system cells called T cells, especially before and during puberty
  • tonsils
  • appendix
  • lymph nodes

Lymph nodes are small clumps of tissue along the network of

lymph vesselsthat clean lymph as it moves through them. They filter out viruses, bacteria, and fungi that can cause illnesses.

Most lymph nodes are in clusters in the neck, armpit, and groin area. They’re also found along the lymphatic pathways in the chest, abdomen, and pelvis, where they filter blood. Inside the lymph nodes, T-cells and another type of lymphocyte, B-cells, help the body fight infection. B cells make antibodies — special proteins that stop infections from spreading by trapping disease-causing germs and destroying them.

When someone has an infection, germs collect in the lymph nodes. If their throat is infected, for example, the lymph nodes in the neck may swell. That’s why doctors check for swollen lymph nodes (sometimes called swollen “glands”) in the neck when someone has a sore throat. When lymphatic nodes swell, it’s called lymphadenopathy (lim-fad-n-OP-uh-thee).

Lymphatic vessels, or tubes, are the pathways that carry lymph. The major lymphatic vessels are:

  • The thoracic duct: It begins near the lower part of the spine and collects lymph from the pelvis, abdomen, and lower chest. The thoracic (thuh-RA-sik) duct runs up through the chest and empties into the blood through a large vein near the left side of the neck.
  • The right lymphatic duct: It collects lymph from the right side of the neck, chest, and arm, and empties into a large vein near the right side of the neck.

How to find out your destination or Lunar nodes in the horoscope: berta_mair – LiveJournal

I decided to make a selection of materials from the network on the topic of Lunar nodes in the natal chart.

One of the methods for determining the destination is to look at the location of the position of the Lunar nodes in the natal chart. Lunar nodes are the points at which the Moon’s orbit intersects with the ecliptic plane, they are located 180 ° relative to each other.
The ascending lunar node is also called Rahu in Vedic astrology and Dragon’s Head in western astrology.Rahu is the future to strive for, a necessary stage of evolution in the present life of a person. The descending lunar node is called Ketu or Dragon’s Tail. This is the point from which a person pushes off, this is his past experience, which he has already gone through. Thus, having seen in which house of the horoscope the Rahu point is located, we can understand in which area we should apply and develop our powers. Rahu is responsible for the future, for expansion, for expansion. Ketu personifies the past. It is believed that the one who will be able to cope with the energies of the lunar nodes will open the gates to spiritual growth.

Rahu – as an indicator of karmic tasks for this incarnation, areas of life where we can succeed. Rahu is the energy of expansion, it opens up new karmic opportunities in this life. In particular, the position of Rahu on the map shows the zone of new growth in this incarnation.

The house in which Rahu is located deserves the closest attention – a person must direct his development within the framework of this house, work to improve this house. This is the area of ​​life where a person has great opportunities, but is afraid to take a step.But if he overcomes himself, he will receive a reward in the form of overwhelming success. It is usually difficult at first, but then a person will be able to achieve a lot in this area of ​​life.
Disposer Rahu (the ruler of the sign in which he is located) controls the expansion of the energy of Rahu, and his position also shows the sphere in which a person will develop in this incarnation.
Two signs and two houses, which are occupied by Rahu and his dispositor, determine the path of the soul chosen for this incarnation, and in terms of karma, this is one of the main decoding.Special attention is paid to these houses. First of all – to the house where Rahu is located. Usually this house brings good luck to a person.

Ketu, the entering node, shows the events of the past, the consequences of which are present in the present.
The sign and the house where Ketu is located show the sphere in which we worked in a past life and where we have deep realizations. This is where our true talents are. Ketu represents a gift in which we achieved perfection in past incarnations, as a result of which we quite naturally come to the same in this life.
A person’s talents in this life can usually be easily deciphered through the Ketu dispositor and his position in the chart. Ketu symbolizes our achievements. In most cases, a person’s talents are directly related to the indicators of the planet and its specific position on the map; dispositor Ketu. If the dispositor is Ketu, Venus a person has artistry, talent in art, Saturn a person has organizational skills, the ability to serve others, Mars management, leadership, surgery, Moon emotions, psychology, pedagogy, Mercury astrology, Sun leadership, medicine, spiritual knowledge, spiritual psychology, Jupiter pedagogy, teaching.
Two signs and two houses occupied by Ketu and his dispositor, this is the key to unraveling the talents, abilities and basic nature of man. Ketu shows what we have taken from the past incarnation. For example, Ketu in the house gives intuition, a penchant for philosophy, deep insightful abilities, shows that a person worked a lot on himself in a past life.
The connection between the two karmic controlling planets (dispositors Rahu and Ketu) usually determines the path along which a person will progress in this life.

The text was compiled according to an article by the psychologist and Vedic astrologer Rami Blekt. The full version can be read here

What is needed to determine the destination by the Lunar nodes?

1) Know the time, date and place of birth.
2) Determine what time zone (GMT) was at the time of birth in your area. You can see here, if you are from Belarus, then my post about time will do.
3) Then there are 3 options:
a) The simplest one is to use the site http: // www.astrologo.ru/karma/. He will immediately give an interpretation of the location of your Lunar nodes in the signs of the zodiac.
b) Make a natal chart in one of the online astroprocessors according to the western system http://astro-online.ru/natal.html.
c) Make a natal chart according to the Vedic system http://lagna.ru/goroskop.php But for a beginner this is a rather complicated chart for interpretation.
4) Once again, check whether GMT is indicated correctly in the compiled map (I seem to set it always correctly, but sometimes it gives the wrong thing).
5) Find the location of the Lunar nodes (house and sign) in the map and determine the dispositors. *
6) Read to yourself your loved ones information on the links:
The meaning of Rahu in the houses of the horoscope
The meaning of Rahu in the signs of the zodiac
The meaning of Ketu in houses and signs
An exhaustive and voluminous description of the zodiacal axis on which Rahu and Ketu are located
Just a good article about astrology and karma http://astroqueen.ru/karma/

* Dispositor is the ruler of the sign in which the planet is located.In our case, Ketu or Rahu.
Planetary control system of the signs of the Zodiac

The sun rules Leo
The moon rules Cancer
Mercury owns Gemini and Virgo
Venus owns Taurus and Libra
Mars owns Aries and Scorpio.
Jupiter rules Sagittarius and Pisces
Saturn rules Captain and Aquarius

synlab: lymph nodes

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

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

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

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

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

Uterine fibroids

This classification system allows the clinician to separate leiomyoma, which deforms the uterine cavity, from its other forms, since it is the submucosal myoma nodes that often cause abnormal uterine bleeding.

All removed nodes are obligatory subjected to histological examination in order to confirm the benign quality of the process, which suggests correlation with the following histological variants of leiomyomas: normal MM (mature benign tumor), cellular, fancy myoma, leiomyoblastoma (epithelioid proliferative leiomyoma), intravascular leiomyoma, intravascular leiomyoma and leiomyoma with symptoms of myosarcoma (malignant).

Sarcoma (malignant tumor of the body of the uterus) – detected among 0.5 – 0.7% of women with MM have certain clinical and laboratory – instrumental characteristics that make one suspect atypical growth.

Clinical manifestations

Uterine fibroids can proceed for a long time without pronounced clinical manifestations. Symptoms of uterine fibroids can be isolated or in various combinations, including uterine bleeding, pain, dysfunction of adjacent organs, infertility, often combined with endometrial hyperplasia, small cystic changes in the ovaries, and dyshormonal diseases of the mammary glands.

Uterine bleeding, observed in 70% of patients, is the most common cause of surgery for MM. Pain syndrome in every third patient is manifested by secondary dysmenorrhea (menstrual pain), constant aching pain with rapid growth of the node, compression of adjacent organs. With broad-based subserous corporal myoma, symptoms may be absent despite a significant increase in the size of the uterus.

Diagnostics

Examination by a gynecologist and taking anamnesis suggest excessive proliferation, but palpation does not always give a complete picture of the location and number of myomatous nodes.The main method of screening and primary diagnosis is ultrasound (ultrasound). Echography provides an opportunity not only for topical diagnosis of myomatous nodes, but also for their structure, differentiation with other myometrial pathology (adenomyosis, sarcoma, etc.), as well as assessment of the dynamics of node growth.

CT and MRI allow, with high resolution, not only to determine the ratio of the pelvic organs, bone structures and vessels of the pelvis, uterine cavity and fibroids, which helps to choose the right tactics, the scope of surgical treatment.

Conservative treatment

The tactics of managing patients with MM includes observation and monitoring, drug therapy, various methods of surgical intervention and the use of new minimally invasive approaches, for each patient an individual management tactics is developed.

Methods of treatment of uterine fibroids can be classified as follows:

1. Groups of drugs for drug therapy:

1.1. Agonists and antagonists of gonadotropic releasing hormone (GnRH).

1.2. Intrauterine system with levonorgestrel.

1.3. Selective progesterone receptor blockers. 3.4. Experimental and promising drug methods.

When choosing a drug treatment, the doctor is guided by the assessment of clinical manifestations, the dynamics of the growth of nodes, the patient’s age, and the patient’s reproductive plans. Most often, drug therapy is perioperative in nature, increasing the reduction and delimitation of the node during the operation and securing the absence of fibroid growth in the future.

Most patients with uterine fibroids require surgical treatment. Indications for surgical treatment are:

  • Heavy menstrual bleeding, leading to anemia,
  • Submucosal, isthmus and interconnection location of the node,
  • Chronic pelvic pain, which reduces the quality of life, disruption of the normal functioning of adjacent organs
  • Large tumor size (nodes are larger 40 mm)
  • Rapid tumor growth,
  • MM growth in postmenopausal women
  • Infertility, in the absence of other causes.

As a rule, surgical treatment is performed routinely in the first phase of the menstrual cycle.

2. Minimally invasive (not requiring anesthesia) organ-preserving methods of treatment of uterine fibroids:

2.1. X-ray bilateral emBolization of the uterine arteries is a method based on occlusion of the uterine arteries using a suspension embolizing substance – polyvinyl alcohol. A decrease in the trophism of the myomatous node leads to its irreversible regression.

2.2. Focused ultrasound ablation of a node – a technology of tissue destruction by high-intensity focused ultrasound under the guidance of MRI. This is a subject for patients with a single node along the anterior wall without obesity and adhesions.

2.3. Radio wave ablation, cryodestruction and other experimental methods are used less frequently.

Surgical treatment

Most often, patients with MM are offered certain surgical methods:

3.Types of surgical interventions:

3.1. Radical – associated with the removal of the uterus – the only surgical method leading to a complete cure: total hysterectomy (with the cervix) or subtotal hysterectomy (removal of only the body of the uterus).

Access is chosen by the operating gynecologist depending on the size, location, concomitant pathology, technical equipment and the degree of qualification of the specialist.

  • laparotomy – a Pfannenstiel incision or lower midline laparotomy is used.
  • Laparoscopic hysterectomy – removal through 2 or 3 small (up to 1 cm) trocar openings.
  • Laparoscopically assisted hysterectomy (total and subtotal) – a combination of laparoscopic and vaginal approaches
  • Vaginal (vaginal) hysterectomy is a promising area of ​​modern operative gynecology, combining the advantages of radical surgery and the art of aesthetic minimization of access. Patients after vaginal hysterectomy have less blood loss, less pronounced pain syndrome, minimal risks of the formation of adhesive disease, early activation, no damage to the skin, quick recovery of working capacity.Such operations are often combined with correction of the pelvic floor prolapse.

Although total hysterectomy is a radical operation, it should not be recommended for young women or those who wish to preserve the uterus or reproductive function. In the presence of indications for surgical treatment, these categories of patients perform organ-preserving operations – myomectomy, aimed at removing a node or nodes:

3.2. Conservative myomectomy:

Laparoscopic myomectomy – has the advantages of small incisions in the abdominal wall, but the suitability of this access for possible pregnancy in the future is largely determined by the topography of the nodes.

  • Laparotomic myomectomy – like all organ-preserving surgeries, requires perioperative drug support
  • Hysteroscopic myomectomy / fibroid resection – an operation for small submucous myomas performed under intravenous anesthesia.
  • Vaginal myomectomy – for cervical, isthmus and other types of low – located fibroids.

Almost each of these methods has its own niche in the treatment of uterine fibroids, its advantages and disadvantages, indications and contraindications.The acceptability of the method in a given situation is determined by the doctor individually.

Rehabilitation after surgeries

After breast-conserving surgeries, the patient needs to remember about the need for regular ultrasound examination, observation of a gynecologist in order to prevent and / or early diagnosis of recurrent myoma growth.

After organ-removal operations, after making sure that the process is benign, the patient, together with the doctor, discusses the need for supportive hormonal therapy.It should be emphasized that such operations do not directly affect the quality of life, including sexual life.

Prevention

Is it possible to prevent uterine fibroids?

Apparently possible. In addition to general recommendations on adherence to a rational lifestyle, the exclusion of abortions, timely correction of hormonal disorders, and adequate treatment of gynecological diseases play a role. There is also specific prevention. This is the timely implementation of reproductive functions.It is necessary to maintain the first pregnancy, especially in young women with the so-called “hereditary myoma”. Excessive ultraviolet radiation, increased temperature exposure should be avoided, especially after 30 years.

In conclusion, it should be emphasized that uterine fibroids are the result of somatic mutation of myometrial cells due to numerous damaging factors. Therefore, prevention should be based on a healthy lifestyle and preservation of reproductive health.

Nodules in the mammary gland (nodules in the mammary gland)