Where can lymph nodes be found: Lymph Nodes and Cancer
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.
Lymph nodes | healthdirect
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What are lymph nodes?
Lymph nodes (or lymph glands) are small lumps of tissue that contain white blood cells, which fight infection. They are part of the body’s immune system and filter lymph fluid, which is composed of fluid and waste products from body tissues. They help fight infections, and also play an important role in cancer diagnosis, treatment and the chance of recovery or recurrence.
Where are lymph nodes located?
Lymph nodes are located throughout the body, including the neck, armpits, groin, around the gut, and between the lungs. Lymph nodes drain lymph fluid from nearby organs or areas of the body.
How do lymph nodes filter lymph fluid?
Lymph fluid is carried to the lymph nodes by lymphatic vessels. The lymph nodes filter out harmful substances and waste products. They also contain immune cells called lymphocytes that destroy cancer cells and bacteria.
The filtered fluid is then returned to the blood circulation.
If you have an infection or cancer, a lymph node may become swollen. If you are concerned about your lymph nodes, speak to your doctor.
Lymph nodes are located throughout the body. They drain lymph fluid from nearby organs or areas of the body.
How are lymph nodes and cancer related?
Sometimes cancer can start in the lymph nodes (such as in lymphoma), but some others types of cancer can also spread from one part of the body to another through lymph nodes.
If a person has cancer, doctors examine lymph nodes carefully to see whether or not they are affected by cancer. They can do this by:
- feeling all the nodes in the body
- getting scans, for example a CT scan
- removing nodes near the cancer, then examining them under a microscope
- taking a biopsy of the lymph nodes near the cancer, then examining them under a microscope
This is done to see if the cancer has spread or not. This helps doctors work out the best treatment for the cancer.
Having swollen lymph nodes is only very rarely a sign of cancer. Lymph nodes may be swollen due to infection or inflammation. Swollen lymph nodes may be in the neck, under the arm or anywhere else there are lymph nodes. They can swell up to several centimetres and may stay swollen for weeks after the infection has cleared up.
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Last reviewed: January 2021
Location In Body, Purpose, Common Problems
Lymph nodes are your immune system’s first line of defense, protecting you from things like bacteria or viruses that could make you sick.
You have hundreds of the small, round, or bean-shaped glands all over your body. Most are spread out, but some are found in groups in a few major places, like your neck, under your arm, and in your chest, belly, and groin. You might be able to feel some of the clusters in those areas as little bumps, but typically, you don’t feel them or even know they are three.
Your lymph nodes are part of your lymphatic system. Along with your spleen, tonsils, and adenoids, they help you fight off illness and infections.
How Do They Work?
Your lymph nodes are connected to one another by lymph vessels (tubes that run through your body like veins). They carry lymph fluid — a clear, watery liquid that passes through the nodes.
As the fluid flows through, cells called lymphocytes help protect you from harmful germs.
There are two kinds of lymphocytes — B-lymphocytes (or B-cells) and T-lymphocytes (or T-cells).
- B-cells make antibodies that attach to germs and let your immune system know they need to be killed off.
- T-cells have a couple of jobs. Some destroy germs, while others keep track of immune cells. They let your body know when to make more of certain kinds and less of others. Memory T cells are T-cells that remain dormant after an infection and become active again when they are faced with the same infection.
Lymph fluid also carries protein, waste, cellular debris (what’s left after a cell dies), bacteria, viruses, and excess fat that are filtered by the lymphatic system before it’s dumped back into the bloodstream.
Swollen Lymph Nodes
When there’s a problem in your body, like an illness or an infection, your lymph nodes can swell. (This usually happens only in one area at a time.) It’s a sign that more lymphocytes are in action than usual, trying to kill off germs.
You may notice this most often in the glands in your neck. That’s why your doctor feels the area under your jawbone. They’re checking to see if those glands are bigger than usual or tender.
Many things can make your lymph nodes swell. Any infection can trigger it, including a cold or the flu, an ear infection, STDs (usually inguinal), shingles, tuberculosis, or an abscessed tooth. Rarely a vaccine can cause swollen lymph nodes on the side of the vaccination. Much less often, it can be a sign of something more serious, like cancer.
Sometimes medicines like phenytoin (taken for seizures), or drugs that prevent malaria can cause swollen lymph nodes, too.
Structure, Function, Types, and Diseases
Lymph nodes or lymph glands are an important part of the immune system, acting as “nodes” between the lymphatic vessels that span the body. Immune cells that cluster in these nodes stand ready to attack any bacteria, viruses, or other foreign substances that enter the body.
The lymph nodes are susceptible to diseases such as infections, cancer, and trauma. Let’s look at the role these nodes play in the day to day function of your body, as well as their role in disease.
Lymph nodes are small, bean-shaped glands that are located along the lymphatic system (a system of vessels similar to arteries and veins through which lymph fluid travels). Lymph nodes are classified as “secondary” lymphoid organs, with the primary lymph organs being the thymus gland, tonsils, spleen, and bone marrow.
If you visualize the primary lymph organs as the courthouse, the lymphatic vessels are the highways the immune police cells travel to survey the body, and the lymph nodes are like police stations along the way. There are hundreds of lymph nodes throughout the body, but they are clustered in certain regions.
The structure of a lymph node is actually quite complex. Lymph nodes are divided into lobules, each of which contains an outer cortex, followed by a paracortex, with the medulla (core) on the inside.
Simplistically, B lymphocytes (B cells) are found in the cortex, with T lymphocytes (T cells) and dendritic cells in the paracortex. Plasma cells and macrophages are present in the medulla. The entire lymph node is enclosed by a tough fibrous capsule.
Lymph nodes can vary in size from only a few millimeters to up to 2 centimeters in diameter.
Lymph nodes work like filters, or in our analogy security guards to filter bacteria, viruses, parasites, other foreign material (even cancer cells) that are brought to the nodes via lymphatic vessels.
This is the reason that lymph nodes are evaluated in people with cancer, as this is the first place where cancer cells may be “caught” on their journey to explore and set up home elsewhere in the body.
Lymph nodes play important roles in fighting infections. Not only do they “trap” viruses and bacteria so that T cells can attack, but one type of T cells presents the invader (or an antigen from the invader) to B cells so the B cells can make antibodies against the invader. In this way, lymph nodes are a place where immune cells can communicate and work together.
Types and Locations
Lymph nodes are well-known as the “swollen glands” people may note in their neck when they are fighting a cold or sore throat, but these nodes are actually located in many regions of the body.
Lymph nodes that lie near the surface of the skin, such as in the neck, armpit, groin, and sometimes those in the arm (elbow) and back of the knee may be felt when enlarged, but others may only be seen on imaging studies such as a computed tomography (CT) scan.
Lymph nodes are more easily felt in people who are thin, and sometimes finding nodes that are seldom felt in general can be alarming. Some important lymph nodes include:
Cervical (Neck) Lymph Nodes
Cervical lymph nodes are the nodes you have likely felt in your neck when fighting an upper respiratory tract infection, and filter lymphatic fluid coming from the head, scalp, and neck.
Cervical lymph nodes (lymph nodes in the neck) in turn, can be broken down into three primary regions, and which region is involved can give doctors important information when diagnosing an illness:
- Anterior cervical lymph nodes: Lymph nodes nearest the front of your neck are referred to as anterior cervical lymph nodes. It is these nodes that most people have felt at some time when battling the common cold or strep throat.
- Posterior cervical lymph nodes: Lying behind the band of muscle that runs on the lateral side of the neck (sternocleidomastoid) lie the posterior nodes. These nodes are frequently enlarged when people contract mono (infectious mononucleosis).
- Occipital lymph nodes: These nodes lie on the back of the neck at the base of the skull, and are also frequently enlarged in people who have mono.
Lymph nodes may also be felt in front of and behind the ear and along the jawline.
Axillary (Armpit) Lymph Nodes
Axillary lymph nodes are the lymph nodes located in your armpit. In the movie “Terms of Endearment,” these nodes heralded breast cancer, but there are more common causes for enlargement. There are usually between 10 and 40 lymph nodes in the axilla, many of which are removed when a person has an axillary lymph node dissection for breast cancer.
The axillary lymph nodes can be used to describe an important finding with cancer. When cancer cells are picked up in the lymphatic fluid, they first travel to lymph nodes. It’s been found that these lymph nodes are affected in order.
A sentinel lymph node biopsy may be done with breast cancer or melanoma and can often spare a person from having all nodes removed. A tracer is injected into the cancer, and only the first few nodes to which the cancer would travel may be to be biopsied.
Supraclavicular Lymph Nodes (Above the Collarbone)
Supraclavicular lymph nodes are, when enlarged, can be felt just above the collarbone (clavicle). Most of the time, enlargement of these nodes signifies a serious underlying problem (such as lung cancer or a lymphoma).
Mediastinal Lymph Nodes
Mediastinal lymph nodes reside in the mediastinum, the area in the center of the chest between the lungs. People cannot feel these nodes, but they can be visualized on imaging studies such as a CT scan or positron emission tomography (PET) scan. Determining whether cancer is present in these nodes is important in staging lung cancer and some lymphomas.
Inguinal (Groin) Lymph Nodes
Inguinal lymph nodes are present in the groin region. Since they drain tissues from the feet to the groin, there are many reasons why these nodes can become inflamed. Most often they become swollen after an injury or infection in the legs, but may also be a sign of anything from a sexually transmitted disease to cancer.
Keep in mind that most people experience swollen inguinal nodes at some time, and the vast majority of the time they are not a problem; they are only doing their job of catching viruses or bacteria that enter your body from a sore on your feet or legs.
Retroperitoneal Lymph Nodes
Retroperitoneal lymph nodes lie deep in the abdomen and can only be seen on imaging studies. They are the nodes to which testicular cancer first spreads.
Mesenteric Lymph Nodes
Mesenteric lymph nodes are similar to retroperitoneal nodes, lying deep in the abdomen in the membranes that surround the intestine. In adolescents, these nodes may become inflamed (mesenteric lymphadenitis) with symptoms that can sometimes mimic appendicitis. They may be enlarged with some cancers, but this is much less common.
Pelvic Lymph Nodes
Pelvic lymph nodes lie deep in the pelvis and can only be seen on imaging studies. They may be involved with cancers such as those of the bladder, prostate, and more.
Other Lymph Nodes
There are clusters of lymph nodes near the elbow, behind the knee, along the large airways (tracheobronchial), along the aorta (paraaortic), and many other regions of the body.
There are many conditions in which lymph nodes become involved. Doctors use the term lymphadenopathy to describe inflammation or swelling in these glands. When doctors evaluate lymph nodes there are a number of terms they may use:
- Mobile vs. fixed: Mobile lymph nodes are those that can easily be moved around when touched, whereas fixed appear to be attached to a structure deeper in the body. In general, mobile lymph nodes are benign whereas fixed nodes suggest the possibility of cancer.
- Painful vs. non-painful: In general, infections can cause tender lymph nodes and cancerous nodes are often not tender. But there are many exceptions.
- Localized vs. generalized: The term localized refers to enlarged lymph nodes in only one location. When generalized lymphadenopathy (enlarged nodes) is present, it is more likely to be infections such as mononucleosis (but can also be due to other conditions).
- Matted: Sometimes lymph nodes appear to be attached together in a clump and the term matted is used.
Illustration by Brianna Gilmartin, Verywell
Since lymph nodes store the white blood cells that are our first line of defense against infection, they are often enlarged due to infections. Enlargement of lymph nodes with an infection can be good or bad.
It is good in the sense that they are the powerhouses storing immune cells. In other words, enlargement of the lymph nodes may mean your body is doing its job to resolve an infection.
This concept was not always well understood, however, and for a long time it was thought that removing the tonsils would help prevent infections. When tonsils are severely damaged, removing them can be a good idea.
But if they are healthy and only doing their job, removing them gets rid of the functional “first place” where bacteria traveling in the lymphatic vessels could be “arrested.”
Lymph nodes can catch viruses and bacteria but are also susceptible to infections themselves. For those who have been told to watch for a “red streak” after an injury have learned that infections (usually staph or strep) may begin in an infected wound and spread rapidly along lymph channels.
Infections involving the lymph nodes often cause a significant fever and chills. Cat scratch fever is an infection caused by the bacterium Bartonella henselae and is transmitted by exposure (usually via a break in the skin) from an infected cat. Enlarged lymph nodes related to catch scratch fever are usually non-tender but can be very large.
Lymph nodes are commonly involved with cancer, but their role often differs between solid tumors and lymphomas. With solid tumors such as breast cancer, the cancer cells usually travel to lymph nodes before traveling (metastasizing) to other regions of the body.
Cancers that have spread to lymph nodes are usually a higher stage than those that have not, meaning they have a greater risk of recurring or spreading. In a sense, the spread of cancer cells to lymph nodes has declared its intent to travel elsewhere.
With lymphomas, in contrast, the cancer begins in the lymph nodes. When lymphomas spread to regions other than lymph nodes, it is not referred to as metastasis as with solid tumors, but rather as “extranodal involvement.”
There are many other conditions that can cause enlarged lymph nodes, ranging from autoimmune diseases (such as rheumatoid arthritis) to genetic syndromes, sarcoidosis, and more.
Injuries and Trauma
Since the lymph nodes are the rest stops for the “workers” or the white blood cells which clean up a site of trauma, they are often enlarged with any injury. You can think of the lymph nodes as being a truck stop near a natural disaster where the firemen and paramedics are hanging out ready to do their job.
A Word From Verywell
We often think of lymph nodes as heralding disease, but most of the time they are performing their job in fighting off foreign invaders. Even with solid tumors, the lymph nodes are catching the first cancer cells to travel before they can move farther in the body.
Lymphoma Action | The lymphatic system
What is the lymphatic system?
The lymphatic system is a network of tubes, tissues and organs that runs throughout your body. It is part of your immune system, which helps protect you from infection.
Figure: The lymphatic system
The lymphatic system includes:
- lymphatic vessels that carry a fluid called lymph
- organs where immune cells develop:
- organs and tissues where immune cells collect ready to fight infection:
Any part of the lymphatic system can be affected by lymphoma.
What does the lymphatic system do?
The lymphatic system has three main functions:
- It drains fluid from your tissues and returns it to your bloodstream.
- It protects your body from disease by removing germs (bacteria, viruses and parasites) and toxins (poisons), and helps to destroy cells that are old, damaged or abnormal.
- It helps absorb fats and vitamins from your digestive system and transports them to your bloodstream.
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Lymph is the liquid that flows through your lymphatic system. It is formed from the fluid that surrounds all the cells in your body. This fluid drains from your tissues into tiny lymphatic vessels through flaps or valves in the vessel walls.
Lymph can contain:
- sugars, proteins and fats
- vitamins, minerals and salts
- waste products from cells
- germs or toxins that have got into your body
- damaged or abnormal cells, including cancer cells.
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Lymph travels through tubes called lymphatic vessels. Tiny lymphatic vessels in your tissues join to form gradually larger and larger lymphatic vessels, a bit like streams flowing into rivers. They eventually drain into large vessels called lymphatic ducts.
Lymph from the lymphatic ducts empties into large veins near your heart to enter your bloodstream. This removes excess fluid from around your body, which helps keep your blood pressure stable and prevents swelling.
Lymph is not pumped around your body by your heart. Instead, it is pushed along when your lymphatic vessels are squeezed by your muscles, and by gravity if the vessels are above your heart. There are also muscle cells in the walls of the lymphatic vessels that help squeeze the lymph along. One-way valves inside the vessels stop the lymph flowing backwards.
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Lymphatic vessels pass through lots of ‘checkpoints’ called lymph nodes (sometimes known as lymph glands). Lymph nodes are small, bean-shaped structures. They are usually 1 to 2cm long.
Figure: Structure of a lymph node
Where are lymph nodes found?
You have hundreds of lymph nodes all over your body, except in your brain and spinal cord. They are often grouped together.
Some lymph node groups are near the surface of your skin – for example, in your neck (cervical lymph nodes), armpits (axillary lymph nodes) or groin (inguinal lymph nodes). You can sometimes feel these if they swell up. This often happens if you have an infection and isn’t usually a sign of something serious.
There are lots of other lymph nodes deep inside your body – for example, in your chest (mediastinal lymph nodes) or tummy (abdominal lymph nodes). You can’t feel these from the outside.
What do lymph nodes do?
Lymph nodes filter lymph. They trap germs and damaged or abnormal cells, and activate immune responses to help your body get rid of them.
Lymph nodes contain lots of white blood cells called lymphocytes. If you have an infection, the lymphocytes multiply inside your lymph nodes. They help fight the infection and make chemicals that activate other parts of your immune system. This is why your lymph nodes swell up when you have an infection. The swelling usually goes away in a couple of weeks, when the infection gets better.
Lymphocytes are the cells that grow out of control if you have lymphoma. If lymphoma cells build up inside your lymph nodes, the swelling does not usually go down.
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Bone marrow is the spongy tissue in the middle of some of the bigger bones in your body, such as your thigh bone (femur), breastbone (sternum), hip bone (pelvis) and back bones (vertebrae). Your bone marrow makes blood cells from special cells called stem cells. These are undeveloped cells that can divide and grow into all the different types of blood cell your body needs. These include red blood cells, platelets and white blood cells.
Figure: The different blood cells that develop in the bone marrow
Lymphocytes (the cells that grow out of control if you have lymphoma) are a type of white blood cell. They are made in your bone marrow. Some of them fully mature there. These are called B lymphocytes. Others mature in your thymus. These are called T lymphocytes.
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The thymus is a small, butterfly-shaped gland in your chest. It sits behind your breastbone, just above your heart.
In the thymus, white blood cells called T lymphocytes develop into active immune cells. They also learn to tell the difference between things that belong in your body and things that don’t, so they only respond to things that shouldn’t be there (for example, viruses and bacteria).
When fully developed, the T lymphocytes enter your bloodstream and lymphatic system.
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The spleen is an organ that filters your blood. It lies behind your ribcage on the left-hand side of your body, just behind your stomach. It is about the size of a clenched fist.
Your spleen contains lots of white blood cells, including lymphocytes. These cells help to protect you from infection by:
- removing germs from your bloodstream
- making antibodies
- activating other parts of your immune system.
Your spleen also removes old and misshapen red blood cells and platelets from your bloodstream. It stores a small supply of healthy red blood cells and platelets for your body to use in an emergency. If your bone marrow isn’t working as it should, your spleen can also be a back-up site for making new blood cells.
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Mucosa-associated lymphoid tissue
‘Mucosa’ is the moist, protective layer of cells that lines many parts of your body, such as your mouth, gut and airways. ‘Lymphoid tissue’ means a collection of lymphocytes (white blood cells). Mucosa-associated lymphoid tissue (MALT) is a collection of lymphocytes in your mucosa.
You have MALT in lots of places in your body, especially areas where germs might be able to enter easily. MALT includes:
- the tonsils at the back of your throat
- the adenoids at the back of your nose
- bronchus-associated lymphoid tissue in your airways
- gut-associated lymphoid tissue in your bowel.
The immune cells in MALT protect you by trapping and destroying germs and toxins before they get further inside your body.
All these different parts of your lymphatic system work together to help protect you from infection.
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Cancer That Spreads To Lymph Nodes | Signs, Treatments
The body’s lymphatic system helps fight disease and infection. Lymph nodes, also called lymph glands, are a key part of this network of vessels, tissues and organs. Lymph nodes are small, bean-shaped organs that produce and store blood cells, filter waste materials and harmful germs from the body’s tissues, and carry immune cells that fight infection.
There are hundreds of lymph nodes scattered in groups throughout the body, with large concentrations of the glands in the neck, armpits, abdomen and groin. The lymph system is part of the body’s immune system, producing white blood cells—B lymphocytes (B cells) or T lymphocytes (T cells)—that fight infection. The lymph system also includes the tonsils, spleen and thymus.
The lymph system is part of the body’s circulatory system. Lymph vessels are similar to the veins in the cardiovascular system. Instead of blood, the lymphatic vessels carry a clear, watery fluid called lymph (pronounced limf). This lymphatic fluid brings oxygen and other nutrients to tissue cells and takes away waste products from the cells. Each lymph node filters the lymphatic fluid draining from the vessels that lead to it.
The lymph fluid filtered by the lymph nodes, no matter where they’re located, moves to the chest, where it collects into a large vessel that drains into a blood vessel near the heart. From there, the filtered fluid, along with salts and proteins, moves into the bloodstream. Each group of lymph nodes filters a specific region of the body.
Swollen lymph nodes: What do they mean?
Swollen lymph nodes, or swollen glands, are a symptom of many illnesses—from the common cold to some forms of cancer—and a sign that something is wrong in the body. The swelling or enlargement, called lymphadenopathy, occurs in the lymph nodes when they’re filtering cells affected by a condition, such as an infection, injury or cancer. The most common reason lymph nodes swell is because of an infection, particularly viral infections such as a cold. It’s much rarer for swollen lymph nodes to be a symptom of a more serious condition such as cancer.
The lymph nodes are likely to swell in one specific region depending on the illness. This will usually occur in the neck, armpits or groin. Less common is when lymph nodes swell in several regions at the same time. That condition may be brought on by infections such as strep throat or mononucleosis, a reaction to certain medicines, an immune system disorder such as rheumatoid arthritis, and forms of cancer such as lymphoma and leukemia.
When lymph node swelling persists and is accompanied by other symptoms, such as fever or night sweats, or when there’s no obvious infection, it may be time to seek medical advice or evaluation from a doctor.
When touching an affected area, swollen lymph nodes may feel soft and round, like lumps the size of a pea, peanut or grape. If they’re painful when touched, that may be a sign of inflammation. Since lymph nodes appear in parallel—as, for instance, on both sides of the neck—you can feel lymph glands on both sides to see whether they are a normal size on one side and enlarged on the other, which may be a sign of infection.
In determining a diagnosis, it’s important for doctors to look at other symptoms or factors. Swollen lymph nodes near the ear may indicate an ear infection, for instance. Swollen glands in the neck area near the collarbone, combined with a sore throat and cough, may be a sign of an upper respiratory infection. When multiple regions of lymph nodes are swollen, it may indicate a body-wide disease that needs immediate attention.
Besides reviewing your medical history, doctors may use some of the following methods to diagnose the cause of swollen lymph nodes:
- Physical examination, feeling with fingers the nodes in the affected area to check their size and whether they feel hard, tender or warm
- Lab tests, including blood tests to check for suspected underlying conditions
- Imaging tests, including an X-ray, computed tomography (CT) scan, magnetic resonance imaging (MRI) or ultrasound test
- Biopsy to remove sections of lymph tissue or an entire lymph node to examine under a microscope
Cancer in the lymph nodes
In rare cases, lymph node swelling may be related to cancer. Some cancers start in the lymph nodes. Non-Hodgkin lymphoma and Hodgkin lymphoma are types of lymph system cancers, as is acute lymphocytic leukemia.
More often, a cancer may appear in the lymph nodes as a metastasis, spreading from somewhere else in the body. Some cancer cells break off from a tumor and metastasize in another location. Those cancer cells may travel through the bloodstream and reach other organs, or go through the lymph system and reach lymph nodes. However, most of the cancer cells traveling through the bloodstream or lymph system will die or be killed off before they have a chance to metastasize, according to the American Cancer Society (ACS).
When cancer is present in a lymph node, a biopsy helps determine what type of cancer it is when the removed tissue or node is examined under a microscope. The cancer cells will look like the cancer cells of the tumor where they originated, so breast cancer cells in the lymphatic system will still look like breast cancer.
Lymph nodes and staging cancer
Oncologists use cancer staging to determine the extent of cancer in the body. Lymph nodes play an important role in one of the most commonly used staging systems, called TNM. The TNM system is based on the extent of the tumor (T), how much it has spread to nearby lymph nodes (N) and the presence of metastasis (M). Each letter is assigned a numerical value based on clinical observations.
If no cancer is found in the lymph nodes near the cancer, the N is assigned a value of 0. If nearby or distant nodes show cancer, the N is assigned a number that increases based on the number of nodes affected, the size and extent of the cancer, how large the nodes are and where they’re located. The numbers for each initial are added up. The higher the sum, the more advanced the cancer. The lower the TNM score, the easier it may be to treat.
Treatment for cancer in the lymph nodes
Treatment for cancer in the lymph nodes varies depending on the tumor size and location and whether the cancer has metastasized to other areas of the body.
Surgery may be used to treat some forms of metastatic cancer that has spread to the lymph nodes. Other treatment options for cancer in the lymph nodes may include chemotherapy, radiation therapy, a stem cell transplant, immunotherapy or targeted therapy.
There’s a higher risk for cancer to come back following surgery when a cancer has spread to lymph nodes. In those cases, chemotherapy or radiation therapy may be recommended after surgery.
Removing lymph nodes during cancer surgery is “highly unlikely” to weaken the patient’s immune system, because it is “large and complex and is located throughout the body,” the ACS says. Lymph node removal may leave the affected part of the body unable to drain off lymph fluid, which may lead to a fluid backup (lymphedema) and may become a continuing problem. The greater the amount of lymph nodes removed, the greater the chance for lymphedema to occur.
Lymphatic System: Facts, Functions & Diseases
The lymphatic system is a network of tissues and organs that help rid the body of toxins, waste and other unwanted materials. The primary function of the lymphatic system is to transport lymph, a fluid containing infection-fighting white blood cells, throughout the body.
The lymphatic system primarily consists of lymphatic vessels, which are similar to the veins and capillaries of the circulatory system. The vessels are connected to lymph nodes, where the lymph is filtered. The tonsils, adenoids, spleen and thymus are all part of the lymphatic system.
Description of the lymphatic system
There are hundreds of lymph nodes in the human body. They are located deep inside the body, such as around the lungs and heart, or closer to the surface, such as under the arm or groin, according to the American Cancer Society. The lymph nodes are found from the head to around the knee area.
The spleen, which is located on the left side of the body just above the kidney, is the largest lymphatic organ, according to the U.S. National Library of Medicine (NLM). “The spleen . . . acts as a blood filter; it controls the amount of red blood cells and blood storage in the body, and helps to fight infection,” said Jordan Knowlton, an advanced registered nurse practitioner at the University of Florida Health Shands Hospital.
If the spleen detects potentially dangerous bacteria, viruses, or other microorganisms in the blood, it — along with the lymph nodes — creates white blood cells called lymphocytes, which act as defenders against invaders. The lymphocytes produce antibodies to kill the foreign microorganisms and stop infections from spreading. Humans can live without a spleen, although people who have lost their spleen to disease or injury are more prone to infections.
The lymphatic system helps keep the body healthy by eliminating infections and diseases. (Image credit: by Ross Toro, Infographics Artist)
The thymus is located in the chest just above the heart, according to Merck Manual. This small organ stores immature lymphocytes (specialized white blood cells) and prepares them to become active T cells, which help destroy infected or cancerous cells.
Tonsils are large clusters of lymphatic cells found in the pharynx. According to the American Academy of Otolaryngology, they are the body’s “first line of defense as part of the immune system. They sample bacteria and viruses that enter the body through the mouth or nose.” They sometimes become infected, and although tonsillectomies occur much less frequently today than they did in the 1950s, it is still among the most common operations performed and typically follows frequent throat infections.
Lymph is a clear and colorless fluid; the word “lymph” comes from the Latin word lympha, which means “connected to water,” according to the National Lymphadema Network.
Plasma leaves the body’s cells once it has delivered its nutrients and removed debris. Most of this fluid returns to the venous circulation through tiny blood vessels called venules and continues as venous blood. The remainder becomes lymph, according to the Mayo Clinic.
Unlike blood, which flows throughout the body in a continue loop, lymph flows in only one direction — upward toward the neck. Lymphatic vessels connect to two subclavian veins, which are located on either sides of the neck near the collarbones, and the fluid re-enters the circulatory system, according to the Mayo Clinic.
Diseases and disorders of the lymphatic system
Diseases and disorders of the lymphatic system are typically treated by immunologists. Vascular surgeons, dermatologists, oncologists and physiatrists also get involved in treatment of various lymphatic ailments. There are also lymphedema therapists who specialize in the manual drainage of the lymphatic system.
The most common diseases of the lymphatic system are enlargement of the lymph nodes (also known as lymphadenopathy), swelling due to lymph node blockage (also known as lymphedema) and cancers involving the lymphatic system, according to Dr. James Hamrick, chief of medical oncology and hematology at Kaiser Permanente in Atlanta.
When bacteria are recognized in the lymph fluid, the lymph nodes make more infection-fighting white blood cells, which can cause swelling. The swollen nodes can sometimes be felt in the neck, underarms and groin, according to the NLM.
Lymphadenopathy is usually caused by infection, inflammation, or cancer. Infections that cause lymphadenopathy include bacterial infections such as strep throat, locally infected skin wounds, or viral infections such as mononucleosis or HIV infection, Hamrick stated. “The enlargement of the lymph nodes may be localized to the area of infection, as in strep throat, or more generalized as in HIV infection. In some areas of the body the enlarged lymph nodes are palpable, while others are to deep to feel and can be seen on CT scan or MRI.”
Inflammatory or autoimmune conditions occur when a person’s immune system is active, and can result in enlargement of lymph nodes. This can happen in lupus, according to Hamrick.
This refers to cancer of the lymph nodes. It occurs when lymphocytes grow and multiply uncontrollably. There are a number of different types of lymphoma, according to Dr. Jeffrey P. Sharman, director of research at Willamette Valley Cancer Institute and medical director of hematology research for the U.S. Oncology Network.
“The first ‘branch point’ is the difference between Hodgkin lymphoma and non-Hodgkin lymphoma (NHL),” Sharman said. Non-Hodgkin lymphoma is more common of the two, according to the Lymphoma Research Foundation.
The most common types of NHL are follicular, which accounts for about 30 percent of all NHL cases; diffuse large B-cell lymphoma (DLBCL), which comprises 40 to 50 percent of NHL cases; and Burkitt’s lymphoma, which accounts for 5 percent of NHL cases. “The remainder of cases makes up the bewildering complexity of NHL,” Sharman said.
“Though there can be a significant range within an individual category, the clinical approach to each category is unique and the expectations of patient outcome varies by category,” Sharman said.
When a person has had surgery and/or radiation to remove a cancer, the lymphatic flow back to the heart and can result in swelling or lymphedema, Hamrick noted. This most commonly occurs in women who have had surgery to remove a breast cancer. Part of the operation to remove the breast cancer involves removing lymph nodes in the armpit.
The more lymph nodes removed the higher the risk of chronic bothersome swelling and pain due to lymphedema in the arm, Hamrick explained. “Fortunately, modern surgical techniques are allowing for fewer lymph nodes to be removed, and thus fewer cases of severe lymphedema for breast cancer survivors.”
Some interesting research has been done on why people possibly get lymphoma. For example, VU University Medical Center in Amsterdam researched a nationwide Dutch pathology registry between 1990 and 2016. From the research, they estimated that the risk of developing anaplastic large cell lymphoma in the breast after getting implants is 1 in 35,000 at age 50, 1 in 12,000 at age 70, and 1 in 7,000 at age 75. The study was published in the Jan. 4, 2018 issue of the journal JAMA Oncology.
This disease refers to a group of inflammatory disorders that cause lymph node enlargement and can result in multiple-organ dysfunction, according to the Castleman Disease Cooperative Network. While not specifically a cancer, it is a similar to a lymphoma and is often treated with chemotherapy. It can be unicentric (one lymph node) or multicentric, involving multiple lymph nodes.
This disease involves multiple cysts or lesions formed from lymphatic vessels, according to the Lymphangiomatosis & Gorham’s Disease Alliance. It is thought to be the result of a genetic mutation.
Tonsil stones are another problem that can happen to the lymphatic system. Small bits of debris catches on the tonsils and white blood cells attack the debris and leave behind hard a hard biofilm that breaths oxygen. They are not smooth like regular stones, though. “Instead, they look like prunes, with crevices where bacteria can accumulate,” said Chetan Kaher, a dentist in London. Usually, tonsil stones fall away and get swallowed, but sometimes they need to be manually removed.
Diagnosis and treatment
Diseases of the lymphatic system are usually diagnosed when lymph nodes are enlarged, Hamrick noted. This may be discovered when the lymph nodes become enlarged enough to be felt (“palpable lymphadenopathy”) or are seen on imaging studies such as CT scans or MRIs.
The majority of enlarged lymph nodes are not dangerous; they are the body’s way of fighting off an infection, such as a viral upper respiratory infection. If the lymph nodes become significantly enlarged and persist longer than the infection, then they are more worrisome. There is no specific size cutoff, but typically nodes that persist at larger than a centimeter are more worrisome and warrant examination by a doctor.
Common symptoms of any lymphatic disorder include swelling of the arm or groin, weight loss, fever and night sweats, according to Stephanie Bernik, chief of surgical oncology at Lenox Hill Hospital in New York. “A PET or CAT scan is usually ordered to further investigate.”
The diagnosis of lymphadenopathy depends on the location of the abnormal lymph nodes and other things that are going on with the patient. If the patient has a known infection, then the lymph nodes can simply be followed to await resolution with treatment of the infection. If the nodes are growing quickly and there is no obvious explanation then typically a biopsy is warranted to look for a cancer or an infection. If the node can be felt then this can be done at the bedside with a needle, according to Hamrick.
If the lymph node is deeper, such as in the abdomen or pelvis, Hamrick said the biopsy might need to be done by an interventional radiologist using image guidance to place the needle into the node. Sometimes the biopsy needs to be done by a surgeon in the operating room. This is often where the most tissue can be obtained to make a diagnosis, he said.
With many types of lymphoma and leukemia, there are unique treatment options for each type, according to Sharman. “There is no one ‘summary’ of treatment options. Treatment options can include traditional chemotherapy, immunotherapy (such as using antibodies or immune modulating drugs), and even radiation.”
Treatment of lymphatic diseases depends on treating the underlying cause. Infections are treated with antibiotics, supportive care (while the immune system does its job, as in a viral infection) or antivirals. Lymphedema can be treated by elevation, compression and physical therapy. Cancers of the lymphatic system are treated by chemotherapy, radiotherapy, surgery, or a combination of those modalities, Hamrick noted.
In last several years, Sharman noted that there has been explosion of new treatment options. “There are a handful of newly approved drugs that target the actual disease causing processes within cells. Ibrutinib, idelalisib, obinutuzumab, lenalidomide have been approved in various indications and it is likely that we will see multiple more in coming years.”
Additional reporting by Alina Bradford, Live Science contributor
You use your eyes to see, your ears to hear and your muscles to do the heavy lifting. Well, sort of. In fact, most body parts are far more complicated than that, while some seem to have no business being inside there at all.
Ready for Med School? Test Your Body Smarts
Systems of the human body
- Circulatory System: Facts, Function & Diseases
- Digestive System: Facts, Function & Diseases
- Endocrine System: Facts, Functions and Diseases
- Immune System: Diseases, Disorders & Function
- Muscular System: Facts, Functions & Diseases
- Nervous System: Facts, Function & Diseases
- Reproductive System: Facts, Functions and Diseases
- Respiratory System: Facts, Function & Diseases
- Skeletal System: Facts, Function & Diseases
- Skin: Facts, Diseases & Conditions
- Urinary System: Facts, Functions & Diseases
Parts of the human body
- Bladder: Facts, Function & Disease
- Human Brain: Facts, Anatomy & Mapping Project
- Colon (Large Intestine): Facts, Function & Diseases
- Ears: Facts, Function & Disease
- Esophagus: Facts, Function & Diseases
- How the Human Eye Works
- Gallbladder: Function, Problems & Healthy Diet
- Human Heart: Anatomy, Function & Facts
- Kidneys: Facts, Function & Diseases
- Liver: Function, Failure & Disease
- Lungs: Facts, Function & Diseases
- Nose: Facts, Function & Diseases
- Pancreas: Function, Location & Diseases
- Small Intestine: Function, Length & Problems
- Spleen: Function, Location & Problems
- Stomach: Facts, Function & Diseases
- The Tongue: Facts, Function & Diseases
Lymphatic marking with sentinel node biopsy
This information explains how lymphatic marking with sentinel node biopsy is performed at Memorial Sloan Kettering (MSK).
You may be prescribed this procedure if you have breast cancer or melanoma. It will help your doctor understand if cancer cells have spread to the lymph nodes.
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Information on the lymphatic system
The lymphatic system has 2 main functions:
- helps fight infections;
- promotes the outflow of fluid from different parts of the body.
The lymphatic system consists of lymph nodes, lymphatic vessels and lymphatic fluid (see Figures 1 and 2).
Figure 1. Lymphatic system in the breast
- Lymph nodes are small bean-shaped formations located along the lymphatic vessels. They filter the lymphatic fluid, trapping bacteria, viruses, cancer cells and metabolic products. A sentinel lymph node (also called a sentinel lymph node) is the first lymph node that cancer cells spread to.
- Lymphatic vessels are tiny tubes (similar to blood vessels) that carry lymphatic fluid to and from the lymph nodes.
- Lymphatic fluid is a clear fluid that travels through the lymphatic system. It carries cells that help fight infections and other diseases.
Figure 2. Lymphatic system of other parts of the body
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Lymphatic Marking is the first step in the sentinel node biopsy.It is done to find the signal node. Lymphatic marking may be done the day before the sentinel node biopsy.
The location for the lymphatic marking procedure is listed on the reminder you received.
During pegging procedure
During the procedure, you will need to lie on a reclining chair for about 20 minutes. While you are in the chair, your doctor or nurse will inject a small amount of radioactive fluid under the skin under the areola of the affected breast.You may feel a tingling sensation or burning sensation during the injection.
After injection, you will need to massage the area around the injection site for 10 minutes. This is necessary for the radioactive liquid to enter the signaling unit (s). The technician will then measure the level of radioactivity in the breast, armpit and thigh on the affected side and check how much fluid has been absorbed. This can be done in 2 ways:
- The technician can use a small handheld device called the Neoprobe;
- can put you in a large full-body medical imaging machine.
Both methods are equally effective. Your doctor or nurse will tell you what to expect.
After pegging procedure
If you are scheduled for a sentinel biopsy on the day of your stripping procedure, you will be taken to the biopsy area.
If you are scheduled for a sentinel biopsy on a different day from your stripping procedure, you will go home after the procedure.
Refrain from breastfeeding for 24 hours after lymphatic tracing.You can express milk, but do not feed your baby with it. You can discard this milk or store it for 24 hours.
After 24 hours, you can resume breastfeeding or feed your baby previously expressed milk.
If you have questions, talk to your radiologist.
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Sentinel lymph node biopsy
Sentinel biopsy is a surgical procedure.A sentinel biopsy is often done during breast surgery or melanoma surgery.
If you are scheduled for a sentinel biopsy as a separate surgery, read the resource Preparing for Surgery. It explains how to prepare for a biopsy. Your nurse will give you this material at your appointment. You can also find it online.
During biopsy procedure
Before your procedure, you will receive anesthesia (medication that will make you fall asleep).
When you are asleep, your surgeon will inject you a small amount of blue dye near the cancer site. This dye will travel through the lymphatic vessels to the lymph nodes. It will color the signal nodes blue.
Your surgeon then uses a Neoprobe (a small handheld device) to measure the radiation from the fluid injected during the lymphatic marking procedure. Having found the area where the signal nodes are located, he will make an incision (surgical incision).It will find blue signal nodes and remove them. The nodes will be sent to the pathology department and examined for cancer cells.
If sentinel nodes contain cancer cells, you may need to remove more lymph nodes. This is called axillary lymph node removal. The surgeon will discuss this with you in more detail if necessary.
After biopsy procedure
You may go home on the day of your biopsy, or you may need to stay in the hospital.It depends on the number of operations performed to you. Your doctor or nurse will tell you what to expect.
To learn what to expect after your procedure, read the resource Caring for Yourself After a Sentinel Lymph Node Biopsy.
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90,000 ultrasound of lymph nodes in the Clinical Hospital on Yauza, Moscow
In the clinical hospital on Yauza, an ultrasound scan of the lymph nodes is performed – the easiest and safest way to detect pathological processes in various groups of lymph nodes and to determine their activity.The study is performed on premium equipment by highly qualified ultrasound doctors.
Indications for ultrasound of lymph nodes
The examination is carried out to identify diseases of various etiology, which are accompanied by the activation of lymph nodes and an increase in their size.
- Infectious pathology: viral, bacterial, fungal, chlamydial, parasitic, spirochete, mycobacterial.
- Malignant neoplasms – hematological diseases (leukemia, lymphoma, malignant histiocytosis), metastatic lesions of lymph nodes in melanoma, tumors of the mammary glands, lungs, gastrointestinal tract, prostate, neck and head tumors, Kaposi’s sarcoma, seminoma.
- Endocrine diseases (hyperthyroidism).
- Pathology of fat metabolism (Neumann-Pick disease, Gosh disease).
- Mucocutaneous lymph node syndrome, familial Mediterranean fever.
- Diseases of unknown etiology: amyloidosis, sarcoidosis, sinus histiocytosis, lymphogranulomatosis, macrofollicular hyperplasia of the lymph nodes.
- Identification of acute and chronic lymph node pathology and monitoring the dynamics of various diseases.
- Evaluation of the effectiveness of antitumor and anti-inflammatory treatment.
- Qualitative assessment of the lymph nodes – the state of the architectonics, the intensity of the vascular pattern.
- Determination of the most effective trajectory for lymph node puncture.
- Preventive examination.
Regional lymph nodes
As a rule, one or more groups of regional lymph nodes are examined.A group of lymph nodes is taken as one region:
- lymph nodes of the neck and head,
- axillary lymph nodes – paramammary (near the mammary gland) and axillary lymph nodes,
- lymph nodes of the anterior-thoracic region – subclavian, supraclavicular, parasternal (near the sternum), intersectoral (between the pectoral muscles),
- inguinal and femoral region – superficial and deep inguinal, femoral lymph nodes,
- deep intra-abdominal (parietal) lymph nodes – retroperitoneal
- Superficial abdominal (visceral) lymph nodes
Usually, deep intra-abdominal and superficial abdominal lymph nodes are not examined separately, since this study is included in the ultrasound of the abdominal cavity and kidneys.Normally, these lymph nodes are not visualized
If you need to do an ultrasound of the lymph nodes in the presence of complaints or suspicion of any disease, the specialists of our hospital will conduct an examination quickly and efficiently.
You can look at prices for services in the price list or check the phone number indicated on the website.
90,000 Sentinel lymph node biopsy, online appointment for a consultation with a specialist – MEDSI
network of clinics
Sentinel lymph node biopsy by the fluorescent method began to be performed in Russia only in 2018, so it is an inaccessible procedure that is performed only in a few clinics in Moscow and large cities.Clinical Hospital MEDSI in Botkin Proezd is one of the first clinics where you can take this study. It is carried out by highly qualified specialists who have special certificates for performing this type of biopsy.
Sentinel (sentinel) lymph nodes are pathways for early metastasis of malignant breast tumors. The nodes are located in the armpit. It is they who catch the first atypical cells that spread through the lymphatic tract, and react to the tumor earlier than others.Often, it is the increase in sentinel lymph nodes that is the first sign of breast cancer.
Some time ago, during operations to remove tumors, along with the lesion, a significant volume of surrounding tissues was captured, including all regional lymph nodes, since they could contain atypical cells. In MEDSI, surgical treatment is carried out using the most gentle techniques. The scope of the operation strictly corresponds to the scale of the lesion.Biopsy avoids the removal of lymph nodes “as a precaution” and reduces the invasiveness of the intervention.
Indications and contraindications
The study can be performed on all women who have a primary breast tumor. A contraindication is the presence of distant metastases: if the tumor has spread to other organs and tissues, then in the near foci (lymph nodes), malignant cells will be in any case.
How is the procedure
To localize the sentinel lymph node, a contrast agent is injected intradermally into the area of the affected breast.This allows you to determine the path of the outflow of lymph and detect those nodes in which, first of all, the tumor can metastasize.
Sentinel tissue is taken for examination. A piece of tissue is processed with special dyes, its thinnest sections are created, which are studied under a high magnification microscope.
Sentinel lymph node biopsy results
The results are prepared in the form of a conclusion containing information on the presence or absence of atypical cells in the sample for research.The absence of cancer cells in the node indicates that there is no need to remove regional (axillary, subscapularis, subclavian) lymph nodes.
Biopsy is the only way to reliably detect malignant cells in sentinel lymph nodes. Even in comparison with the most advanced research methods (ultrasound, CT, MRI), biopsy is many times more accurate and reliable method for detecting the initial metastasis of cancer.
Sentinel biopsy allows you to:
- The most accurate definition of the stage of the disease
- Eliminate unreasonable crippling step of operation
- Speed up rehabilitation after surgery
- To avoid complications of lymphadenectomy (swelling of the arm, damage to blood vessels and nerves, venous thrombosis, seroma formation in the postoperative wound area, impaired hand mobility, impaired skin sensitivity)
- Improve long-term results of operation
Benefits of sentinel lymph node biopsy at MEDSI
- Technically flawless execution of the procedure by highly qualified specialists
- Knowledge and experience of doctors of the Competence Center “Mammology” on the basis of the Clinical Hospital in Botkinsky proezd
- Modern advanced diagnostic equipment
- Express Results
- Practice of oncoconsiliums
- Possibility of extended diagnostics and treatment by MEDSI specialists
ultrasound of lymph nodes in Saratov
Ultrasound of the lymph nodes is prescribed to detect abnormalities in the functioning of the lymphatic system or diseases of internal organs.The study is carried out quickly, and its results are ready almost immediately after the procedure, so the attending physician quickly receives information and can make a diagnosis.
If there are indications for an ultrasound of the lymph nodes, you can undergo such an examination at the “Alpha Health Center” in Saratov, and then contact a general practitioner or other specialist with the results.
Indications for ultrasound
It is important to examine the lymph nodes if there is a suspicion of an inflammatory process in them and nearby organs, infection or neoplasms in the body.Normally, the lymph nodes are practically not palpable, they are not felt and do not cause any discomfort. If something has changed, an ultrasound scan will help to identify the cause.
The doctor may send an ultrasound scan of the lymph nodes with symptoms such as:
- An increase in the groin, cervical and other nodes located directly under the skin and are clearly visible;
- Soreness of the lymph nodes when touched;
- High temperature for a long time;
- The presence of seals in the area of the lymph nodes.
In case of discomfort and seals in the area of the mammary glands, an ultrasound of the axillary lymph nodes and regional nodes of the chest is additionally done.
What the ultrasound shows
Peripheral lymph nodes are clearly visible on ultrasound: these include nodules in the armpits, groin, neck, under the elbows and knees. Peripheral nodes are close to the skin and palpable on palpation.
Ultrasound of regional lymph nodes (located close to internal organs, often at a fairly large depth) is also performed.To make it informative, the equipment is tuned to the desired frequency.
During the study, the ultrasound diagnostic doctor records:
- The shape of regional or peripheral nodes, their compliance with normal sizes;
- The state of each examined lymph node – how many inflamed nodules and how many healthy ones;
- Mobility of knots;
- The presence of infectious or neoplastic lesions.
Ultrasound examination of the lymph nodes is absolutely safe and painless. During the procedure, the doctor moves a sensor across the skin surface, which emits safe ultrasound waves of the desired frequency. The technique has no contraindications, therefore, an ultrasound scan can be performed repeatedly to clarify the diagnosis or during treatment.
Make an ultrasound of the lymph nodes in Saratov
In the clinic “Alfa-Health Center” in Saratov, you can undergo an ultrasound scan of the lymph nodes of the neck, as well as the groin area, armpits and other areas, depending on the disturbing symptoms.The procedure is carried out on a safe General Electric LOGIQ apparatus with a minimum level of radiation and without harm to the body.
To make an appointment for an examination and have it on any convenient day without waiting and stress, call us.
Sentinel lymph node biopsy
Sentinel lymph node biopsy technology using indocyanine green
The patient’s left arm is swollen (see figure). She was previously diagnosed with cancer, which was successfully treated.As part of the operation, the axillary lymph nodes were removed. Subsequently, an edema of the hand developed, which is called lymphostasis.
The axillary lymph nodes receive lymph flowing from the mammary gland, and cancer cells migrate from the tumor in the mammary gland through the lymphatic pathways into them. Preoperative diagnosis of lymph node lesions is imperfect if cancer cells are obtained during puncture (puncture) of the lymph node, and there is metastasis. But if the lymph nodes are outwardly normal and metastases in them are not visible according to ultrasound (as well as puncture of an enlarged lymph node), this does not mean the absence of metastases.
In such situations, lymph node metastases are found on histological examination in 20-30% of cases. Therefore, during radical operations, it is necessary to remove all axillary lymph nodes, but through the same lymph nodes, lymph flows out of the hand. In the case when they are removed, the outflow of lymph occurs through other nodes, slows down sharply and lymphatic edema of the hand – lymphostasis can develop. The likelihood of developing lymphostasis is 15-40%, it is quite rarely as severe as in the photograph, usually it is less.
Sentinel lymph node biopsy in patients with no lymph node metastases as determined by preoperative examination is a good alternative for these patients to avoid unnecessary removal of lymph nodes. The concept of sentinel lymph node biopsy implies that the location and morphological assessment of the status of the lymph node that first receives lymph from the organ affected by the malignant tumor makes it possible to assess the likelihood of metastatic involvement of other lymph nodes.In the absence of such a lesion, predict with a high degree of certainty the absence of metastases in subsequent lymph nodes and refuse to remove them without prejudice to the effectiveness of anticancer treatment. With regard to breast cancer, we are talking about the preservation of axillary lymph nodes and the prevention of complications associated with axillary lymphadenectomy – lymphatic edema of the upper limb, lymphatic edema of the mammary gland (during organ-preserving operations), impaired skin sensitivity on the shoulder and in the axillary region.
Historically, sentinel lymph node biopsy technology is based on radionuclide lymphography; lymphotropic dye (isosulfan or methylene blue) could be used as an additional imaging method. Over the past 10 years, there has been a growing interest in fluorescence lymphography as a method for finding the sentinel lymph node. The first study dates back to 2005. Over the past years, the method has been evaluated in about 300 breast cancer patients (Japan, England, Germany, USA) and has established itself as an effective way to search for a sentinel lymph node, which is either no worse than or better than a radionuclide node.
Indocianin green (ICG) is used to visualize the lymph node in the armpit that first receives lymph from the breast. The drug has the ability to fluoresce in infrared light, and its fluorescence through tissues can be recorded by a special video camera. The drug is injected intradermally into the areola. After 2-3 minutes, the screen displays the lymphatic drainage pathways, along which the first lymph node, that is, the sentinel, can be found.The lymph node is removed and sent for histological examination.
The successive steps of this manipulation are presented in the photos:
1. Introduction of indocyanine green (0 min.)
2. Obtaining an image of the dominant lymph drainage pathway (3 min.)
3. Fluorescent knot in the wound (6 min.)
4. Fluorescent knot on the preparation (14 min.)
Diagnostics is carried out by the well-known oncologist-mammologist of Russia, Doctor of Medical Sciences Sergei Mikhailovich Portnoy.Sentinel Lymph Node Biopsy (Sentinel Lymph Node Biopsy), based on fluorescence lymphography, is by far the most advanced method. The photodynamic eye-camera displays an image in the infrared range on the screen and allows the procedure to be performed as accurately as possible and to avoid the use of radionuclides. On the territory of the Russian Federation, it is represented only in Frau Klinik.
Histological examination may reveal a metastatic lesion of the sentinel lymph node, and may confirm the absence of metastasis in it.
In the first case, it is necessary to remove the remaining axillary lymph nodes, that is, to perform axillary lymphadenectomy. In the second case, this operation is not necessary, since it is possible to preserve healthy lymph nodes and avoid the development of lymphostasis.
Today we have extensive experience in such operations. With the help of this technology, it is almost always possible to find a lymph node, and in 97% of cases it turns out to be a true signaling node (that is, if it is not affected by metastasis, there are also no metastases in other nodes).An additional advantage of this technology is the absence of patient exposure (no radionuclides are used).
Sentinel lymph node biopsy for breast cancer
In the vast majority of cases, lymph from the mammary glands flows into the axillary (axillary) lymph nodes.
In order to find the sentinel lymph node in breast cancer, a radiopharmaceutical is injected into the mammary gland (either into the tumor itself, or subcutaneously – under the nipple), which is a set of small particles the size of a cell. These particles are labeled with a radioactive isotope, which allows them to be seen with gamma detectors. The particles behave in the same way as cells detached from the tumor, which enter the intercellular space, that is, they are carried away along with the lymph and get stuck in the lymph nodes.Thus, most of these particles will be stuck in the first lymph node in the lymph outflow pathway, that is, in the sentinel lymph node.
After the introduction of the radiopharmaceutical, it is necessary to determine where the sentinel lymph node is located. This is done using a gamma camera (SPECT / CT). Thanks to this, the surgeon can determine in advance what access he needs in order to find this lymph node minimally traumatic for the patient.
During the operation, the sentinel lymph node is localized using a gamma probe through a small incision in the skin, to which the lymph node is fed.The isotopically labeled lymph node is removed and transferred for intraoperative histological examination. If no metastases are found in the lymph node, then the wound is sutured, and the removed lymph nodes are sent for an extended histological examination to the laboratory. If the lymph nodes are intact, then the patient with minimal postoperative changes (with small scars) goes home to recover. If micrometastases are still detected in the lymph nodes, a decision is made on how to further treat the patient.This can be chemotherapy, radiation therapy, or extended surgery.
Currently, multicenter studies are underway, which show that even if there are micrometastases in one or two sentinel lymph nodes in breast cancer that do not grow into the capsule of the lymph node itself, then it is not necessary to do an extended lymph node dissection. In this case, radiation therapy is performed on the armpit area. The data show that the life expectancy after surgery in such patients is comparable to the life expectancy of patients who underwent lymphadenectomy, but the quality of life remains at a higher level.
What happens if sentinel lymph node biopsy is not performed for breast cancer?
At the earliest stages of the disease, when all diagnostic methods showed the absence of distant metastases, there are two options for surgical treatment of patients without sentinel lymph node biopsy:
1. Removal of the tumor and extended lymph node dissection (removal of all, or almost all of the lymph nodes).
As a result of extended lymph node dissection, many complications develop, such as edema, impaired motor function of the arm, and, as a result, the patient’s disability.
Lymphedema is the most serious of all side effects after lymph node removal and can be irreversible. Lymphedema is manifested by swelling of the fingers, palms and hands, or even the entire arm, formed due to the accumulation of lymph.
2. Removal of the tumor itself while preserving the lymph nodes and further irradiation of of the axillary region, that is, chemotherapy and / or radiation therapy.
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Lymph node biopsy | Clinic Family Doctor
Lymph nodes are part of the lymphatic system and are connected by vessels of the same name.In oncological and infectious diseases, they often assume barrier functions, signaling the presence of a pathological focus. Swollen lymph nodes can be a symptom of various diseases.
A biopsy is a minimally invasive diagnostic method that involves the collection of a portion of tissues or cells for further examination under a microscope. The procedure is performed by oncologist surgeons if there is a suspicion of structural changes, enlarged lymph nodes. A lymph node biopsy can help clarify the suspected diagnosis.
Types of procedure
There are several types of lymph node biopsies:
Fine-needle, or puncture. Allows, on the basis of a cytological study, to determine the defeat of the lymph nodes, to establish the presence of tumor metastasis.
Trephine biopsy. Provides for the use of a thick needle. This allows a tissue column to be taken, which is sufficient for histological examination, without making any incisions.
Sentinel lymph node biopsy. Sentinel, or sentinel, lymph nodes represent the first route of early metastasis of tumors. They are the first to catch atypical cells.
The procedures are performed under local anesthesia. Sometimes the lymph node can be removed and examined completely, in this case more serious preparation will be required, the doctor will definitely explain the specifics of the manipulation.
Features of laboratory study
The resulting fluid, tissue or cells are sent to the laboratory for cytological and histological examination. In the laboratory, they are processed in a special way, under certain conditions for the study of the material and with the possibility of long-term storage.
The section is treated with dyes and placed on a glass slide. When atypical cells are detected, the data must be reflected in the written opinion.
The use of a biopsy allows:
determine the existing disease and its nature;
carrying out the most organ-preserving surgery;
avoid complications of lymphadenectomy;
improve the results of the operation;
choose the right radiation and chemotherapy;
make sure in the presence / absence of a malignant process.
This method is one of the most informative.
Biopsy of the lymph nodes in the neck, in the axillary, groin and other areas is successfully performed by the oncologists of the Family Doctor clinic.
We possess the necessary diagnostic methods, use modern instruments and anesthetics, and comply with all the conditions for conducting invasive procedures.
To make an appointment with a doctor, call the unified contact center in Moscow +7 (495) 775 75 66, use the online appointment service or contact the clinic’s registry.