Lymphadenopathy and lymphadenitis - enlargement and inflammation of the lymph nodes: causes, diagnosis, treatment. Why a packet of lymph nodes is formed A group of inguinal lymph nodes

Salvatore Mangione, M. D.

GENERAL INFORMATION

Lymph nodes = l / y.

Lymph node (L/N) examination is an important part of the overall clinical examination. A methodical search for enlarged lymph nodes can provide valuable information about malignancy or systemic disease. Some of these "warning" swollen lymph nodes have become part of medical folklore, named after the physicians who first described them.

1. What are the important characteristics The lymph nodes should be assessed by palpation?

1. The size. The size is easy to determine with a plastic ruler. An increase in l / y > 1 cm is recognized as clinically significant, with a certain degree of probability indicating a pathological process. However, there are exceptions to this rule: for example, anterior ear l / y< 1 см часто свидетельствуют о патологии и, наоборот, значительно увеличенные л/у доброкачественной природы часто обнаруживаются у лиц, принимающих наркотики внутривенно. Увеличение л/у >5 cm is almost always due to neoplasm.
2. Consistency. The stony density of l / y is usually due to their involvement in the malignant process, but there are exceptions. For example, in Hodgkin's disease, l / y is most often of rubber density. Fluctuating lymph nodes reflect necrosis or bacterial lymphadenitis. They can open on the skin, forming fistulas (typical of tuberculosis). L / y of this type is often called buboes, especially if they are localized in the groin. Sometimes l / y are palpated, giving a feeling of large fractions or peas. Most often they are small, close (but not the same) in size in different patients; firm, but not of stony density; mobile, painless on palpation and clearly demarcated.
3. formation of conglomerates.When merging and forming conglomerates, individual l / y are transformed into large tumor-like formations. The formation of l / y conglomerates is characteristic of malignant neoplasms, but it can also be caused by inflammatory processes, for example, chronic infections or sarcoidosis. In addition to fusion, l / y can be soldered to the skin or underlying tissues.
4. Pain on palpation.Pain on palpation is important clinical characteristic, usually caused by inflammation, but sometimes by malignant tumors. With tuberculosis, l / y can be both painful and painless.

On a note. The lymph nodesin benign diseases, they are characterized by small size, soft texture, painlessness on palpation, good delimitation. Lymph nodes in malignant neoplasms are large, stony density, painless on palpation, form conglomerates. Inflamed lymph nodes are painful on palpation, hard (but not stony in density), occasionally fluctuate, and often form conglomerates.

2. What features should be taken into account when assessing the clinical significance of lymph nodes?

The location of the lymph nodes is important. As stated above, the clinical significance of palpable anterior auricular lymph nodes of any size is greater than that of similar-sized lymph nodes in any other area. It is very important to distinguish between generalized and regional lymphadenopathy, which are caused by two different groups of pathological processes and imply a different algorithm for the differential diagnosis.

The reasons generalized lymphadenopathy:

1. disseminated malignant tumors, especially hematological (lymphomas, leukemias);
2. connective tissue diseases (including sarcoidosis);
3. infections ( Infectious mononucleosis, syphilis, cytomegalovirus infection, toxoplasmosis, rheumatism, AIDS, tuberculosis and, of course, the bubonic plague of yesteryear);
4. other, including drug reactions (for example, to phenytoin), intravenous administration drugs.

Regional lymphadenopathyusually due to local infection or neoplasm.

3. In what anatomical areas should palpation be performed in order todetection of lymph nodes?

L / y should try to palpate in the armpits, in the area of ​​the epicondyles, on the head and neck, in the supraclavicular fossae, in the groin and on the front of the thigh. Increased lymph nodes of clinical significance may be found in the popliteal fossae and umbilical region.

4. What is the clinical significance of enlarged axillary lymph nodes?

Normally, axillary lymph nodes are not palpable, although small, mobile, soft, painless lymph nodes can also be found on palpation. healthy people. Larger, mobile, painful on palpation l / s occur with small wounds and infectious processes in the hand (cat-scratch disease, skin infections). More dense, immobile, conglomerate l / y most often indicates metastases (usually lung or breast cancer).

Rice. 18.1. Groups of axillary lymph nodes.(Reproduced with permission from: De Gowin R.L.: De Gowin & De Gowin’s Diagnostic Examination, 6th ed. New York, McGrow-Hill, 1994)

5. Describe the method of palpation of axillary lymph nodes.

Fingertips are carried out deep palpation axillary fossa and its apex. First, this manipulation is performed when the patient's hand is relaxed and passively withdrawn from chest, then repeat it when the hand is passively brought to the chest.

6. What is the clinical significance of enlarged l / y of the head and neck?

Clinical significance depends on localization.

On palpation of l / u stony density of the following localization, the following diagnosis can be assumed.

• Upper posterior cervical lymph nodes- tumor of the nasopharynx.
• Submental and submandibular- swelling of the nose, lip, front of the tongue, or front of the floor of the mouth.
• Medium deep cervical l/u- swelling of the base of the tongue or larynx.
• Lower deep cervical l/u- primary cancer thyroid gland or cervical esophagus.

7. What is scrofula?

Scrofula is an obsolete term for tuberculous cervical lymphadenitis. Because of the enlarged l / y, the patient's neck resembles the neck of a pig; scrofa- in Latin means "pig". In the pre-Pasterian era, scrofula was widespread, especially in children fed milk from infected cows. Scrofula was treated as follows: children were lined up in front of the king, who healed them with his touch. The effectiveness of such "therapy" does not speak of the healing power of royalty, but of the benign nature of the disease.

8. What is the clinical significance of l/n of the head and neck, resembling a large shot on palpation?

L/s of this type are small, pea-sized, painless on palpation, mobile, well demarcated. They are very common, especially in young children, and in most cases reflect a previous infection. Once healed, they may persist for several weeks. Their location reflects the localization of the infectious process.

• Anterior cervical l / y- infections of the upper respiratory tract and anterior part of the oral cavity.
• Posterior cervical l / y - otitis media and scalp infections.

9. What are Delphic nodes?

Delphic knots- this is a group of small, medianly located pre-laryngeal lymph nodes lying on the cricothyroid membrane. They are called Delphic because of their high predictive value (in ancient greece famous soothsayer was an oracle from the city of Delphi). An increase in these l / y occurs in diseases of the thyroid gland (subacute thyroiditis, Hashimoto's disease, thyroid cancer), as well as in tracheal cancer. Delphic nodes should not be confused with the pyramidal lobe of the thyroid gland.

Rice. 18.3. A. The pyramidal lobe of the thyroid gland is an upward outgrowth of thyroid tissue, usually starting from the isthmus or left lobe of the gland. The pyramidal lobe may run parallel to the thyroglossal duct as far as the hyoid bone. B. Delphic lymph nodes are enlarged lymph nodes located on the thyroid-hyoid membrane. Most often indicate thyroid cancer or subacute thyroiditis. (Reproduced with permission from: De Gowin R.L.: De Gowin & De Gowin’s Diagnostic Examination, 6th ed. New York, McGrow-Hill, 1994)

10. What is the clinical significance of enlarged supraclavicular lymph nodes?

Detection of enlarged l / y in the right or left supraclavicular fossais an important finding, most often indicating cancer of the ipsilateral lung or breast. However, it should be noted that the increase in l / y in right supraclavicular fossa can be observed in cancer of the lower lobe left lung due to cross lymphatic drainage. Increased supraclavicular l / y in left supraclavicular fossa may be due to metastasis of various malignant tumors coming from organs abdominal cavity and small pelvis (see below). A large left supraclavicular lesion is often referred to as signal knot (warning of a distant malignancy) or Troisier's knot (see below).

11. What is a Troisier knot?

This is a single l / y in left supraclavicular fossa, often located behind the clavicular head of the sternocleidomastoid muscle. Troisier's node can occur due to metastasis of cancer of the ipsilateral lung, breast, and esophagus. Most often, however, the Troisier node is due to the metastatic spread of tumors emanating from the organs of the abdominal cavity and small pelvis - the stomach, intestines, liver, kidneys, pancreas, testicles and endometrium. When this node is due to metastasis in stomach cancer, it is called the Virchow's gland (Virchow's node).

12. Tell us about Troisiers.

Charles E. Troisier(1844-1919) - graduate and then professor at the University of Paris. A brilliant pathologist and an excellent clinician, he made a great contribution to medicine, studying the spread of malignant tumors through the lymphatic tract. Troisier's work also touched on other areas: rheumatoid nodules, meningitis, deep vein thrombosis, hemochromatosis. And now bronze diabetes (hemochromatosis) is often called Troisier's syndrome.

13. Tell us about Virchow.

Rudolf L. K. Virchow(1821-1902) graduated from the Military Medical Institute. Friedrich Wilhelm in Berlin. He entered this institute after he realized that his voice was not strong enough for a successful career as a preacher. Virchow retired from the armed forces in 1847. After many unsuccessful attempts to cooperate with various medical journals, Virchow founded his own periodical, which became known as Virchow's Archive. He made a huge contribution to medicine, dealing with hemostasis and pulmonary embolism (see Virchow's triad in venous thrombosis), leukemia, social hygiene and preventive medicine. At times a scientific reactionary, in politics Virchow was a liberal with socialistsympathies. When an uprising broke out in Berlin in 1848, Virchow even took part in the construction of the barricades. He severely criticized the social injustice and poor hygiene conditions of his time, which he considered the cause of frequent epidemics. In his report to the government, which practically became an indictment against the industrial revolution, he asked: "Will the triumph of human genius lead to the fact that the entire human race will become miserable?" His interests included anthropology, archeology, and the history of medicine. Virchow died at the age of 81 from complications of a hip fracture he sustained while jumping from a moving tram.

14. How should supraclavicular lymph nodes be palpated?

The patient sits, looks straight ahead, his arms are lowered (which reduces the risk of mistaking cervical vertebrae or muscles for l / y). The doctor is behind the patient - from this position it is more convenient to palpate the supraclavicular fossa. Palpation is also carried out in the position of the patient lying on his back, when, due to the effect of gravity, the l / s become more mobile, which increases the chance of detecting them. Finally, performing the patient's Valsalva maneuver or even a simple cough can move deep-lying lymph nodes closer to the surface of the skin, allowing them to reach the doctor's fingers.

15. What is the clinical significance of enlarged supracondylar (ulnar) lymph nodes?

An increase in supracondylar l / y occurs with an inflammatory process in the arm or forearm. These l / y can be increased in people who abuse narcotic drugs (with intravenous use), as well as in sarcoidosis.

16. How should supracondylar lymph nodes be palpated?

The doctor shakes his right hand right hand of the patient, at the same time with the fingertips of the left hand palpating the area of ​​the epicondyles (the distal third of the medial groove of the biceps muscle - Note. transl.). The study of supracondylar l / y on the left is carried out similarly to that described, changing hands.

17. What is the clinical significance of enlarged inguinal and femoral l / y?

Inguinal l / y are located lateral to the femoral, located closer to the genitals. The differences are not only anatomical, but also clinical. An increase in femoral l / y is less alarming than inguinal. Often, femoral l / y increase with mycoses of the feet. An increase in inguinal l / y is much more informative and may indicate a malignant neoplasm. A biopsy of the inguinal l / y can provide various diagnostic information; at a biopsy of femoral l/at usually find out only jet process.

18. What is the clinical significance of enlarged popliteal lymph nodes?

Very small. Popliteal l / y are located so deep that palpation is not available. Even if they can be palpated, the clinical significance remains unclear.

19. What is Sister Mary Joseph's knot?

This is a paraumbilical nodule or a dense tumor-like formation, detected during examination or palpation of the navel. This extremely valuable symptom indicates metastasis of an intrapelvic or intra-abdominal tumor - most often cancer: of the stomach or ovary. This symptom was first described in 1928 by Dr. W. J Mauo. The article is based on the observation of Dr. W. J. Mauo's first assistant, Surgical Sister Mary Joseph of St. Mary's Hospital.

20. Tell about Sister Mary Joseph.

Maria Joseph was born in Salamanca, New York in 1856. In 1878 she entered the congregation of Our Lady of Lourdes and received an appointment at St. Mary's Hospital in Rochester, Minnesota. There she trained in nursing and first worked under Edith Graham (who later became the wife of Dr. C. N. Mauo), and then became a hospital manager and retained this post until her death in 1939. From 1890 to 1915 she was the first assistant Dr Mayo. It was Mary Joseph who brought Dr. Mayo's attention to the symptom that would later bear her name.

LITERARY SOURCES

1. Ioachim H.L: Lymph Node Biopsy, 2nd ed. Philadelphia, Lippincott-Williams & Wilkins, 1994.
2. Kuiper D.H, Papp J.P: Supraclavicular adenopathy demonstrated by the Valsalva maneuver. N Engl J Med 280:1007-1008, 1969.

In medical practice, the following ways of spreading malignant neoplasms are known:

• lymphogenous;
• hematogenous;
• mixed.

Lymphogenic metastasis is characterized by the penetration of tumor cells into the lymphatic vessel and then through the flow of lymph to nearby or distant lymph nodes. Epithelial cancers (eg, melanoma) are more likely to spread via the lymphogenous route. Tumor processes in the internal organs: stomach, colon, larynx, uterus - can thus create metastases in the lymph nodes.

The hematogenous pathway refers to the spread of tumor processes with the help of blood flow from the affected organ to a healthy one. Moreover, the lymphogenous pathway leads to regional (close to the affected organ) metastases, and the hematogenous pathway promotes the spread of affected cells to distant organs. Lymphogenic metastasis is well studied, which makes it possible to recognize most of the tumors at the stages of inception and provide timely medical care.

In the neck zone, the lymph nodes form a collector that accumulates lymph coming from the organs of the head, sternum, upper limbs, as well as from the peritoneum, trunk and legs. Doctors have established a pattern between the path of metastasis and the course of the lymphatic channel. In this regard, metastases in the lymph nodes located at the level of the chin and under the jaw are detected in tumor processes of the lower lip, anterior section tongue and oral cavity, upper jaw. Metastases of malignant neoplasms of the posterior sections of the tongue, floor of the mouth, thyroid gland, pharynx and larynx areas spread to the lymph nodes of the neck area, namely to the region of the carotid neurovascular bundle. Metastases in the lymph nodes of the area above the collarbone (outside the sternocleidomastoid muscle) often develop with breast or lung cancer. Malignant neoplasms of the peritoneal region metastasize to the lymph nodes above the clavicle (inside the sternocleidomastoid muscle). Inguinal lymph nodes contain cancer metastases lower extremities, areas of the sacrum and buttocks, as well as external genital organs.

Metastasis is a secondary pathological lesion of cells that grows in tissues. human body from the source of the primary disease.

The function of the lymphatic system is to maintain metabolic processes, as well as cleansing (filtering) at the cellular level, as an addition to the cardiovascular system. Lymph nodes are combined into groups in accordance with localization in the human body and serve to produce lymphocytes - immune cells fighting harmful foreign microorganisms that enter the body.

Reasons affecting the development of metastases:

• age factor (metastases appear more often at an older age);
• the development of concomitant diseases (chronic, weakening the body's defenses);
• size and location of the initial focus malignant neoplasm(the presence of a large tumor increases the possibility of metastases);
• spread of tumor cells (the growth of malignant tumors into the wall of the organ is the most dangerous and often causes metastasis than neoplasms growing into the lumen of the organ).

Symptoms of metastases in the lymph nodes

The International Classification of tumors of a malignant type defines metastases in the lymph nodes with the Latin letter N. The stage of the disease is described by the number of metastases, and not by the size of the affected tissue. N-0 indicates the absence of metastases, N-1 means a single metastasis of nodes adjacent to the neoplasm, N-2 - a large number of metastasis of regional lymph nodes. The designation N-3 means the simultaneous defeat of close and distant lymph nodes, which is inherent in the fourth stage of the tumor process.

The primary symptoms of metastases in the lymph nodes are a significant increase in size, which is determined by visual examination and palpation. Most often, changes in the cervical, supraclavicular, axillary and inguinal lymph nodes are differentiated, which have a soft-elastic structure and are painless.

The growth of lymph nodes in size is often accompanied by weight loss, and the patient's condition is characterized by general weakness, anemia. Other warning signs include fever, frequent colds, neurosis, liver enlargement, migraine, redness of the skin. The appearance of metastases indicates the progression of a malignant neoplasm. With self-identification of lymphadenopathy (enlarged lymph node), you should consult a specialist without self-medication.

It is important to note that often metastases in the lymph nodes are recognized earlier than the source of the problem - a malignant tumor.

Metastases in the lymph nodes of the neck

Tumors of the neck region are combined into a small, but quite diverse clinical manifestations group. Neoplasms are observed both in the organ itself (larynx, pharynx, esophagus, thyroid gland, etc.), and in soft tissues neck non-organ.

The main lymphatic collector is located on the neck, and the formation of metastases in its nodes occurs due to damage to the lymphoreticular tissue, as a result of lymphogranulomatosis, hematosarcoma, lymphosarcoma, metastasis of malignant tumors (Virchow's metastasis).

Metastases in the lymph nodes of the neck lead to a change in the shape, size, structure and echogenicity of the nodes. Lymphogranulomatosis most often (60% of cases) occurs with metastases to the nodes of the neck. In this case, pathological processes can be observed in the axillary, inguinal, mediastinal, as well as lymph nodes of the retroperitoneal zone. There are cases of simultaneous damage to the thyroid gland and the lymph nodes of the neck, which is clinically similar to cancer of the thyroid gland with metastasis to the cervical nodes.

Lymphogranulomatosis is more likely to affect 20-30-year-old patients or persons over 60 years old (usually males). The primary manifestation of the disease is an increase in the lymph node or a group of nodes with an elastic consistency. Further, the fusion of lymph nodes of various density and size into a single conglomerate is noted. Patients complain of: general weakness, sweating, itching of the skin, temperature and lack of appetite. The clinical picture varies depending on the individual course and stage of the disease, so the symptoms described may be vague or completely absent.

Often, metastases in the lymph nodes are detected with lymphosarcoma. The nodes are enlarged and have a dense structure, and the rate of internal changes in the affected conglomerate can cause compression of adjacent organs in a couple of weeks. During the examination, the patient may reveal the growth of inguinal and axillary nodes.

Along with malignant tumors of the head and neck (tumor processes of the tongue, salivary glands, thyroid gland, larynx) metastases in the lymph nodes of the neck are detected in breast cancer, damage to the lungs or abdominal organs, which indicates the fourth stage of the disease.

About 30% of situations of primary tumor processes remain undifferentiated. In order to examine the patient for the presence of neck cancers, diagnostics using anesthesia is used. Thyroid cancer can take a latent form, manifesting itself only as metastases to the cervical lymph nodes. The method of palpation and ultrasound does not always reveal dense neoplasms, therefore, puncture and excisional biopsies are widely used.

Metastases to cervical lymph nodes

The defeat of the cervical lymph nodes - metastases in the cervical lymph nodes are characterized by common symptoms:

• significant growth of nodes;
• change in shape (contours are uneven, fuzzy);
• anechoic lesions are noted.

An ultrasound examination reveals a violation of the ratio of the transverse and longitudinal size of the node or a difference (less than 1.5) between the long and short axes. In other words, if the lymph node acquires a rounded shape, then the probability of its defeat is high.

Cancer processes in the lymph nodes increase the fluid content in them. Ultrasound scan shows the blurring of the contour of the node. The capsule of the lymph node at an early stage of the disease is still recognized. As malignant cells grow, the contours are erased, the tumor grows into nearby tissues, and it is also possible for several affected lymph nodes to coalesce into a single conglomerate.

Metastases in the cervical lymph nodes are formed from lymphomas, cancers of the lungs, gastrointestinal tract, prostate or breast. Most often, when metastases are found in the lymph nodes of the neck, the localization of the primary tumor is in the upper sections of the respiratory or digestive system.

An increase in the lymph nodes of the neck occurs with the following cancers:

• cancerous processes of the larynx, tongue, oral mucosa;
• damage to the thyroid gland;

Diagnosis is carried out by puncture or excisional biopsy. Treatment methods are radiation and surgical removal of the affected node.

Metastases in the lymph nodes in the groin

The lymph nodes of the inguinal zone trap and destroy pathogenic microorganisms penetrating the lymphatic system from the pelvic organs (usually the genital area) and lower extremities. In the inguinal lymph nodes themselves, primary malignant neoplasms or lymphomas can form.

Inguinal lymph nodes are divided into deep and superficial. The latter are located in the area of ​​the so-called "femoral triangle" and on the surface of the wide fascia of the thigh, their number varies from four to twenty pieces. Inguinal nodes communicate with the tissues of the lower extremities, the perineum, the anterior wall of the peritoneum below the navel. The number of deep lymph nodes in the groin ranges from one to seven. Their location is under the surface of the plate of the wide fascia of the thigh. These nodes are interconnected with the lymphatic vessels located on the surface of the inguinal region and deep in the femoral zone.

A painless symptom with a characteristic increase in size of the nodes may indicate metastases in the lymph nodes in the groin. Growth inguinal lymph nodes occurs in the following cancers:

• lumbar melanoma or cancer of the skin of the lower extremities;
• malignant neoplasm in the rectum;
• genital cancer;
• lymphogranulomatosis (Hodgkin's lymphoma).

Cases of damage to the inguinal nodes require a thorough examination of the condition of the skin of the legs, as well as organs located in the small pelvis and peritoneal cavity. For diagnostic purposes, use: computed tomography(CT), colonoscopy, cystoscopy, hysteroscopy, FEGDS.

Metastases to inguinal lymph nodes

Lymph nodes in the inguinal zone pass lymph coming from the genitals, lower rectum and abdominal wall, lower limbs. By location, the nodes are divided into superficial and deep.

Malignant neoplasms of the legs, sacro-gluteal zone, external genital organs form metastases in the inguinal lymph nodes. Lymph nodes take the form of rounded seals in the inguinal folds. The nodes are tightly soldered to nearby tissues and are inactive, which is observed when trying to move them.

Types of cancer that cause swollen lymph nodes in the groin:

• melanoma or cancerous lesions of the skin of the legs (lumbar zone);
• oncology of the rectum;
• malignant formations of the genital area;
• Hodgkin's lymphoma (lymphogranulomatosis).

The initial development of lymphogranulomatosis with lesions of the lymph nodes in the groin is quite rare (10%). The disease is characterized by weight loss, an unreasonable rise in temperature, excessive sweating at night.

During the examination, the doctor examines the lymph nodes by palpation, first along and then across the fold of the groin, using sliding circular motions, and passes into the area of ​​the wide fascia of the thigh.

Metastases to retroperitoneal lymph nodes

The retroperitoneal space is the area of ​​the abdomen behind the wall of the peritoneum, bounded by the peritoneum, back muscles, sacrum, diaphragm, and side walls of the abdomen. The lymphatic system of the retroperitoneal space includes regional lymph nodes, vessels and large lymphatic collectors, from which the thoracic lymphatic duct originates.

Localization of malignant neoplasms in the peritoneal area has the following symptoms: fever, cramping pain in the abdomen (appears paroxysmal), stool disorder in the form of diarrhea (less often constipation). Metastases to the retroperitoneal lymph nodes are observed in germ cell tumor processes in the testis, kidney, cancer gastrointestinal tract. Enlargement of the retroperitoneal lymph nodes leads to severe pain in the back due to compression of the nerve roots, sometimes covering the psoas muscle. Gastrointestinal symptoms are common, and there is a dramatic weight loss.

Assessment of the state of the lymph nodes and organs of the retroperitoneal space is carried out according to the results of ultrasound, computed and magnetic resonance imaging. Ultrasound scanning shows nodes with metastases as round or oblong, characterized by clear contours and homogeneity of the structure. The CT method determines metastases in the lymph nodes by a rounded shape, soft tissue structure. The affected lymph nodes of the retroperitoneal cavity have a homogeneous structure and density, as well as clear contours, and can merge into large conglomerates. In the case when the arrays of lymph nodes cover the spine, the aorta in the peritoneal area and the inferior vena cava, for better recognition tumor processes at the same time use intravenous contrasting.

Metastases to para-aortic lymph nodes

Location of the para-aortic lymph nodes - anterior lumbar spine, along the aorta.

Metastases to the para-aortic lymph nodes are observed in patients with cancer of the genital area, kidneys and adrenal glands, and gastrointestinal tract. For example, in malignant neoplasms of the stomach, affected para-aortic lymph nodes are detected in 40% of cases. Tumor processes with metastasis to the para-aortic lymph nodes are classified as the third or fourth stage of the disease. Moreover, the frequency of damage to para-aortic nodes of the third degree of oncology reaches 41%, and the fourth degree - 67%. It should be noted that, for example, para-aortic lymph node metastases of ovarian cancer are resistant to chemotherapy.

The development of pancreatic cancer has its own stages of lymphogenous metastasis:

• the first stage - metastases reach the head of the pancreas;
• the second stage - retropyloric and hepatoduodenal lymph nodes are affected;
• the third stage is the penetration of metastases into the celiac and superior mesenteric nodes;
• the fourth stage is metastasis to para-aortic lymph nodes.

Doctors note that malignant tumors of the pancreas are characterized by an aggressive course and have a poor prognosis. Cases of death from pancreatic cancer rank 4th-5th among all cancers. High mortality is associated with recurrence of tumor processes in the postoperative period (K-ras mutations in para-aortic lymph nodes).

Metastases in the lymph nodes of the abdominal cavity

A large number of lymph nodes are located in the abdominal cavity, representing a barrier to infection and cancer cells. The lymph nodes of the peritoneum are divided into parietal (concentrated in the lumbar region) and intraparietal (arranged in rows).

The defeat of the peritoneal lymph nodes is the result of a lymphoproliferative disease (the primary tumor is formed in the lymph node itself) or the result of metastasis. Lymphogranulomatosis and lymphosarcoma are lymphoproliferative diseases that cause compaction and growth in the size of the node without pain. Metastases in the lymph nodes of the abdominal cavity are detected in a number of cancers, when tumor cells penetrate into the lymph nodes from the affected organ with lymph flow. So malignant tumors of the peritoneal organs (for example, the stomach) and small pelvis (for example, the ovary) cause the formation of metastases in the peritoneal lymph nodes.

The main criterion confirming the presence of metastases in the lymph nodes is an increase in the size of the node (up to 10 cm or more). CT and MRI studies of the peritoneal cavity also come to the rescue in order to obtain visualization of anatomical structures.

Melanoma metastases to lymph nodes

Melanoma is a rare malignant tumor that most often affects residents of the southern regions. It should be noted that in 70% of cases, melanoma is formed at the site of an existing pigmented nevus or birthmark.

The development of melanoma occurs in two phases:

• horizontal - growth within the epithelial layer (lasts from 7 to 20 years);
• vertical - ingrowth of layers of the epidermis and subsequent invasion through the basement membrane into the dermis and subcutaneous fatty tissue.

The vertical stage is characterized by rapidity and the ability to metastasize. Metastases of melanoma in the lymph nodes are primarily due to the biological characteristics of the tumor. Metastasis by the lymphogenous route occurs in the skin, regional lymph nodes. Affected lymph nodes become dense in consistency and increase in size.

Among the diagnostic methods, aspiration biopsy of the formation, surgical biopsy of the lymph nodes, radiography, CT and MRI of the whole body are distinguished. Removal of melanoma metastases in the lymph nodes is carried out by complete excision of the regional lymph collector or removal of lymph nodes adjacent to the tumor (if the diagnosis is made on the basis of a biopsy).

Metastases to supraclavicular lymph nodes

Metastases in the supraclavicular lymph nodes occur when:

• undifferentiated cancer (the primary tumor is located in the neck or head);
• tumor processes in the lungs;
• cancer of the gastrointestinal tract.

Identification of Virchow's (Troisier's) nodules in the left supraclavicular region indicate the presence of a malignant neoplasm of the abdominal cavity. The defeat of the supraclavicular nodes on the right side makes it possible to suspect lung or prostate cancer. Metastases in the lymph nodes of the subclavian triangle may indicate lung or breast cancer.

One of the most common tumors, gastric cancer, is diagnosed by identifying "Virchow metastases" (more often in the left supraclavicular lymph nodes). Malignant ovarian cells sometimes penetrate through the lymphatic vessels of the diaphragm and lumbar lymph nodes, which causes lymphogenous metastasis above the diaphragm - metastases to the supraclavicular lymph nodes.

An increase in supraclavicular nodes is an alarming symptom, most often meaning tumor processes in the sternum or abdomen. In 90%, such symptoms occur in patients older than 40 years, and younger patients account for 25% of cases. The defeat of the lymph nodes on the right corresponds to a tumor of the mediastinum, lungs, esophagus. An increase in the size of the nodes on the left in the supraclavicular zone indicates cancer of the ovaries, testes, prostate, Bladder, kidneys, stomach, pancreas.

Metastases in mediastinal lymph nodes

The mediastinum is a section of the chest cavity, which is bounded in front by the sternum, costal cartilages and retrosternal fascia, and in the back by the anterior zone. thoracic spine, rib necks, prevertebral fascia, on the sides - sheets of the mediastinal pleura. The area of ​​the mediastinum is indicated from below by the diaphragm, and from above by a conditional horizontal line. The thoracic lymphatic duct, retrosternal lymph nodes, and anterior mediastinal lymph nodes enter the mediastinal zone.

In addition to lung cancer, metastases in the lymph nodes of the mediastinum form tumor processes of the thyroid gland and esophagus, kidney hypernephroma, testicular cancer (seminoma), pigmented malignant formation (melanosarcoma), uterine cancer (chorioepithelioma) and other neoplasms. The defeat of the lymph nodes of the mediastinum ranks third in the development of malignant processes after lymphogranulomatosis and lymphosarcoma. Cancer cells cover all groups of mediastinal lymph nodes, paratracheal and bifurcation ones are most often affected.

Primary tumors of a small size often give extensive metastases in the lymph nodes of the mediastinum. A striking example of such metastasis is lung cancer mediastinal form. AT clinical picture swelling of the soft tissues of the neck and head, swelling and intertwining of veins in front of the chest (“jellyfish head”) are described, dysphagia, hoarseness, and stridor type breathing are noted. X-ray in most cases reveals the predominance of metastases in the posterior mediastinum.

In breast cancer, the accumulation of affected lymph nodes is localized in anterior mediastinum. Mammaryography (contrast examination of the veins of the mammary glands) is used for the refinement method. Interruption of the venous bed, squeezing, the presence of marginal defects are evidence of the presence of metastases that require removal or treatment by radiation.

Treatment of metastases in the lymph nodes

The main rule of oncology is the study of the state of the lymph nodes, both in the tumor zone itself and in remote ones. This allows you to most accurately establish the diagnosis and prescribe an effective treatment program.

The lymph nodes lying on the surface, which are accessible to external examination, are examined by biopsy and puncture methods. The condition of deeper lymph nodes is examined using ultrasound, CT, MRI. Positron emission tomography (PET) is considered the most accurate method for detecting metastases in the lymph nodes, thanks to which it is possible to recognize the origin of malignant cells in the most inaccessible and slightly enlarged lymph nodes.

Treatment of metastases in the lymph nodes is based on the same principles as the fight against primary cancer - surgery, chemotherapy, radiotherapy. The combination of these techniques is applied on an individual basis, depending on the stage of the disease (malignancy), the degree of damage to the lymphatic system.

Excision of the primary tumor, as a rule, is accompanied by the removal of all its regional lymph nodes (lymphadenectomy). Lymph nodes with affected cells, located further than the cancerous tumor, are treated with radiotherapy methods or perform bloodless radiosurgery using CyberKnife.

Timely diagnosis and treatment of metastases in the lymph nodes can block the growth of tumor cells and prolong the life of the patient.

Prognosis of metastases in the lymph nodes

Factors affecting the survival of patients are conditionally divided into related:

• with cancer;
• with the patient's body;
• with the treatment provided.

The most important prognostic factor is the defeat of regional lymph nodes without the presence of distant metastases. For example, the prognosis of metastases in the lymph nodes of the neck of "non-squamous cell carcinoma" remains disappointing - 10-25 months. Survival of patients with gastric cancer depends on the possibility of radical operation. Only a small proportion of non-operated or non-radically operated patients reach the 5-year milestone. Average duration life is 3-11 months, and this figure is influenced by the presence or absence of distant metastases.

The presence of metastases in the lymph nodes in breast cancer significantly worsens the prognosis. As a rule, relapses and metastasis are observed in the first five years after surgery in 35-65% of women, which indicates the activation of the process. Life expectancy after treatment is 12-24 months.

Patients with melanoma of the head, neck, and trunk have a more unfavorable prognosis than those with melanoma of the extremities, since the risk of metastasis to the lymph nodes of these tumors is 35% higher.

The criterion for successful treatment can serve as a five-year survival rate. The prognosis after excision of the tumor is determined not only by the presence or absence of metastases in regional lymph nodes, but also by the number of affected nodes.

If metastases are found in lymph nodes without a primary tumor focus, the prognosis may be favorable. The outcome of special treatment based on the five-year survival rate for isolated metastasis to the lymph nodes is: in the case of damage to the axillary lymph nodes - more than 64%, inguinal - more than 63%, cervical - 48%.

It's important to know!

The defeat of peripheral lymph nodes is more often caused by mycobacteria of the bovine type. This must be taken into account when making a diagnosis in certain regions of Russia, especially in rural areas. Many authors associate the development of a specific process in the lymph nodes with the lymphotropism of MBT and barrier function lymph nodes rich in elements of the mononuclear phagocyte system, in which initial reactive (and then specific) changes most often occur.

The lymphatic system is a dense network of small and large vessels that are in close relationship with circulatory system human, and performs a number of important functions in the work of the body. In particular, it is one of the components of our immunity, which guards the health of the human body. Failures in the operation of this system can cause quite serious consequences, and can also become a signal of the development of an infectious process. In this article, we will discuss one of the most common pathologies of the lymphatic system - lymphadenitis and find out what diseases can be accompanied by a similar symptom.

Lymphadenitis - common name for a number of pathologies of the lymphatic system

lymphatic system

In order to understand what lymphadenitis is and what its causes are, it is necessary to have an idea of ​​what the lymphatic system is. Like the circulatory system, the lymphatic system consists of many small and large vessels through which lymph flows.

Lymph is a special, so-called liquid tissue, which is a type of connective tissue. Unlike blood, lymph does not contain red blood cells - erythrocytes. But it is rich in lymphocytes and proteins, and its basis is interstitial (tissue) fluid.

The formation of lymph occurs in several stages. First, blood plasma seeps by diffusion through the walls of the smallest capillaries into the tissues of the body. This happens due to the difference in pressure in the vessels and surrounding tissues. Interstitial fluid cannot constantly accumulate around the cells and its excess, according to the same principle of pressure difference, penetrates into the lymphatic vessels, the walls of which are extremely thin. At this stage, the composition of the lymph is similar to the composition of the blood plasma. However, passing through the lymph nodes (they are often affected by lymphadenitis), in which the formation of lymphocytes occurs, this fluid is saturated with them.

In the human body, there are several hundred lymph nodes of different sizes - from the smallest, not exceeding 0.5 mm, to quite large (1 - 1.5 mm). Each of the lymph nodes is approached by many tiny supply vessels. At the same time, there are only two outlet ducts - right and left. Through them, the lymph, having been cleansed of foreign substances, enters, respectively, the right and left vena cava thus returning back to the bloodstream.

There are hundreds of lymph nodes in the human body.

Despite the huge number of lymph nodes, we can find only a few of the largest of them on our body. These are superficial lymph nodes located in the groin area, mandible and in the armpit. However, when a pathological process occurs, the lymph nodes increase in size and can be palpated (palpable) in other areas.

All pathologies of the lymphatic system are united by one term - lymphadenopathy. Any lymphadenopathy can be both an independent disease and a consequence of any other pathological process occurring in the body. In any case, the signs of disruption of the lymphatic system, which we will discuss below, are a signal to seek the advice of a specialist.

Classification and types of lymphadenitis

One of the diseases of the lymphatic system is lymphadenitis - inflammation of the lymph nodes. This is a fairly common pathology, the causative agents of which, as a rule, are staphylococci and streptococci, as well as some other pyogenic bacteria.

Lymphadenitis, as one of the varieties of lymphopathy, in turn, is also divided into several types. According to the "International Classification of Diseases" (ICD-10), lymphadenitis is classified according to the principle of their localization.

Allocate accordingly:
acute lymphadenitis of the neck, head and face,
acute lymphadenitis of the lower extremities,
acute lymphadenitis of the upper extremities,
acute lymphadenitis of the trunk,
acute unspecified lymphadenitis,
lymphadenitis of other localizations,
lymphadenitis of the supraclavicular nodes.

Depending on the number of affected lymph nodes, there are localized and generalized lymphadenitis. However, it is impossible to determine on your own how much the inflammatory process has spread, since a large number of lymph nodes are located quite deep and are not palpable during external examination. In this case, an accurate diagnosis requires additional methods research.

Also, all types of lymphadenitis can be divided into acute and chronic, depending on the nature and duration of the course of the disease. Based on the etiology, this pathology can be specific and nonspecific. Each of the above forms of lymphadenitis may have symptoms characteristic of it. However, there are general signs of the disease that are characteristic of any of its forms.

Symptoms of the disease

Visually, lymphadenitis can be determined by swelling and redness of the skin in the areas where the lymph nodes are located.

Like any other inflammatory process, inflammation of the lymph nodes is accompanied by a number of characteristic reactions. In response to inflammation, the body begins to produce special substances - prostaglandins, bradykinin, histamine and some others. All of these are inflammatory mediators. They contribute to the expansion of blood vessels in the focus of infection and the formation of exudate. At the same time, the inflamed lymph node increases in size, the walls of its capsule stretch and, squeezing the adjacent tissues, cause pain. Inflammatory mediators themselves play an important role in the development of pain. Pain and enlargement of the lymph node are the main symptoms of lymphadenitis.

We can visually observe the expansion of blood vessels in the area of ​​inflammation in the form of hyperemia (redness) and swelling of the skin over the affected area, which can even be seen in the photo. With lymphadenitis, over time, the skin in this area may begin to peel off. In the future, it can acquire a pronounced red and even beet color. As you recover skin covering is being restored.

In some cases, individual inflamed lymph nodes can merge, forming so-called conglomerates. They are large, inactive seals under the skin. The appearance of such a symptom may indicate the development in the body of some other pathological conditions.

With the addition of a purulent infection and rupture of the thin walls of the lymph nodes, lymphadenitis can turn into phlegmon. Also, advanced forms of lymphadenitis can lead to necrosis of nearby tissues. Most dangerous consequence sepsis can become lymphadenitis - a generalized infectious infection of the body, which develops when several groups of lymph nodes are affected at once. With purulent inflammation, the sensation of crepitus (crunching) during palpation of the affected area is characteristic.

Acute lymphadenitis may also be accompanied by fever. An increase in body temperature can be either subfebrile (up to 38 ° C) or febrile (up to 40 ° C). Chronic form disease can occur without fever. For chronic lymphadenitis, in principle, mild symptoms are characteristic.

Reasons for the development of lymphadenitis

We have already mentioned above that lymphadenitis develops against the background of infection with certain types of bacteria. The infection can penetrate both from other organs and tissues, and directly from environment with damage to the lymph node. Most often, the infection migrates from nearby organs in which there is an inflammatory process. For example, submandibular lymphadenitis can develop against the background of inflammatory diseases of the oral cavity and even untreated or advanced caries. Often the above diseases, as well as inflammatory diseases throat and tonsils can cause axillary lymphadenitis.

Inguinal lymphadenitis in men and women is often the result of any sexually transmitted diseases. In this regard, inguinal lymphadenitis in children is extremely rare. Lymphadenitis in a child most often affects the cervical, parotid and axillary lymph nodes.

People who often suffer from tonsillitis, tonsillitis and other diseases of the throat are prone to developing a disease such as cervical lymphadenitis. However, the detection of this type of lymphopathy is complicated by the fact that the cervical lymph nodes are located quite deep and difficult to palpate. Most often, the patient pays attention to the occurrence of persistent pain and discomfort in the corresponding area.

One type of specific lymphadenitis is tuberculous lymphadenitis. It may occur as a consequence of primary tuberculosis and be one of the symptoms of the onset of the disease. Most often, an increase in lymph nodes in primary tuberculosis is observed in childhood. In adults, lymphadenitis may accompany secondary tuberculosis. A feature of the course of tuberculous lymphadenitis is that several isolated groups of lymph nodes are affected at once. However, a diagnosis can only be made after careful medical examination. Swollen lymph nodes can also accompany serious diseases such as hepatitis B, tularemia, toxoplasmosis, and some others. Also, inflamed lymph nodes may indicate the development of a malignant tumor and not be the result of an infection.

Lymphadenitis can be not only bacterial, but also viral in nature. So an increase in lymph nodes accompanies such a common disease as rubella. A similar symptom is observed in HIV-infected people. Therefore, persistent inflammation of the lymph nodes should be the reason for an early visit to the doctor and examination.

Another reason for an increase in the size of the lymph node may be taking some medicines. These include allopurinol, quinidine, phenytoin, atenolol and some others. In this case, the emerging side effect not considered as a pathology of the lymphatic system.

Swollen lymph nodes can be triggered by the use of some medical preparations

In most cases, with an increase in lymph nodes, the doctor diagnoses acute or chronic lymphadenitis caused by the development of an infectious process in the body. However, in order to exclude the possibility of developing more serious pathologies or to start treatment of the disease that caused lymphopathy in a timely manner, a visit to the clinic should not be delayed.

Diagnostics

As we have already found out, there are a huge number of reasons that can cause the development of lymphadenitis. That is why self-diagnosis is unacceptable and, in principle, impossible. Before determining how to treat lymphadenitis in this particular case, the doctor collects a detailed history: what other symptoms bother the patient, what is his occupation, whether he has recently traveled to exotic countries, whether he has previously used or is currently using drugs funds, etc.

So, visiting exotic countries can cause infections that are not characteristic of our latitudes. These include leishmaniasis, trypanosomiasis, bubonic plague and some others. Drug use, as well as numerous casual sex, are risk factors for the development of HIV infection, one of the symptoms of which is also lymphadenitis.

With regard to certain activities, hunters, as well as people employed in the agricultural industry, are exposed to some diseases that are carried by wild or farm animals. These include, for example, tularemia.

After collecting all the necessary data, the doctor evaluates other symptoms that accompany lymphadenitis. For example, inflammation of the tonsils, stomatitis, caries, tonsillitis - all these conditions often cause cervical lymphadenitis. In children with chronic tonsillitis, this condition is especially common. Often occurring inflammatory diseases of the oropharynx can also cause submandibular lymphadenitis.

It is often quite difficult for a doctor to detect deep inflamed lymph nodes. So, for example, it is quite difficult to diagnose cervical lymphadenitis, the treatment of which most often comes down to the treatment of diseases of the oropharynx. The patient in this case may have a neck pain, but the pain will not have a clear localization.

It is possible that upon discovery inflamed lymph nodes in a certain area, the doctor will refer you for an additional examination and require you to pass some tests. So, inflammation of the lymph nodes in the groin may indicate any sexually transmitted diseases, and persistent inflammation of the supraclavicular lymph nodes may indicate oncology. In the latter case, the final diagnosis can be made only after the necessary biochemical research.

Accurate diagnosis of lymphadenitis is possible only after biochemical analyzes

Also of no small importance is the size, soreness, nature of compaction, the presence or absence of conglomerates of lymph nodes. The size of the lymph nodes can be very diverse - from tiny to quite large. However, normally, their size does not exceed 1.5 cm. The detection of larger formations indicates the development of the pathological process.

Pain are characteristic of inflammation. Much more important is the intensity of the pain. Severe pain may accompany inflammation of the lymph node with suppuration. However, some diseases, such as the occurrence of benign or malignant tumors, can in some cases be accompanied by a painless enlargement of the lymph nodes.

On palpation, the doctor also determines the nature of the compaction. So the initial forms of acute lymphadenitis are accompanied by the appearance of rather dense and mobile lymph nodes. In the process of development of the infectious process and the involvement of surrounding tissues, in particular subcutaneous fat, the lymph node becomes less mobile. Dense, "stone" lymph nodes may indicate the development of a malignant tumor.

Some viral infections, most common in children, may be accompanied by the formation of multiple small seals. Such formations are also called "buckshot" lymph nodes. Soft, extensive and painful seals, which on palpation cause a crunching sensation, indicate purulent fusion of the tissues of the lymph node and the development of phlegmon - damage to the intercellular spaces.

Combining several inflamed lymph nodes into one large conglomerate is also very characteristic symptom lymphadenitis. It may indicate the presence of tuberculous lymphadenitis, the development of a benign or malignant tumor, as well as cancer metastasis. If cancer is suspected, a biopsy will also be required.

Treatment of lymphadenitis

The basis of the treatment of acute lymphadenitis is the fight against the causative agent of the infection. Treatment of lymphadenitis of a bacterial nature is carried out with antibiotics and antimicrobial agents, and for viral invasion, antiviral drugs are used. If the pathology is a consequence of the development of any infectious process in the body, then it is necessary, first of all, to cure the underlying disease. For example, in childhood with chronic tonsillitis, submandibular lymphadenitis is quite common. Its treatment primarily comes down to treating the throat infection and preventing exacerbations.

Lymphadenitis of a bacterial nature is treated with antibiotics of different groups that are active against the main pathogens of the disease - streptococci and staphylococci. Antibiotics for lymphadenitis caused by any other pathogenic bacteria, are selected on the basis of data on their sensitivity to a particular drug. Depending on the severity of the course of the disease, both tablets and injections of antibiotics can be prescribed.

Treatment of lymphadenitis with antibiotics is ineffective if the disease is viral in nature. A striking example is lymphadenitis with rubella. In this case, antiviral drugs, as well as immunomodulators, are used for treatment. In order for any of the above medicines to give the most effective and quick results, a number of physiotherapeutic procedures are performed before starting treatment, such as UHF, galvanotherapy, electrophoresis and some others.

Treatment of lymphadenitis is selected taking into account its nature.

If there is still no improvement after a week of treatment, the doctor may suspect that the patient has one of the forms of specific lymphadenitis - tuberculous lymphadenitis, which develops against the background of tuberculosis. In this case, the patient is given a referral to a phthisiatrician, and the necessary studies are carried out to clarify the diagnosis. When the diagnosis is confirmed, therapy will be carried out according to special schemes developed for the treatment of tuberculosis. For this purpose, drugs such as Ftivazid, PAS, Prothionamide, Ethambutol, etc. are used. Tuberculosis is treated with a long course of six months.

Purulent lymphadenitis is treated according to the principle of any other purulent wounds or abscesses. In most cases, the patient needs surgical intervention. The abscess is opened, the wound is cleaned of pus, drained and treated with antiseptics. In the future, the patient is prescribed antibiotics to prevent re-infection.

Initial forms uncomplicated lymphadenitis is treated using conservative methods - compresses, heating, and other methods of physiotherapy. Often, alternative methods of treating lymphadenitis can be used as an adjuvant therapy in agreement with the doctor.

Folk methods of treatment

Among the recipes traditional medicine There are a fairly large number of drugs for the treatment of lymphadenitis. Folk remedies are represented by compresses, infusions and decoctions for internal use, various drug fees. We will consider only a few of them.

As a compress for removal inflammatory process you can use echinacea tincture. It is mixed with water in a ratio of 1: 2, a napkin is moistened with the prepared solution and applied to the affected area. The napkin is covered on top with a slightly larger layer of cotton wool, then an even larger layer of compression paper is applied, after which the compress is fixed with a bandage.

It should also be noted that echinacea tincture itself is also an excellent immunomodulator and can be used for viral serous lymphadenitis for oral administration in combination with traditional antiviral agents. However, its use should not exceed 4 weeks.

Echinacea tincture is used for home treatment of lymphadenitis

Another wonderful folk remedy for the treatment of lymphadenitis is beetroot juice. It can be obtained both from the root crop itself and from the tops. Such a simple remedy normalizes the functioning of the lymphatic system and has a cleansing effect on the body.

To relieve the inflammatory process in complex therapy lymphadenitis can be used infusion of white lamb. To do this, a tablespoon of dried herbs is poured with a glass of boiling water and infused in a water bath for 15 minutes. Then the infusion is cooled for at least 45 minutes, filtered and brought to 200 ml with boiled water. accept this remedy half a glass 3 times a day.

Prevention of lymphadenitis can be carried out with such a simple and affordable folk remedy as parsley. Use this product in sufficient quantities, due to the high content of vitamin C, it helps to strengthen the immune system, which means it also supports the functioning of the lymphatic system.

Lymphadenitis is a very common symptom that can accompany many infectious processes, and can also be an independent disease in itself. Do not attach importance to the increase in lymph nodes, even if they do not cause you any inconvenience, is fundamentally wrong. When the first symptoms of lymphadenitis appear, it is necessary to consult a specialist and be examined for more serious pathologies. In most cases of enlarged lymph nodes, lymphadenitis is diagnosed, which, with proper and timely therapy, can be successfully and completely cured. Be more attentive to your body, do not show carelessness towards yourself and do not neglect a qualified medical care. Be healthy!

Video

Lymph nodes are collectors into which fluid, metabolic products, toxins and microbial particles enter from organs and tissues. Lymph nodes are involved in various pathological processes, including those susceptible to malignant lesions. Inflammation of the lymph nodes in cancer can be caused by the development of a tumor in the lymph node itself or by the introduction of metastases.

To study the affected lymph nodes, in addition to visual inspection and palpation, the following methods are used:

• puncture (puncture) followed by histological analysis content;
• radiography;
• tomography.

Neoplasms that originate from lymph nodes and cells of the lymphocytic series are called lymphomas. The most common lymphomas are lymphosarcomas and lymphogranulomatosis (Hodgkin's disease).

Lymphomas more often affect the male part of the population. A painless enlargement of the lymph nodes against the background of complete health is the leading one. Both deep and superficial nodes can be affected, but most often with such localization:

• on the neck;
• under the arm;
• above the collarbone;
• on the elbows;
• in the groin area.

They are painless to the touch, have a compacted consistency, easily move under the skin. Starting in the lymph nodes of one group, the tumor process spreads to almost all organs and tissues. At the fourth stage of the disease, metastatic cells are found in the lymph nodes and tissues of the lungs, pleura, breast, move to the liver, large intestine and rectum.

With primary involvement of mediastinal lymph nodes initial signs diseases can be cough and pain behind the sternum. Inflammation blocks blood flow through the superior vena cava and causes symptoms such as:

• swelling of the face;
• swelling of the veins in the neck;
• shortness of breath
• headache;
• drowsiness.

With lymphoma, the affected lymph nodes can merge with each other, forming voluminous conglomerates. The disease is complicated by enlargement of the liver, damage to the nervous system and frequent febrile conditions.

Metastases of malignant tumors

The process of transfer of tumor cells in the body with the formation of secondary foci of the disease is called metastasis. It is for cancerous tumors that metastasis through the lymphatic system is characteristic. The first to be affected are the regional lymph nodes - the closest to the diseased organ. Lymph nodes play a protective role, preventing the spread of metastases throughout the human body. In good condition immune system Cancer cells may not transform into pronounced metastases or even die.

The degree of damage to the lymph nodes by metastases is used to assess the stage of the cancer process:

• Stage 1 - no metastases;
• Stage 2 - single metastases are detected in regional lymph nodes;
• Stage 3 cancer - the presence of multiple metastases in nearby nodes;
• Stage 4 - metastasis to distant nodes, tissues, organs.

Often, a person notices inflammation of the lymph nodes even before the manifestation of the main signs of cancer. The most accessible for research and diagnostically significant are the following lymph nodes:

• on the neck;
• under the arm;
• inguinal.

cervical lymph nodes

Frequent inflammation and metastases are associated with its anatomical features. This is where a large number of blood and lymphatic vessels, nerve fibers.

In a state of health, the lymph nodes in the neck are not determined. In oncology, superficial cervical lymph nodes look like protruding formations with rounded contours. When probing, they have a densely elastic consistency, painless, slightly displaced by pressure. Inflammation of deep lymph nodes may not be palpable, but areas of asymmetry are visually noticeable on the neck.

In the lymph nodes in the neck, metastases are found in cancer of such organs:

In addition, malignant cells are often transferred to the right supraclavicular lymph node in the neck in case of tumors of the lungs and esophagus. Complaints of inflammation of the left are observed in patients with malignant diseases localized in the abdominal cavity and small pelvis:

• liver cancer;
• stomach cancer;
• colon or rectal cancer.

Axillary lymph nodes

There are several powerful lymph nodes under the armpit, in which metastases are found in breast cancer, the most common cancer in women. This type of cancer begins as a small, painless lump in the breast and may go unnoticed for a long time.

By the time breast cancer is diagnosed, 50% of patients already have developed metastases.

At the beginning of the disease, the lymph nodes under the arm on the side of the lesion are slightly enlarged, painless, mobile. During this time, patients may experience a sensation foreign body in the region of the lymph node. With the progression of a breast tumor, multiple metastases under the arm are fixed among themselves and with surrounding tissues. Outwardly, the lymph nodes look like bumpy formations. Squeezing by metastases of blood vessels and nerve fibers leads to numbness and swelling of the hand, accompanied by severe pain.

The defeat of the lymph nodes under the arm significantly aggravates the prognosis for breast cancer. To avoid further dissemination metastases, doctors have to remove breast tissue along with regional lymph nodes. In addition to breast tumors, metastases are transferred to the lymph nodes under the arm in case of skin cancer of the arm, shoulder and back.

Inguinal lymph nodes

Lymph from the skin subcutaneous tissue lower extremities and external genital organs first enters the superficial inguinal lymph nodes. Deep inguinal lymph nodes, along with the vessels of the thigh, are located under a layer of muscles, they carry lymph into the abdominal cavity. An increase in the lymphatic vessels of this group is observed in malignant tumors of such organs:

• large intestine;
• rectum;
• uterus;
• liver;
• ovaries in women;
• prostate and testicles in men;
• Bladder.

Externally, lymph nodes with metastases resemble inguinal hernia. A large lymph node presses on the surrounding tissues, causing pain and swelling of the leg on the side of the lesion.

deep lymph nodes

In the chest, abdominal and pelvic cavity there are a large number of deep lymph nodes, which receive lymph from the internal organs. Some nodes are located along the walls of the cavities, others are located near the membranes of the internal organs (lungs, heart, esophagus, liver). There is a lot of lymphoid tissue in the fiber around the small and large intestines, rectum.

The defeat of deep lymph nodes by metastases can for a long time not give any external symptoms. An increase in nodes is detected by chance during examination (X-ray, ultrasound) for another disease.

Lung cancer is often found in its advanced form - one of the most common oncological diseases in the world. Lung tissues do not have pain receptors, and the tumor develops asymptomatically for several years. With the defeat of the lymph nodes of the bronchi, the root of the lung, shortness of breath, cough, sputum with an admixture of blood, which are mistaken for inflammation, can be observed.

Another late diagnosed disease is colorectal cancer, which includes damage to the rectum and large intestine.

Colon cancer is the third most common cancer in the world. The defeat of metastases in the anal lymph nodes located on the lateral surface of the rectum is accompanied by the release of blood and mucus with feces. Therefore, the disease is often mistaken for hemorrhoids. Metastases in the lymph nodes of the intestinal tissue cause symptoms, as in inflammatory processes:

• bloating;
• colic;
• indigestion;
• soreness.

Cancer metastases in the lymph nodes of the liver can compress the portal vein and provoke blood stasis and edema in the lower half of the body, causing accumulation of fluid in the abdominal cavity. Due to the increase blood pressure dangerous internal bleeding develops in the vessels of the stomach and esophagus. Enlarged hilar lymph nodes can cause jaundice.

Important diagnostic sign may be the identification of an enlarged and dense umbilical lymph node in the navel. Metastases in this node most often come from malignant tumors of the stomach, liver, ovary and rectum.

Prolonged inflammation of the lymph nodes is an alarming symptom that manifests itself in many serious illnesses. Therefore, if seals are found in any lymph node, a person should definitely seek the advice of a doctor.

anonymous , Woman, 35

Good afternoon, Elena Sergeevna. I am 35 years old. Two years ago, a bump jumped up on the neck in the middle. They did an ultrasound, they said that it was a cyst, several months passed and the cyst disappeared, they did an ultrasound, they said that it was not a cyst, but the lymph node was inflamed. They didn't prescribe anything, they said it would pass. Periodically, the lymph nodes on the neck become inflamed more often in the spring, and this spring they inflamed again, there is no pronounced pain to the touch, but when I turn my head, it seems to pinch and hurt. I did an MRI of soft tissues, the conclusion: enlarged submandibular lymph nodes are determined in the form of conglomerates. On the right, the size of the conglomerate of lymph nodes is 22.4 x 8.7 mm, on the left, 17 x 6.2 mm. A few submental lymph nodes with a diameter of up to 7 mm are determined. The tonsils of the root of the tongue are somewhat hypertrophied, up to 5 mm in diameter. Mr picture, submandibular, submental, lingual lymphadenopathy. Tell me, p-hundred, how dangerous is this, and what does this mean in general, what should I do? If possible, comment on my question in more detail. I will also add that my throat often hurts, but now my throat does not hurt. And I have to talk a lot (such work), i.e. constant tension. Thanks for the answer.)