Breast and regional lymph. All about regional thyroid lymph nodes

02.04.2020

Paramammary lymph nodes are located on the pectoralis major muscle, along its outer edge. They are the main nodes of the first stage. The efferent vessels, which form the basis of the structure of the lymph nodes of the mammary glands, flow into the axillary lymph nodes. They, in turn, are the lymph nodes of the first stage. Localized on the fourth tooth, sometimes called Bartels' node.

The main and largest group of lymph nodes is the axillary group. Some of them are on the surface, they are divided into three subgroups. This includes the external, central and subscapular nodes. External or lateral axillary nodes are located near the lateral thoracic artery. The central nodes are along the axillary vein. To them there is an outflow of lymph from the outer quadrants of the mammary gland. The posterior axillary nodes have a slightly different location and run along the subscapularis artery.

Another group of lymph nodes includes the lymph nodes located under the collarbone. They are located in the area under the collarbone. They are referred to as the nodes of the first stage, which are included in the upper quadrants of the mammary glands. Lymphatic vessels flow into them. At the same time, they belong to the nodes of the first stage of the upper part of the mammary gland.

The parasternal lymph nodes are located along the internal mammary artery. They are located in the first to seventh intercostal spaces. The largest accumulation of them is observed within the second-fourth intervals. Parasternal lymph nodes, located on the second to fourth intercostal space. They are referred to as nodes of the first stage of outflow from the mammary gland. The nodes of the second stage include the efferent vessels of the axillary lymph nodes.

The glands of the lymphatic vessels from their base follow to the lymph nodes of the retromammary space. After which they penetrate the pectoralis major muscle and pass into the interpectoral nodes. From this area, lymph begins to flow into the central axillary lymph nodes.

Some of the vessels pass not only through the pectoralis major, but also the pectoralis minor. Then, through the ribs, they penetrate to the parasternal lymph nodes, that is, the first stage. The mammary gland also contains non-permanent lymph nodes. They are located in the area between the pectoralis minor and pectoralis major muscle.

Regional lymph nodes of the breast

The mammary gland is characterized by its complex structure. Its "composition" includes a mass of lymph nodes of various stages. The regional lymph nodes located in the mammary gland include a whole group of axillary nodes. It is subdivided into three main levels. The first level is the lower axillary nodes. They are located laterally to the lateral border with the pectoralis minor. The second level represents the middle axillary nodes. They are located in the area between the medial and lateral edges of the pectoralis minor. The third level is represented by the apical axillary nodes. They are located in the center, relative to the medial edge of the pectoralis minor. These include the subclavian and apical lymph nodes.

Internal lymph nodes are also referred to as regional. They are on the side of the lesion, that is, they most often suffer from breast cancer. Moreover, they are even designated with a special symbol M.

Axillary lymph nodes in the mammary gland

Sometimes these lymph nodes are found by mammography on the lateral region, which is located at the top of the breast quadrant. It contributes to the appearance of a small rounded shadow. Due to this feature of the axillary lymph nodes in the mammary gland, areas of enlightenment can be seen. They are noticeable due to the accumulation of fat.

Axillary lymphadenopathy is a dysfunction of the axillary nodes. This process entails enlargement of the lymph nodes. On palpation, unpleasant pain is felt. This phenomenon can be a sign of the development of a serious illness. Including breast cancer, tuberculosis and many other diseases. Axillary lymph nodes suffer more often than others. Therefore, when they increase, it is necessary to start looking for the reason that caused this process. The most in a simple way examination in this case is a biopsy.

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Intramammary lymph node of the breast

Under the intramammary lymph nodes, axillary or axillary lymph nodes are encoded. Due to their location, they most often suffer from serious diseases, including breast cancer. If breast involvement is suspected, the intramammary lymph node is examined first. The examination is carried out by means of mammography.

As mentioned above, the intramammary node belongs to the axillary. They, in turn, are divided into several levels, which are divided in their own way. Details on axillary lymph nodes have been provided above.

If the functionality of the intramammary lymph node is impaired, its significant increase occurs. In some cases, the process is accompanied by pain. An enlarged lymph node is a serious problem and requires immediate examination. To investigate this lymph node resort to biopsy assistance.

Examination of the lymph nodes of the breast

Today, there are a lot of research methods. The first step is clinical diagnostics... This method of examining the lymph nodes of the mammary gland allows you to collect all data about the patient, as well as to conduct an examination and palpation. When collecting anamnesis, it is necessary to pay special attention to the duration of the course of the disease, as well as the development of symptoms.

The physical examination is the examination and palpation of the breast. The procedure should be carried out in daylight. Particular attention is paid to the symmetry of the mammary glands, the presence of deformities around the nipples and areolas. After examination and palpation, resort to morphological diagnostics... Verification of the diagnosis using this study is an important measure if there is a risk of developing a malignant process in the mammary gland.

Cytological examination most often used in oncology. It is characterized by a diagnostic puncture using thin needles. Use the tip of the needle to determine the most dense place on the chest and pierce it. The test material is set with a syringe, after which it is transferred to the glass. This research method will determine the nature of the process, as well as the degree of cell differentiation. The technique is not so widespread, it is used only to clarify the lymphogenous spread of cancer.
Radiation diagnostics... Today this type of research plays a leading role. The main methods radiation diagnostics consider the X-ray and ultrasound examination method. This includes other activities such as computed tomography, magnetic resonance imaging, thermography and radionuclide imaging. They are used exclusively for special indications.
X-ray examination ... This method will allow you to take pictures of the affected area and understand the location of the pathological process by the darkening on them. In some cases, they resort to using radiographs in non-standard projections.
Axillography... This method of research allows you to identify lesions of the lymph nodes. He gives a complete picture of what is happening.
Ductography carried out in case of suspicion of the presence of pathological secretion from the nipple. For this, 0.5-2 mo of water-soluble is introduced into the lacteal ducts of the mammary gland. contrast agent based on iodine.
Pneumocystography... This technique consists in carrying out a puncture of the cyst, as a result of which its outlines can be seen.
Ultrasound... This research method is the most common. It has a number of advantages and allows you to accurately determine the presence of a pathological process. Moreover, the study is harmless and safe.
Thermography... This principle consists in remote registration of infrared thermal imagers from the surface of the human body. They reflect the degree of bioenergetic processes that take place in different parts of an organ. The research result can be obtained in the form of a thermogram.
CT scan... This research method is used to detect metastases in breast cancer, as well as to assess the prevalence of the pathological process.
Magnetic resonance imaging... This research method has modest possibilities. It is rarely used as a separate method for diagnosing a disease.
Breast radionuclide examination... This technique is used as an additional one. It allows you to determine the malignancy of the pathological process, as well as to evaluate the effectiveness of the prescribed antitumor treatment. This research method is highly effective.

Ultrasound of the mammary glands and lymph nodes

This research method is used because of its effectiveness and safety. It has no contraindications and is considered absolutely harmless. Today, ultrasound of the mammary glands and lymph nodes is used quite often. It is recommended for a general examination of a woman with complaints of breast tenderness. Ultrasound is safe even for pregnant women and young patients.

This method allows you to determine the exact cause of the pain and monitor the condition of the mammary glands as a whole. In the early stages, it allows you to identify cancer and begin its timely treatment. It is necessary to resort to the help of an ultrasound scan with constant soreness of the mammary glands, especially during the premenstrual phase. In case of nipple discharge, skin discoloration and enlargement of axillary lymph nodes, examination must be performed. It is recommended to do an ultrasound scan at least 2 times a year. The procedure does not require special preparation. It is advisable to come for an examination in the first phase of the menstrual cycle.

The lymphatic system is a network of lymphatic vessels that transport lymph. Lymph nodes are an important part of this system. They are distributed unevenly throughout the body. The human body contains about 700 lymph nodes.

Lymph is a colorless liquid in the human body that washes all tissues and cells of the body

Lymph collects in many small lymphatic vessels that converge in the lymphatic trunk. On the way to the heart, the lymph overcomes various lymph nodes. Each of them is responsible for absorbing and filtering lymph in a specific area of \u200b\u200bthe body. The most important regions where lymph nodes are located are the neck, lower jaw, armpit, groin, abdomen, and chest.

IN international classification diseases of the 10th revision (ICD-10), inflammation of regional lymph nodes is indicated by the code L04.

Anatomy and physiology

Lymphatic fluid from the head and neck is collected in two places: the right and left jugular trunks. From the right lymphatic vessel, lymph enters the right lymphatic duct, and from the left into the thoracic duct. Before entering the ducts, it passes through the regional lymph nodes:

Mastoid.
Occipital.
Parotid.
Submandibular.
Facial.

Lymph nodes eliminate bacterial, viral and cancer cells. They contain a large number of B-, T- and NK-lymphocytes.

Regional lymph nodes play an important role in the body's defense against disease. They perform different tasks. The central function is the removal of intercellular fluid from the body, the peripheral function is lymph filtration. Smaller lymph nodes receive lymph from surrounding tissues and transfer it to larger ones. If the lymph contains degenerated cells (cancer cells), the lymph nodes release molecules that initiate cell death.

It is important that the lymph fluid moves and is filtered constantly. Otherwise, it may stagnate. If the lymph does not move enough, lymphedema may occur. After filtration, the purified lymph returns to the tissue and the process begins again.

Normal lymph node sizes

The size of the lymph nodes depends on the person's health status and previous immunological diseases. Normal size lymph nodes range from 2 mm to 2 cm. If an infectious or cancerous disease occurs, they can increase significantly. When inflammation occurs, the lymph nodes form more protective cells to fight off pathogens. If the lymph nodes are larger than 2 cm and take a spherical shape, then they are in an activated state.

Reason for visiting a doctor

With inflammation of the lymph nodes and an increase in body temperature, it is necessary to make an appointment with a doctor

If you develop a fever (over 38.5 degrees Celsius), sudden weight loss, or night sweats, you should see your doctor urgently as symptoms indicate malignant lymphoma. Lymph nodes also enlarge in response to a bacterial or viral infection.

Swollen lymph nodes

The causes of enlarged lymph nodes can vary significantly, but common property is increased activity immune system... The lymph nodes play a crucial role in the immune response as they are the central filtering organs.

The main reasons for the increase in regional lymph nodes:

Malaria.
Metabolic diseases (Gaucher disease).
Systemic infectious diseases - influenza, measles, rubella and mumps.
Kawasaki syndrome (mostly in children).
Necrotizing lymphadenitis.
Lyme disease.
Diseases thyroid gland.
Surgical interventions.
Injuries and wounds.
Cat scratch disease.
Brucellosis.
Tuberculosis.
Hodgkin's lymphoma.
Acute lymphocytic leukemia.
Chronic lymphocytic leukemia.
Acute myeloid leukemia.
Intolerance to certain drugs.

All pathogens that enter the body are filtered in the lymph nodes. Microbes are carried through the lymphatic system and remain in the lymph nodes. Cell growth and division are stimulated there. As a result, there is an increase in lymph nodes, which disappears after the elimination of the pathogen.

In cancer, which can affect the entire body, lymph nodes enlarge throughout the body. Cancer cells malignant tumor enter the tissue fluid and are filtered by the lymph nodes. Sometimes they stay in them, multiply and spread to other organs. This results in so-called metastases to other lymph nodes.

There are two forms of lymphoma: Hodgkin's and. Hodgkin's disease is characterized by the presence of giant cells that grow from B lymphocytes. If one or more lymph nodes are involved in the cancer, it is indicative of an advanced stage of malignant lymphoma.

Pain

Pain in the lymph nodes is a favorable sign that indicates the presence infectious disease... In lymphoma, the lymph nodes are usually painless. If additional complications arise, pain may also occur. The most common painful condition is the common cold.

Interesting! A nonspecific symptom of Hodgkin's lymphoma, which does not appear in all patients, is pain in the lymph nodes after drinking a large amount of alcohol. As a rule, pain appears the next day after ingestion of alcoholic products.

Classification

Acute lymphadenitis is accompanied by pain in the cervical lymph nodes

Regional lymph nodes are classified by location:

Inguinal: legs, abdominal wall, buttocks.
Axillary: hands.
Cervical: head, face, neck.
Mediastinal: breast (mammary gland).
Para-aortic: organs abdominal.

By clinical course distinguish between acute (up to 4 days) and chronic (from 4-6 days) lymphadenitis. Acute inflammation upper respiratory tract usually often accompanied by inflammatory edema of the cervical lymph nodes. Chronic inflammation of the upper airways can also provoke their enlargement. Inflammation in other organs is less often manifested by an increase in lymph nodes.

The stages of lymphoma are determined by the Ann Arbor classification. There are 4 stages, which are characterized by different involvement of lymph nodes and organs outside the system in the malignant process. An asymptomatic and symptomatic form of lymphoma is also distinguished.

Diagnosis of inflammation of the lymph nodes

Physician qualifications and the accuracy and reliability of diagnostic procedures can sometimes affect patient survival. Although lymph nodes can become enlarged in cancer, patients still feel healthy. Many syndromes associated with swollen lymph nodes do not always present with severe local inflammation. Numerous diseases develop slowly.

First, a history is taken and a physical examination is performed. After a medical examination of the lymph nodes, doctors can already draw the first conclusions about the existing disease.

During a physical examination, the doctor takes into account the following characteristics of the lymph nodes:

Soreness.
Consistency.
The size.
Mobility.

Benign neoplasms move well, have a soft texture and are painful. Malignant lymphomas are firm, painless, and adherent to the surrounding tissues, making them difficult to move.

A pus-filled lymph node is easily recognizable as fluid moves back and forth in a wave-like manner under pressure. This phenomenon is called fluctuation. With purulent lymphadenitis, a blood test is performed. If the analysis reveals an increased concentration of inflammatory cells, this confirms acute lymphadenitis. The nature of the elevated inflammatory cells is indicative of the nature of the pathogens. If it is a bacterial infection, a certain type of white blood cells - the so-called neutrophilic granulocytes - significantly increases in the blood.

The patient's medical history is critical to the physical examination. In addition to palpation and auscultation, other vital signs are also measured: blood pressure, heart rate and body temperature. The doctor also evaluates the condition of the skin, mucous membranes and other organs.

If there is a suspicion of a malignant neoplasm, the affected lymphoid tissue is removed and sent for histological examination to a pathologist. If the diagnosis is confirmed, further examinations are carried out to clarify the picture of the disease.

Additional diagnostic methods:

Ultrasound procedure.
General blood analysis.
Magnetic resonance imaging.
Scintigraphy.
CT scan.

How are lymph nodes treated?

Inflammation of the lymph nodes is treated antiviral drugs and antibiotics

If the underlying infection or inflammation disappears, then the swollen lymph nodes also return to their original size. Sometimes when bacterial infections antibiotic treatment required. Patients are advised to inject the antibiotic not in pill form, but with the help of droppers directly into the bloodstream so that it reaches the site of action safely. Antibiotic therapy requires a hospital stay for several days. The inflamed lymph node is also prone to suppuration and is therefore often necessary surgical removalto avoid various consequences.

Indications for the use of broad-spectrum antibiotics:

Anthrax.
Syphilis.
Pharyngitis.
Bacterial diseases of the upper respiratory tract

With viral lymphadenitis, special therapy is usually not required. The inflammation of the lymph nodes goes away on its own if the patient adheres to bed rest, takes enough fluids and vitamins.

Indications for the appointment of antiviral drugs:

Chickenpox.
Hepatitis C, B and A.
Measles.
Polio.
Yellow fever.
Rhinovirus and adenovirus infection.

An exception is glandular fever: in order to recover, doctors advise to rest more, avoid physical activity and, if necessary, use symptomatic agents - antipyretic, anti-inflammatory and analgesic.

If the swollen lymph nodes are due to cancer, chemotherapy or radiation therapy is given. Often, radio and chemotherapy are combined. If chemotherapy or radiotherapy is ineffective, therapy with antibodies, cytokines, or stem cell transplantation is prescribed.

Swollen lymph nodes can also be caused or at least exacerbated by stress and mental pressure. Prolonged rest and relaxation can go a long way towards shrinking regional lymph nodes. Patients are advised to practice autogenous training or Jacobson relaxation.

Advice! With a very sharp and rapid increase in regional lymph nodes, it is recommended to call ambulance... If a painless enlargement of the lymph nodes appears, which is well palpable, it is also recommended to visit a specialist to find out the nature of the symptom. Request for medical help on early stage helps prevent possible complicationsthat can cause a certain disease. It is not recommended to delay a visit to a specialist.

Lymph nodes are an integral part of the human immune system. Thanks to her, the body is protected from the harmful effects of various factors. Any change in the lymph nodes indicates that the body is fighting something bad. Often, on examinations, women are written a conclusion about the presence of an intramammary node. So, an intramammary lymph node - what is it? This is a lymph node from the axillary group, located in the glandular tissue. Its increase indicates the presence of inflammation or breast cancer. Therefore, it is important to find this node at the very beginning of its formation.

Anatomy and function of intramammary lymph nodes

Lymph nodes, ducts and blood vessels are part of the immune system. Lymph nodes in the breasts of women are the first to respond to the inflammatory process and the penetration of foreign particles into the body. The lymph nodes of the mammary gland belong to the axillary regional lymph nodes. They follow the course of the lymphatic vessels and are located in the fatty and glandular tissue of the breast. This is a group of lymph nodes in the chest. Normal intramammary lymph nodes:

placed in the glandular tissue of the breast;
not palpable;
they are not visible to the naked eye;
painless;
normal temperature body;
breast skin is not changed.

The function of the lymph nodes is to protect the body from infections. Its role is as follows:

elimination of certain metabolic products from the body;
are responsible for the correctness of the body's immune response;
are responsible for the maturity of lymphocytes;
biological filter;
detain and neutralize cancer cells.

The lymph nodes of the breast primarily collect lymph from the thoracic ducts and glandular tissues.

Important! You need to know what the intramammary lymph nodes of the mammary glands are. Normally, they do not manifest themselves in any way and do not cause any complaints.

So, intramammary lymph nodes of the breast, what are they? This is a lump in the upper outer quadrant of the chest. They can be both unilateral and bilateral. There are different reasons for the increase this educationwhich we will consider next.

Causes of breast lymph node enlargement

Lymph nodes in the mammary gland can enlarge both with the participation inflammatory process, and without. If we are talking about the usual increase in lymph nodes in women in the breast, that is, lymphadenitis, its causes are:

metastases of cancerous tumors;
imbalance of the hormonal system;
irregular sex life;
breast injury;
with fibroadenoma;
concomitant gynecological diseases;
induced or medical abortion;
disorders in the immune system.

Lymphadenitis is a condition known as inflammation of the breast lymph nodes. They can become inflamed due to:

diseases caused by infection - staphylococcus, streptococcus, protozoa;
the presence of foci of chronic infection in the body - chronic tonsillitis, tonsillitis, carious teeth;
availability silicone implants in the chest;
diffuse purulent diseases of the anterior chest wall - phlegmon.

Bacteria play a fundamental role in the development of a purulent process in the lymph nodes. If you do not seek help in a timely manner, the inflammation goes into the stage of abscess formation (accumulation of pus).

Diseases that cause inflammation of the breast lymph nodes

First of all, it is worth clarifying that the very fact of the appearance of this lymph node is not a disease. Indeed, often the causes of the occurrence of an intramammary lymph node in the mammary gland are other diseases, such as:

mastitis - inflammation of the tissues in the mammary glands;
mastopathy - breast disease associated with hormonal imbalance;
metastases of cancerous tumors from other parts of the body.

Mastitis is a fairly common disease among women. The intramammary lymph node of the breast is most often enlarged for this very reason. More women suffer from this ailment after pregnancy. During lactation, milk stagnates in the breast ducts. This creates ideal conditions for the reproduction of pathogenic microorganisms, the nodes begin to become inflamed. If you do not adhere to the recommendations of the gynecologist, about breastfeeding, there is a high probability of suffering from mastitis.

Breast mastopathy, or fibroadenomatosis, is a benign proliferation of breast tissue associated with hormonal imbalance. An increase in lymph nodes with mastopathy occurs in women of childbearing age, from 18 to 45 years. This condition may be accompanied by inflammation of the lymph nodes in the breast. The main symptoms of mastopathy are:

periodic or persistent breast tenderness, which increases at the beginning of the cycle;
white discharge from the nipples;
the appearance of nodular seals in the tissue of the gland.

Important! What to do to avoid mastopathy? It is necessary to express the milk remaining in the breast and treat concomitant diseases in time

Most often, regional metastases enter the mammary gland through the blood or lymph. They can also dissipate:

into the skin above the chest;
kidneys;
brain;
liver;
lungs.

Metastases are difficult to treat and can lead to death. Therefore, it is important to diagnose the process in a timely manner and start treatment as early as possible.

Which doctor can help

Mastitis - common reason enlarged breast lymph nodes (photo: www.gippokrat.com)

First of all, you need to contact your family doctor. He will conduct an examination and try to find out the cause of the enlarged lymph nodes in breast... The doctor will decide if there is a need for consultation from other specialists. Such consultants can be:

gynecologist;
oncologist;
surgeon.

The function of the gynecologist is to identify infections of the female reproductive system at an early stage. Also conducting an examination, he may notice inflammation of the lymph node of the breast. This doctor deals with the treatment of various inflammations and hormonal disorders in the body.

An oncologist treats breast cancer, which depends on the stage of the disease. In the first stages, minimal excision of the tumor is possible. Subsequently, a total mastectomy may be required. Very often, the hands swell after removal of the mammary gland. The same treatment includes. After such an intervention, it is necessary to perform a set of rehabilitation measures. Rehabilitation includes gymnastics and exercise. Recovery lasts from 3 to 5 months.

The surgeon treats mastitis, namely a purulent form. The operation takes place under general anesthesia. It includes the following stages:

Skin incision.
Opening and sanitation of the abscess.
Suturing and draining the wound.

Having cured the primary pathology, the enlarged lymph node gradually returns to its previous shape.

Necessary diagnostic methods

As a rule, the diagnosis of intramammary lymphadenitis is not difficult. Diagnostic methods include the following:

self examination;
mammography;
ultrasound procedure;
organ radiography chest;
cT scan;
thermography;
biopsy of the node.

Self-examination is carried out on the 10th day of the cycle in two positions - standing and lying. It needs to be done every month. It is necessary to carefully examine the skin of both mammary glands, the nipple area. This manipulation must be carried out with both hands down and up. Further, in a circular motion you need to slowly feel each quadrant of the chest on both sides. If there is a lump, soreness or other sensation, an urgent visit to a doctor.

Important! It must be remembered that intramammary lymph nodes of the mammary gland are dangerous

Mammography and ultrasound examination are some of the most informative diagnostic methods with which you can see:

localization;
sizes;
quantity;
cohesion with surrounding tissues;
the structure of the knot that becomes inflamed.

A high degree of magnification allows you to see the smallest changes in the structure of the mammary gland.

With the help of a biopsy, you can confirm or deny the cancerous origin of the node. In turn, it also comes in different types:

fine-needle aspiration - take a part of the glandular tissue for cell research (cytological);
trukat biopsy - the material is studied at the tissue level;
ductography - examines the ducts of the breast.

Thermography is a method by which you can see fabric typos on film. In healthy tissue, the temperature will be much lower than those that are inflamed.

Computed tomography provides an opportunity to see a complete picture of the pathological process. We can assess the size of the lesion, the presence of metastases. And also see diseases of other organs and systems.

Principles of treatment of breast lymphadenitis

To choose a method for treating lymphadenitis, first of all, it is important to understand the reason for this condition. If the infectious origin of inflammation is proven, the therapy regimen is as follows:

anti-inflammatory;
antibacterial.

Nonsteroidal anti-inflammatory drugs have enough wide range actions that include:

anti-inflammatory action;
antipyretic effect;
antiplatelet effect - thins the blood.

Taking this group of drugs, you must remember about their side effect from different bodies:

peptic ulcer and duodenum;
toxic effects on the liver;
violation of hematopoiesis;
allergic reactions, rash;
fluid retention in the body.

Antibacterial drugs also occupy an important place in the treatment of lymphadenitis. Their mechanism of action is aimed at eliminating pathogenic microorganisms.

The side effects of taking antibacterial agents are:

allergic reactions to the components of the drug;
toxic effect on the kidneys and liver;
nausea, vomiting, constipation;
noise in ears;
dysbiosis.

Before taking antibiotics, it is necessary to determine their sensitivity to this group of drugs. This simple method helps to improve the quality of treatment.

If we are talking about a cancerous process, the therapy is individually selected by the oncologist. It depends on the stage of the cancer and includes:

chemotherapy;
radiation therapy;
surgical intervention.

As you can see, the treatment is quite difficult. It is much easier to prevent the development of lymphadenitis than to treat it. That is why you need to conduct an independent breast examination every month. This simple action will help you avoid dire consequences and stay healthy.

Metastasis is the most important characteristic of any malignant tumor. The progression of the disease is associated with this process, which often ends in the death of the patient. If the lymphatic system is affected by carcinoma of another organ, a man in the street can designate this phenomenon as "cancer of the lymph nodes", from the point of view of medicine - this, that is, a secondary lesion.

The cells of a malignant tumor have a number of differences from healthy ones, including not only local destructive action in a tissue or organ, but also the ability to separate from each other and spread throughout the body. The loss of specific protein molecules that provide a strong bond between cells (adhesion molecules) leads to the detachment of the malignant clone from the primary tumor and its penetration into the vessels.

Epithelial tumors, that is, they metastasize mainly by the lymphogenous pathway, along the lymphatic vessels that carry the lymph away from the organ. Sarcomas (connective tissue neoplasms) can also affect the lymph nodes, although the predominant route of metastasis for them is hematogenous.

On the way of lymph flow, nature provides for "filters" that retain all the "excess" - microorganisms, antibodies, destroyed cellular fragments. Tumor cells also enter such a filter, but they are not rendered harmless, and instead, the malignant clone begins to actively divide, giving rise to a new tumor.

metastasis

Initially, signs of a secondary tumor lesion are found in regional lymph nodes,that is, those that are most closely located to the organ affected by the tumor and which are the first to meet the lymph carrying carcinomatous elements. With further progression of the disease, metastases spread further, capturing more distant lymphatic groups. In some cases, lymph nodes located in another part of the body are affected, which indicates an advanced stage of the tumor and an extremely poor prognosis.

An increase in lymph nodes in cancer is a consequence of the multiplication of tumor cells in them, which displace healthy tissue, filling the lymph node. Inevitably, lymph drainage is obstructed.

By histological structure metastases usually correspond to the primary tumor, but the degree of differentiation in some cases is lower, so the secondary cancer of the lymph node grows faster and more aggressively. There are often cases when the primary tumor manifests itself only as metastases, and the search for their source does not always bring results. Such a defeat is designated as metastasis of cancer from an unexplained source.

Possessing all the features of malignancy, cancer (metastasis) in the lymph node poisons the body with metabolic products, increases intoxication, and causes pain.

Any malignant tumor sooner or later begins to metastasize, when this happens - depends on a number of factors:

Age - the older the patient is, the earlier metastases appear;
Concomitant diseases in a chronic form, weakening the body's defenses, immunodeficiencies - contribute to more aggressive tumor growth and early metastasis;
Stage and degree of differentiation - large tumors that grow into the wall of the organ and damage blood vessels, metastasize more actively; the lower the degree of cancer differentiation, the earlier and faster metastases spread.

Not every tumor cell that enters the lymph node will divide and metastasize. With good immunity, this may not happen or it may happen after a long time period.

In the diagnosis, an indication of metastatic lesion of the lymph nodes is indicated by the letter N: N0 - lymph nodes are not affected, N1-2 - metastases in regional (nearby) lymph nodes, N3 - distant metastasis, when lymph nodes are affected at a significant distance from the primary tumor, which corresponds to a severe, fourth, stage of cancer.

Manifestations of lymphogenous metastasis

Symptoms of lymph node cancer depend on the stage of the disease. Usually the first sign is their increase. If superficially located lymph nodes are affected, then they can be felt in the form of enlarged single nodules or conglomerates, which are not always painful.

Such metastases to the lymph nodes are easily determined in the axillary region with breast cancer, in the groin with tumors of the genital tract, on the neck for diseases of the larynx, oral cavity, above and below the collarbone in case of stomach cancer.

If the tumor affects internal organ, and metastasis occurs in the lymph nodes lying deep in the body, then it is not so easy to detect their increase. For example, enlarged mesenteric lymph nodes in bowel cancer, hepatic hilum in hepatocellular carcinoma, lesser and greater curvature of the stomach in tumors of this palpation organ are inaccessible, and additional examination methods come to the doctor's aid - ultrasound, CT, MRI.

Large groups of metastatic lymph nodes inside the body can manifest as symptoms of compression of those organs or vessels near which they are located. With an increase in the lymph nodes of the mediastinum, shortness of breath, heart rhythm disturbances and chest pain are possible, mesenteric enlarged lymphatic collectors contribute to pain and bloating, and indigestion.

When the portal vein is compressed, portal hypertension will occur - the liver and spleen will enlarge, fluid will accumulate in the abdominal cavity (ascites). Signs of difficulty in the outflow of blood through the superior vena cava - facial swelling, cyanosis, can indicate the defeat of the lymph nodes with cancer.

Against the background of metastasis, changes and general state patient: weakness and weight loss increase, anemia progresses, fever becomes constant, emotional background is disturbed. These symptoms indicate an increase in intoxication, which is largely facilitated by the growth of cancer in the lymph nodes.

Lymphogenous metastasis in certain types of cancer

The most common types of cancer are carcinomas of the stomach, breast in women, lungs, and genital tract. These tumors tend to metastasize to the lymph nodes, and the pathways for the spread of cancer cells and the sequence of damage to the lymphatic system are fairly well understood.

When the first metastases can be found in axillary lymph nodes already in the second stage of the disease, and in the fourth stage they are present in distant organs. Lymphogenous spread begins early and often the reason for looking for a tumor is not a palpable formation in the chest, but enlarged lymph nodes in the armpit.

Breast cancer is manifested by the defeat of several groups of lymph nodes - axillary, peri-sternal, supra- and subclavian. If the carcinoma grows in the outer parts of the gland, then it is logical to expect cancer metastases in the lymph nodes. armpit, the defeat of the internal segments leads to the ingress of cancer cells into the lymph nodes along the sternum. Remote will be considered metastasis in the indicated groups of lymph nodes on the opposite side to the tumor, as well as damage to the nodes of the mediastinum, abdominal cavity, neck.

When defined groups of regional lymph nodes, affected first, and distant, involved in advanced stages. Paratracheal, bifurcation, peribronchial lymph nodes located near the bronchi and trachea are considered regional, while supra- and subclavian, mediastinal, and cervical lymph nodes are distant.

In the lungs, lymphogenous spread of cancer occurs early and quickly, this is facilitated by a well-developed network of lymphatic vessels, which are necessary for the proper functioning of the organ. Central cancer growing from large bronchi is especially prone to such dissemination.

When lymph node metastases can have a peculiar location. The first are the nodes along the greater and lesser curvature, the antrum, then the cells reach the celiac lymph nodes (the second stage), it is possible to detect gastric cancer in the lymph nodes along the aorta, the portal vein of the liver.

Peculiar varieties of lymphogenous metastases of gastric cancer are named after the researchers who described them or first encountered them. Virchow's metastasis affects the left supraclavicular lymph nodes, Schnitzler - the rectal tissue, Krukenberg - the ovaries, Irish - the armpit lymph nodes. These metastases indicate distant dissemination of the tumor and a severe stage of the disease, when radical treatment impossible or no longer practical.

Lymph nodes in the neck are affected by tumors of the bottom, gums, palate, jaws, and salivary glands... The submandibular, cervical, occipital groups of lymph nodes are involved in the pathological process. Distant metastasis to the cervical lymph nodes is possible with carcinomas of the breast, lungs, stomach. For cancer located in the face area, oral cavity lymphogenous spread occurs quickly, which is associated with excellent lymph supply to this zone.

In addition to metastases, in the lymph nodes of the neck primary tumors can form - lymphogranulomatosis, which the average person will also call cancer of the cervical lymph node. In some cases, it is possible to determine whether the primary tumor or metastasis affected the nodes in the neck, it is possible only with an additional examination, including a biopsy.

Lymph nodes in the neck tend to enlarge not only with metastases. Probably, each of us can find at least one enlarged knot under lower jaw or between the muscles of the neck, but this does not necessarily indicate cancer. You should not panic at the same time, although it will not hurt to find the reason.

Cervical and submandibular lymph nodes collect lymph from the mouth, larynx, pharynx, jaws, which very often have inflammatory changes. All kinds of tonsillitis, stomatitis, caries are accompanied by chronic inflammation, therefore, it is not surprising and the increase in regional lymph nodes. In addition, the area of \u200b\u200bthe mouth and upper respiratory tract constantly encounters various microorganisms, which with the flow of lymph enter and are neutralized in the lymph nodes. Such increased their work can also lead to lymphadenopathy.

Diagnosis and treatment of lymph node metastases

Diagnosis of lymph node metastases is based on palpation, if possible. If you suspect damage to the axillary, cervical inguinal lymph nodes the doctor will be able to feel them all over, in some cases palpation of internal lymph nodes is also possible - celiac, mesenteric.

Ultrasound of the vessels of the neck

To confirm metastatic lesions, additional examination methods are used:

Ultrasound - it is especially informative with an increase in the lymphatic collectors located inside the body - near the stomach, intestines, in the gate of the liver, and in the retroperitoneal space, in the chest cavity;
CT, MRI - allow you to determine the number, size and exact location of the changed lymph nodes;
Puncture and biopsy - the most informative ways to see cancer cells in the lymph node, with a biopsy it becomes possible to suggest the source, to clarify the type and degree of cancer differentiation.

lymph node biopsy

Molecular genetic studies are aimed at establishing the presence of certain receptors or proteins on cancer cells, by which, with a high degree of probability, one can judge a type of cancer. Such analyzes are especially shown when metastases are found from an unknown source, the search for which was unsuccessful.

Treatment of cancer metastases in the lymph nodes includes surgical removal, radiation and chemotherapy, which are prescribed individually according to the type and stage of the disease.

Surgical removal of the affected lymph nodes is performed simultaneously with excision of the tumor itself, while the entire group of regional collectors, into which cancer cells have entered or could have entered, are subjected to lymph node dissection.

For many tumors, the so-called "sentinel" lymph nodes are known, where metastasis occurs most early. These nodes are removed for histological examination, and the absence of cancer cells in them with a high degree of probability indicates the absence of metastasis.

When manipulating the tumor itself and the lymph nodes, the surgeon acts very carefully, avoiding squeezing the tissues, which can provoke the dissemination of tumor cells. To prevent the entry of cancer cells into the vessels, their early dressing is performed.

With metastases, it is almost always prescribed. The choice of drugs or their combination depends on the type of primary tumor and its sensitivity to specific drugs. For gastric cancer, 5-fluorouracil, doxorubicin are most effective; for breast tumors, cyclophosphamide, adriamycin, non-small cell lung cancer sensitive to etoposide, cisplatin, taxol.

chemotherapy

If the primary focus cancerous tumor could not be detected, cisplatin, paclitaxel, gemcitabine, etoposide were prescribed. For poorly differentiated carcinomas affecting the lymph nodes, platinum preparations (cisplatin) are effective, for neuroendocrine tumors, cisplatin and etoposide are included in the treatment regimen.

The goal of chemotherapy for metastatic tumors is to inhibit the growth and further spread of the malignant process. It is prescribed before surgery (neoadjuvant chemotherapy) for the prevention of metastasis and destruction of micrometastases in the lymph nodes and after surgery (adjuvant) - to prevent further metastasis, the risk of which increases after surgery on the affected organ.

radiation therapy

It is more important in hematogenous metastases than lymphogenous, but radiosurgery, or a cyberknife, can be effective for lymph nodes, when cancer in the lymph node is removed using a beam of radiation that acts strictly on the affected tissue. This method is justified in case of late single metastases that appear years after treatment, when reoperation can be avoided.

Metastasis to the lymph nodes in cancer, regardless of the type of primary tumor, characterizes the progression of the disease, and the prognosis is the worse, the more lymphatic collectors are involved in cancer growth. Metastases respond to treatment in only one fifth of patients in whom the prognosis may be favorable; in the remaining 80%, treatment at the stage of metastasis is aimed at alleviating symptoms or prolonging life. With multiple lymphogenous metastases of low and undifferentiated carcinomas, life expectancy is on average six months to a year, in the case of highly differentiated cancers, the prognosis is slightly better.

Video: removal of lymph nodes in the treatment of breast cancer

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The human lymphatic system consists of many lymph nodes, most of which are grouped. According to the state of certain lymph nodes, the doctor can determine what diseases the patient has. On examination, doctors often find that a person has enlarged regional lymph nodes of the thyroid gland. Such a symptom may indicate that there is a malignant tumor in the body that urgently needs to be treated.

It's important to know

A disease such as cancer of the thyroid gland, in the initial stages, rarely gives any unpleasant sensations to a person. The disease can long time asymptomatic, and then suddenly manifest itself in full with all the complications and ensuing consequences. In some cases, it is possible to identify a dangerous ailment that poses a threat to life during a routine examination. An ultrasound or X-ray may show an enlarged regional lymph node that becomes larger due to the growth of a malignant tumor or the spread of metastases.

Associated symptoms

The lymph nodes and the thyroid gland are closely related, therefore, a patient with oncology, even before a diagnosis is made, may manifest such indirect symptoms as:

heat;
heavy sweating;
weakness;
induration, goiter on the neck;
hyperplasia of the lymph nodes (lymph nodes can increase to the size of a chicken egg);
painful sensations in the throat, pharynx, trachea;
discomfort when swallowing;
compression of the esophagus;
a feeling of fullness in the neck;
dyspnea;
hoarseness, loss of voice, etc.

Every sick person with suspected oncology can have absolutely different symptoms... This is because the disease rarely follows one scenario and has many varieties.

At-risk groups

Inflammation of the regional lymph nodes and the development of a tumor of the thyroid gland most often occurs in the following categories of people:

those who underwent radiation therapy in childhood for the treatment of hemangioma, shingles and other ailments;
exposed and received radioactive iodine while working in production or under any other circumstances;
having neoplasms of various etiologies in the urogenital area, mammary glands, adrenal glands and other organs;
having a lack of iodine in the body, suffering from thyroiditis;
with a burdened heredity (a predisposition to thyroid diseases can be transmitted at the genetic level).

People who fall into the listed risk groups must, at least once a year, visit an endocrinologist and a therapist, take tests, and also regularly do ultrasound of the lymph nodes in the neck and thyroid gland. Such preventive actions help to identify the disease itself initial stage and to carry out treatment when there is every chance of a full recovery and restoration of the body.

Diagnostic methods

After examination and palpation, the doctor may suspect the presence of a tumor in his patient. To confirm or deny their assumptions, the doctor will have to conduct special studies that give accurate results. The patient can be assigned:

ultrasound diagnostics of the thyroid gland and lymph nodes (even the smallest tumors can be visualized on ultrasound, modern equipment allows you to see the formations, the size of which does not exceed 3 millimeters);
puncture biopsy (sampling of materials from the lymph node using a syringe with a thin needle);
cT scan;
radiography.

The above studies will help identify cancer, cysts, benign formations, blood clots, purulent abscesses and other changes in the thyroid gland and lymph nodes.

In addition to hardware examinations, the patient will need to donate blood for tumor markers and other indicators, urine, an analysis for the level of thyroid hormones and some other tests.

Types of tumors

After the conducted studies, the doctor will be able to establish which type of tumor arose in a sick person:

papillary (can occur even in young children, while the disease has good prognosis and a high percentage of recovery);
follicular (most often diagnosed in the elderly, gives metastases, but is well treated with timely started therapy);
medullary (considered a more aggressive type of cancer, in which there is a rapid growth and spread of metastases);
anaplastic (this disease is often called undifferentiated cancer, it has a high rate of development and often has a poor outcome).

In some cases, during the examination, it can be established that not the tumor itself, but its metastases, is localized in the thyroid gland and lymph nodes. Such symptoms most often occur with lymphoma, sarcoma and some other types of oncology.

Treatment

Enlarged regional lymph nodes and thyroid cancer always require urgent treatment.

Usually, doctors in such cases resort to the following therapeutic measures:

Operation. During surgical intervention doctors usually remove the tumor - the lymph nodes themselves or the thyroid gland. Full or partial resection of a hyperplastic lymph node or enlarged gland is always performed under general anesthesia, so the patient will not experience any pain and discomfort.
Hormone therapy. After removal of the thyroid gland, the recently operated patient should be prescribed a maintenance course of hormonal iodine-containing drugs to normalize the hormonal background.
Chemotherapy and radiation therapy. Such procedures are prescribed to cancer patients as a treatment necessary to prevent further formation of tumor cells and the spread of metastases.
Immunomodulators. A patient who has undergone major surgery and taking potent drugs usually has a weakened immune system. To strengthen the immune system and faster cure for people with oncology, immunomodulating drugs and vitamin complexes are prescribed.

In custody

An increase in regional thyroid nodules is considered a symptom that signals about cancer in the body. With any suspicion of the development of this disease, it is necessary to undergo an examination that gives reliable results. If the presumptive diagnosis is confirmed, the doctor will prescribe treatment for the patient or suggest surgery.

To preserve his life and health, the patient should not give up these types of therapy or postpone treatment measures for later. Full compliance with the recommendations and prescriptions of the doctor will help the patient to recover and normalize the state of his body.