Ultrasound of the lymph nodes. Reactive lymphadenitis

Reactive lymphadenitis- this is the body's reaction to the occurrence of severe pathological processes, and this condition at the initial stage proceeds without the manifestation of any symptoms.

Reactive changes in the lymph nodes are the first "bell" that marked the beginning of the inflammatory process. For example, with the latent form of pulmonary tuberculosis, the lymph nodes react first of all, although the pathogen may not manifest itself differently for a long time.

Under favorable circumstances, the immune system independently recognizes and eliminates the penetration of the pathogen. If external factors will contribute to the development of pathology, then the process of spreading the focus of the disease will increase.

The provocation of this kind of reactions in the lymph nodes can be various factors that should arise in a complex manner. If one reason appears, then chronic inflammatory processes are unlikely.

Reactive lymphadenitis can occur due to the following reasons:

• lowering the "performance" of the immune system;
• frequent SARS;
• constant stress and severe chronic fatigue;
• lack of physical activity;
• alcoholism and nicotine addiction;
• hypothermia, as a constant load on the body.

In children under five years of age, reactive lymphadenitis occurs due to living in unfavorable environmental conditions, lack of a varied diet, a sedentary lifestyle, or as a result of the immaturity of the immune system.

Symptoms

The inflammatory process can first manifest itself in the places of localization of the disturbed microflora. Often, pathogenic agents are activated either near the affected area or directly at the site of infection.

Initially, the symptomatology manifests itself in an increase in lymph nodes, as well as in discomfort on palpation.

Additional signs of reactive lymphadenitis are:

• redness of the skin under the reactive lymph nodes;
• swelling near the nodes;
• disturbance of night sleep and general weakness;
• increased body temperature;
• rhinitis and cough of unrecognized etiology.

Anyway, visual increase lymph nodes, difficulty breathing, interruptions in the work of the heart and an increase in temperature - this is the reason for an urgent visit to the doctor.

Varieties of the disease

Reactive lymphadenitis has two types and several subspecies. First, experts determine the possible factors of occurrence, namely the cause of the lymph nodes becoming reactive. This may be a reaction to an penetrated infection or other pathogenic flora, an exacerbation of a chronic and latent disease.

• nonspecific is provoked by the occurrence of ARVI, influenza. It removes itself after the cure of the underlying disease;
• specific occurs when dangerous diseases such as plague, syphilis, tuberculosis.

Depending on the structure (content) of the affected lymph node, there are three types:

• serous;
• purulent;
• simple lymphadenitis.

From the place of localization of pathology, the following groups are determined:

• cervical;
• axillary;
• inguinal.

Diagnosis of pathology

If the above symptoms occur, the initial consultation should be with a therapist. Further, the doctor determines which narrow medical specialist should be consulted. The following laboratory tests are also carried out:

• blood is donated to increase / decrease hormonal levels;
• analyzes for tumor markers;
• smears are taken for HIV and other pathologies;
• bacteriological examination of urine and blood tests;
• cytology.

Often, an instrumental examination and a puncture are performed. Also, the patient undergoes X-ray, MRI. Sometimes scrapings are taken in organs in which pathology is suspected to develop, for example, bronchoscopy (if the cause is found in an infection of the lungs).

Taken from the medical site www.myshared.ru

Treatment

Reactive lymph nodes are a signal from the body about the occurrence of pathology. Therefore, the treatment regimen first prescribes the eradication of the underlying disease after detection, and then the consequence is removed.

Depending on the initial etiology of the pathology, a line of treatment is built. For example, with an increase in preauricular lymph nodes, the cause must be sought in the face, in the brain or hearing aid... Next, experts determine which drugs can suppress the pathogen or have to remove it. surgically... A therapy is being carried out that stops the consequences.

After complex treatment reactive lymphadenitis, the lymphatic system calms down, "bumps" subside, the nodes become normal in size.

Effects

After a powerful attack of pathogens, the lymphatic system becomes more vulnerable and requires not only treatment, but also preventive therapy, compliance with the rules healthy way life.

Experts recommend that patients bed rest, restriction of movement in order to avoid complications during treatment and recovery of the body after illness. You must also observe the following preventive measures:

• exclude fast food and alcohol from the diet;
• be sure to exercise, choose the load in accordance with age;
• drink plenty of fluids;
• drink vitamins.

At the first symptoms of a new inflammation, you should immediately contact a specialist, since the emergence of vigorous activity of the pathogen is possible.

Reactive lymphadenitis cannot be cured unless the cause is established. If a person develops any changes, you need to consult a doctor and eliminate the pathogenic agent that provokes inflammation.

When the body is fighting an infection or injury, the lymph nodes sometimes become enlarged. Doctors call this reactive lymph node hyperplasia ( reactive lymphadenitis), which is usually not dangerous.

What is the function of the lymph nodes?

Lymph nodes contain B and T lymphocytes, which are the main types of white blood cells. These cells help the body fight bacteria and viruses. Lymph nodes also carry lymphatic fluid and connect through the lymphatic vessels. Together, the lymph nodes and lymphatic vessels make up the lymphatic system, which is an integral part of the immune system.

When something goes wrong in the body, the lymphatic system produces cells to fight bacteria, viruses, and other causes of illness. Then the lymph nodes begin to swell. Lymph nodes can also enlarge in response to injury, sometimes due to cancer.

Lymph nodes usually enlarge near the injury site. For example, lymph nodes near auricle may increase when a person develops ear infection while the lymph nodes in the neck may swell in response to strep throat.

Symptoms of reactive lymphadenitis

The main symptom of a reactive lymph node is edema. Sometimes the area around the lymph node also swells. The body contains hundreds of lymph nodes, and these are most often crowned in the neck and around the face, in the groin and armpits. When lymph nodes become enlarged due to infection or injury, they:

• less than 1.5 centimeters in diameter;
• soft;
• movable.

Swelling usually occurs only in a specific lymph node or group of lymph nodes. A person who has many enlarged lymph nodes throughout the body may have severe systemic infection or certain types of cancer.

Reactive lymph nodes often accompany infection or injury, and a person may notice other symptoms of infection, such as:

• fever;
• pain near the injury;
• symptoms of the disease;
• signs of infection near the injury, such as redness or swelling;
• nausea.

An enlarged lymph node does not necessarily mean that the infection is serious. In some people, enlarged lymph nodes do not cause other symptoms.

Causes

The most common causes of swollen lymph nodes are:

• infections such as skin, ear, or sinus infections;
• exposure to allergens;
• injury or skin irritation;
• dental health problems such as tooth decay or stomatitis;
• exposure to bacteria or viruses;
• mononucleosis, a highly contagious virus that can cause swollen lymph nodes
• skin irritation, such as acne or rashes.

Sometimes immune diseases cause swollen lymph nodes. Less common causes of reactive lymph nodes include:

• cancer metastases that spread from the primary site to nearby lymph nodes
• lymphoma - cancer of the lymph nodes;
• sepsis, which is a type of systemic infection that can become life-threatening.

When a person has cancer or a severe infection, they may have many enlarged lymph nodes. Swelling in one lymph node is less likely to be a sign of a serious problem.

Reactive lymphadenitis - treatment

The correct treatment for enlarged lymph nodes depends on the cause. When a person has no symptoms of infection, the swelling often goes away on its own. When infections cause lymph nodes to become reactive, the person may need antibiotics. More severe infections may require intravenous antibiotics. People with weak immune systems may require hospitalization for even relatively minor infections.

Treatment is available for many forms of cancer, especially if a doctor diagnoses them for early stage... Depending on the type of cancer, your doctor may recommend removal of the lymph nodes, chemotherapy, or radiation.

When to see a doctor

Enlarged lymph nodes can be alarming, especially if the cause is unclear. However, in most cases, enlarged lymph nodes are a sign that the body's immune system is working well. A person with HIV or AIDS who is taking drugs that suppress the immune system, or if the person has a weak immune system, should see a doctor if their lymph nodes are swollen.

Most people can wait 1 to 2 weeks to see if the symptoms go away. You should see your doctor within a day or two if:

• enlarged lymph nodes appear after a skin injury;
• enlarged lymph nodes in a newborn or infant;
• enlarged lymph nodes are accompanied by fever.

You can wait about 2 weeks to see if the swelling decreases. If the swelling persists, or if the lymph node becomes hard or larger than 1.5 cm in diameter, see your doctor.

Forecast

Lymph nodes enlarge for many reasons, most of which are relatively harmless. However, a doctor can determine if a person has a serious infection that requires treatment, as well as assess others. potential causes the occurrence of reactive lymph nodes.

Sometimes the lymph nodes remain enlarged for a long time after the infection has cleared. If the lymph node does not change or harden, this usually should not be a cause for concern.

The human body is daily exposed to the influence of pathological microflora, and therefore needs reliable protection. And it is the lymphatic system that protects each of us from viruses, bacteria, as well as the body's own cells that have undergone mutations. The iliac lymph nodes are an important part of this system. And if they increase and hurt, then this is a clear signal about the presence of a pathological process in the body.

Inflammation of the iliac lymph nodes indicates the development of pathologies of the pelvic organs

The iliac lymph nodes are also called pelvic lymph nodes. They are deeply located formations of the immune system. The place of their placement is the cavity, walls and organs of the small pelvis.

In medicine, it is customary to divide the iliac nodes into two large groups:

• visceral (visceral);
• parietal (parietal).

The latter are located along the arteries of the same name, on the pelvic walls. Such formations can be external, internal and general. Internal, or visceral, lymph nodes are located near the pelvic organs. These include:

• peri-ocular nodes, which are located between the sheets of the wide uterine ligament;
• peri-rectal - occupy the lateral surfaces of the lower parts of the rectum;
• peri-vesical - these are single lymph nodes that are located near the anterior wall of the bladder;
• peri-vaginal, which are located just below the peri-uterus.

The number of lymph nodes in each person is individual. On average, each group has 10-20 lymphoid formations.

Parietal lymph nodes collect lymph from those formations that are located on the pelvic walls. Each section of the visceral group is engaged in cleaning lymph from a specific pelvic organ.

Lymphatic vessels collect lymph from the internal and external iliac nodes and transport it to the common iliac lymph nodes. Their number reaches 10 pieces. After the lymph passes through them, it goes to the subaortic formations, and then to the lumbar lymph nodes.

Inflammation of the iliac lymph nodes indicates the development of pathologies of the pelvic organs. Often we are talking about large-scale inflammatory processes affecting several organs, therefore, in no case can such symptoms be ignored.

Normal lymph node sizes

Magnetic resonance imaging (MRI) allows you to see the affected area and judge the severity of the pathological process

Normally, the lymph nodes should not be felt. In healthy people, they are hidden under the skin, and even with careful palpation, not all such formations are detected. The normal size of the iliac lymph nodes is no more than 10 mm.

In a normal state, only the groin and muscle nodes are palpable. The iliac lymph nodes cannot be probed in a healthy person, since they are located deep in the pelvic cavity.

It is possible to determine the increase in the iliac lymph nodes only with the help of ultrasound or MRI.

Reason for visiting a doctor

Three signs may indicate the development of lymphadenitis or lymphadenopathy:

• the nodes have increased in size;
• soreness occurs in the area of ​​the affected lymph nodes;
• the person complains of general malaise.

The combination of these three signs indicates the presence of a serious inflammatory process in the body and is a reason to see a doctor.

Why are the iliac nodes enlarged?

An increase in any lymph nodes indicates the presence of any pathology in the body. The lymphatic system is the first to react to harmful agents. And the reason for the enlargement of the lymph nodes can be one of the following factors:

Each of the above pathologies leads to an increase in lymph nodes in the iliac region. The process develops in stages:

1. Lymphadenopathy occurs, in which the nodes increase in size.
2. Further, the development of lymphadenitis occurs when the node becomes inflamed.
3. As a complication of the process, a disease characterized by inflammation of the lymphatic vessels can be observed.

With an increase in single lymph nodes, one should talk about a localized infection. An increase in all nodes of the iliac group indicates a regional infection. If several groups are swollen, then the infectious process is generalized and indicates serious complications.

Pain

For any discomfort in the pelvic area, you should immediately consult a doctor

An increase in the iliac lymph nodes may be indicated by characteristic pains that occur during bowel movements or urination.

May appear aching pains in the iliac region. Patients often complain about constant discomfort in the area of ​​the bladder (in most cases, we are talking about aching pain).

Any painful sensations noted in the pelvic organs are the reason for contacting a specialist. For any, even minor discomfort in the pelvic area, the patient should immediately make an appointment with a doctor (therapist or gynecologist).

Diagnostics

The iliac lymph nodes are located deep in the pelvis. This makes it impossible to carry out a visual assessment of their size. In rare cases, it is possible to identify individual lymph nodes during vaginal examination women.

Therefore, when making a preliminary diagnosis, specialists take into account only the patient's complaints and the data that can be obtained during a gynecological examination.

If the doctor suspects an increase in the lymph nodes of the iliac group, then the patient is referred for additional studies.

Laboratory diagnostics involves the following procedures:

• basic blood tests (biochemical and clinical);
• immunological blood test;
• general analysis urine.

The above procedures allow you to identify the presence of pathology in the body. However, they do not give a complete picture of the disease. With their help, it is impossible to determine the localization of the focus of inflammation, as well as the cause of its formation. To obtain such information, instrumental techniques are used:

1. X-ray examination. Due to its low price and availability, this method is a mandatory step. comprehensive diagnostics... It allows you to determine the size and exact location of the affected lymph nodes.
2. Computed tomography and MRI. These techniques are more informative than classical radiography. They allow you to assess the degree of tissue damage, the presence of metastases, etc.
3. Ultrasound. Allows you to explore the lesion in detail.
4. Puncture biopsy. It is the most informative technique. It involves taking a tissue sample directly from the affected lymph node with subsequent examination in the laboratory.

The complex use of the above-described techniques makes it possible to assess the severity of the pathology. The most reliable diagnosis can be made only after a puncture biopsy.

How are iliac lymph nodes treated?

If the inflammation of the iliac lymph nodes is of a cancerous nature, then the oncologist is engaged in its elimination.

Treatment tactics in this case depends on a number of nuances, including:

• the root cause of the inflammatory process;
• the degree of tissue damage;
• the nature of the lesion (if it is oncology, then you need to make sure that there are no metastases);
• the age of the patient;
• the patient's health status, etc.

Depending on the root cause of the disease, one of the following specialists can deal with its elimination:

1. Infectionist - if the inflammation has arisen due to an infectious process.
2. The surgeon - with the development of a purulent process, as well as other cases requiring surgical intervention.
3. Oncologist. If the pathology is of a cancerous nature, then the oncologist is engaged in its elimination. Such treatment is most often based on chemotherapy and radiation therapy. These techniques are used together to get better results.
4. Gynecologist. If the pathology has arisen in the female reproductive system and is not associated with the development of the oncological process, then this doctor is engaged in its elimination.
5. Phthisiatrician. If there are signs of tuberculosis development, the patient is referred for an appointment with this doctor. Treatment in this case will be carried out in the appropriate hospital.

Swollen and sore lymph nodes are alarming symptoms, in which the patient should consult a specialist as soon as possible. The faster it starts professional treatment, the better the chances of a speedy recovery.

Lymph is a liquid that, as it were, collects foreign substances throughout the body and carries them to the lymph nodes. The lymph nodes themselves are the body's natural filters, in which a huge number of cells of the immune system - lymphocytes - are concentrated. The purpose of lymphocytes is to get rid of foreign substances and microorganisms (viruses, bacteria) that are transferred to the lymph nodes along with the lymph.

Lymphadenopathy is a condition in which the lymph nodes swell in size. Such pathological changes indicate a serious illness that progresses in the body (often of an oncological nature). To make an accurate diagnosis, several laboratory and instrumental analyzes are required. Lymphadenopathy can form in any part of the body and even affects the internal organs.

Lymphadenopathy syndrome may indicate the presence serious illnesses in a patient, therefore, this condition should be given special attention when diagnosing a patient.

Normally, lymph flows freely through the lymph nodes, but sometimes it begins to accumulate in them, along with the growing number of cells of the immune system. As a result, the lymph node swells, sometimes enlarging many times.

Swollen lymph nodes can be caused by a number of reasons, including:

In addition to pathological changes in the lymph nodes, additional symptoms can be observed. The nature of their manifestation depends on what caused the development of such a pathology. In general, the following symptoms can be distinguished: skin rashes;

• high temperature;
• increased sweating (especially at night);
• fever attacks;
• increased splenomegaly and hepatomegaly;
• sharp weight loss, for no apparent reason.

In most cases, swollen lymph nodes are a marker of other complex diseases.

Classification

Depending on the nature of the manifestation and localization of the disease, the following forms of lymphadenopathy are distinguished:

Local form

It occurs in 70% of cases and is usually associated with a limited infection or trauma.

Generalized lymphadenopathy

Generalized lymphadenopathy is considered the most complex form of the disease. Unlike local lymphadenopathy, which affects only one group of lymph nodes, generalized lymphadenopathy can affect any area human body... Generalized lymphadenopathy has the following etiology:

• allergic disease;
• autoimmune processes;
• acute inflammatory and infectious ailments.

If an increase in lymph nodes is observed with a chronic infectious disease, then persistent generalized lymphadenopathy is implied. Most often, the pathological process affects the nodes in non-intersecting zones - in the anterior and posterior cervical chain, in the axillary and retroperitoneal region. In some cases, an increase in lymph nodes is possible in the groin and in the supraclavicular. The most commonly diagnosed lymphadenopathy of the neck. Cervical lymphadenopathy may indicate ailments caused by insufficient or excessive production of hormones or cancer diseases.

Reactive lymphadenopathy

Reactive lymphadenopathy is the body's response to infectious diseases. Any number of lymph nodes can be affected. At the same time, the symptomatology is not expressed, there are no painful sensations.

Stages of development of the disease

By the age of limitation, lymphadenopathy can be conditionally divided into the following groups:

In addition, any form of lymphadenopathy can take both neoplastic and non-neoplastic forms. However, any of them is dangerous to human life.

Characteristic localization of lesions

There are more than 600 lymph nodes in the human body, so the pathological process can develop in almost any system of the human body. But most often, lesions are diagnosed in the following places:

• abdomen;
• mammary gland;
• area of ​​the mediastinum;
• groin area;
• lungs;
• submandibular region;
• armpit area;

Each of these types of pathology is indicative of an underlying disease. Often this is an oncological disease. It is possible to establish the exact reasons for the formation of such a pathological process only after a complete diagnosis.

Abdominal lymphadenopathy

Increasing knots in abdominal cavity indicates an infectious or inflammatory disease. Less often, such a pathological process acts as a marker of an oncological or immunological disease. Symptoms, in this case, correspond to the points described above. In a child, the list can be added by the following symptoms:

• an increase in temperature at night;
• weakness and malaise;
• nausea.

Diagnostics, in case of suspicion of damage to the abdominal cavity, begins with the delivery of laboratory tests:

• biochemical and general blood test;
• general urine analysis.

Particular attention in the diagnosis is paid to the history and age of the patient, since some ailments are inherent only in the child. Lymph vessels and nodes of the abdominal cavity

Breast lymphadenopathy

An enlarged lymph node in the breast may indicate a dangerous cancer, including cancer. Therefore, if you have these symptoms, you should immediately consult a doctor. In this case, it is worth noting the nature of the manifestation of the tumor. If an increase in nodes is observed in the upper part of the mammary gland, then it can be assumed benign education... However, almost any benign process can degenerate into a malignant tumor. An increase in nodes in the lower region of the mammary gland may indicate the formation of a malignant process. You should immediately consult a doctor. An increase in lymph nodes in the area of ​​the mammary glands can be easily seen visually. As a rule, the woman herself notices education. No painful sensations are observed. Any extraneous education in the area of ​​the mammary glands of both women and men requires immediate examination by a specialized doctor to clarify the diagnosis and correct, timely treatment. The sooner the disease is detected, the more chances of a positive result are. Especially with regard to intrathoracic pathological changes.

Mediastinal lymphadenopathy

Mediastinal lymphadenopathy, according to statistics, is diagnosed in 45% of patients. To understand what pathology is, it should be clarified what the mediastinum is. Lymphatic vessels and nodes of the mediastinum

The mediastinum is the anatomical space that forms in the cavity chest... In front, the mediastinum is closed by the chest, and behind by the spine. On both sides of this formation are located pleural cavities... Pathological enlargement of nodes in this area is divided into the following groups:

• primary enlargement of the lymph nodes;
• malignant tumors;
• damage to organs located in the mediastinal region;
• pseudotumor formations.

The latter may be due to defects in the development of large vessels, severe viral and infectious diseases.

Mediastinal lymphadenopathy has a well-defined clinical picture. During the development of such a pathological process, the following symptoms are observed:

• sharp, intense pains in the chest area, which radiate to the neck, shoulder;
• dilated pupils or drooping of the eyeball;
• hoarseness of the voice (more often observed in the chronic stage of development);
• headaches, noise in the head;
• heavy permeability of food.

In some cases, there may be cyanosis of the face, swelling of the veins in the neck. If the disease has a chronic stage of development, then the clinical picture is more developed:

• high temperature;
• weakness;
• swelling of the limbs;
• violation of the rhythm of the heart.

The child may have difficulty breathing and sweating, especially at night. If such symptoms appear, then the child must be hospitalized immediately.

Lung lymphadenopathy

Enlarged lymph nodes in the lungs signal current underlying disease. It is not excluded, in this case, and the formation of metastases (lung cancer). But to make such a diagnosis on your own, by only one primary signs, not worth it in any case. Simultaneously with the increase in the lymph nodes of the lungs, the same pathological process can form in the neck and mediastinum. Clinical picture is this:

• cough;
• pain when swallowing;
• labored breathing;
• Fever, especially at night
• chest pain.

Lung damage can be caused by severe infectious diseases - tuberculosis, sarcoidosis and trauma. Also, smoking and excessive alcohol intake should not be ruled out.

Submandibular pathology

Submandibular lymphadenopathy is most commonly diagnosed in children preschool age and adolescents. As shows medical practice, in most cases, such changes are temporary and do not pose a threat to the child's life. But this does not mean that such symptoms should be ignored. The reason for the enlargement of the lymph nodes can be a dangerous oncological formation. Therefore, a visit to a therapist should not be postponed.

Axillary lymphadenopathy

The axillary type of pathology (axillary lymphadenopathy) can develop even due to a hand injury or an infectious disease. But inflammation of the axillary lymph nodes may indicate inflammation of the breast. Therefore, a visit to a therapist should not be postponed. As statistics show, it is the enlargement of the lymph nodes in the axillary region and in the mammary glands that is the first sign of the appearance of metastases in the body of the mammary gland. If an ailment is detected in a timely manner, then the chances of a complete cure for breast cancer increase significantly.

Diagnostics

Diagnostic methods depend on the location of the pathology. To prescribe the correct course of treatment, it is necessary not only to make an accurate diagnosis, but also to identify the cause of the progression of the pathological process. The standard procedure includes:

Since LAP is a kind of marker of another disease, the first step is to diagnose the cause of the development of the disease.

Treatment

It is necessary to treat the disease that caused the lymphadenopathy. If it is a tumor metastasis or a primary oncological process, then chemotherapy, radiation therapy, surgery, or a combination thereof are performed as directed by the oncologist.

In inflammatory processes, as a rule, carry out:

• a course of antibiotic therapy in tablets or injections (if a bacterial infection);
• antifungal treatment (if the cause of the inflammation is a fungus);
• antiviral effect in case of viral infection;
• anti-inflammatory, analgesic therapy (drugs of the NSAID group - ketorol, analgin, ortofen, diclofenac, butadion, nurofen);
• topical application of antiseptics (gargling, rinsing the sinuses);
• physiotherapy (with oncology it is contraindicated) - UHF on the area of ​​enlarged lymph nodes;
• strengthening immunity;
• with suppuration of the lymph node, sometimes it is opened and the abscess is removed.

Removal of tonsils is carried out only when all conservative therapy measures have been exhausted and do not bring a positive result. It has been proven that, in addition to the barrier function, on the path of microbes, the tonsils play an essential role in the maturation of the ovaries in girls. Their early removal can lead to delayed puberty. In the future, in mature age, such women may have problems carrying a child.

For allergic conditions that have caused lymphadenopathy, prescribe antihistamines, carry out the elimination (removal) of the allergen.

At HIV infection assess the patient's immune status (carried out by determining the level of CD4 cells), if necessary (lowering the level of CD4 cells below a certain level), antiretroviral therapy is carried out aimed at suppressing the human immunodeficiency virus.

In case of mechanical injuries that caused lymphadenopathy, pain relievers are prescribed, rest, if necessary, an operation is performed.

Prophylaxis

Since lymphadenitis in most cases develops with colds, then their prevention is associated with hardening the body, strengthening immunity, preventing colds.

Complications

With untimely, late treatment, the following consequences may develop:

• purulent fusion of an enlarged node, the formation of fistulas, abscesses;
• bleeding due to germination of the vessel wall;
• thrombophlebitis of the veins of the affected area;
• violation of lymph outflow, leading to lymphostasis;
• sepsis.

With the timely establishment of the cause of lymphadenopathy and adequate treatment of this pathology, it is possible to defeat the disease and avoid undesirable consequences.

Lymphadenopathy

Lymphadenopathy is pathological condition, characterized by an increase in lymph nodes and is one of the leading symptoms of many diseases.

In about 1% of patients with persistent lymphadenopathy, physical examination reveals malignant neoplasms.

Lymph nodes are peripheral organs lymphatic system... They play the role of a kind of biological filter that cleans the lymph flowing into them from the extremities and internal organs. There are about 600 lymph nodes in the human body. However, only groin, axillary and submandibular lymph nodes, that is, those that are superficially located.

Causes

Infectious diseases lead to the development of lymphadenopathy:

The development of lymphadenopathy can lead to therapy with some drugs, including cephalosporins, gold preparations, sulfonamides, Captopril, Atenolol, Allopurinol, Carbamazepine, Phenytoin, Penicillin, Hydralazine, Quinidine, Pyrimethamine.

The most often pronounced lymphadenopathy is observed against the background of the following diseases:

• lymphadenitis;
• Infectious mononucleosis;
• rubella;
• streptoderma;
• lymph node tuberculosis;
• non-Hodgkin lymphomas;
• lymphogranulomatosis (Hodgkin's disease);
• Gaucher disease;
• viral hepatitis;
• Still's disease;
• sarcoidosis;
• Waldenstrom's macroglobulinemia;
• Niemann-Pick disease;
• Lyme disease
• tularemia;
• HIV infection;
• benign lymphoreticulosis.

An increase in lymph nodes in the right supraclavicular region is often associated with a malignant process in the esophagus, lungs, mediastinum.

Infections of the oropharynx often lead to cervical lymphadenopathy. Usually, this condition develops in children and adolescents against the background of childhood infectious diseases and is associated with functional immaturity of the immune system, which does not always adequately respond to infectious stimuli. The highest risk of developing cervical lymphadenopathy in children who have not received timely vaccination against diphtheria, mumps, measles, rubella.

Axillary lymphadenopathy is caused by:

• purulent-inflammatory processes localized in the arms, shoulders or chest;
• some types skin pathology(neurodermatitis, psoriasis);
• immunodeficiency states;
• diseases of the mammary glands (mastitis, mastopathy, cancer);
• autoimmune systemic diseases (systemic lupus erythematosus, rheumatoid arthritis, ankylosing spondylitis, systemic scleroderma).

Depending on the number of lymph nodes involved in the pathological process, the following types of lymphadenopathy are distinguished:

• localized - an increase in one lymph node;
• regional - an increase in several lymph nodes located in one or two adjacent anatomical areas, for example, axillary lymphadenopathy;
• generalized - enlarged lymph nodes are localized in several non-adjacent anatomical areas, for example, groin and cervical adenopathy.

Localized lymphadenopathies are much more common (in 75% of cases) than regional or generalized ones. In about 1% of patients with persistent lymphadenopathy, medical examination reveals malignant neoplasms.

Depending on the etiological factor, lymphadenopathy is:

• primary - caused by primary tumor lesions of the lymph nodes;
• secondary - infectious, medicinal, metastatic (secondary tumor process).

In turn, infectious lymphadenopathy is subdivided into specific (caused by tuberculosis, syphilis and other specific infections) and non-specific.

Sexually transmitted infections usually lead to the development of inguinal lymphadenopathy, and cat scratch disease is accompanied by axillary or cervical lymphadenopathy.

By duration clinical course isolate acute and chronic lymphadenopathy.

Signs of lymphadenopathy

With cervical, inguinal or axillary lymphadenopathy, an increase in lymph nodes is observed in the corresponding area, from insignificant to noticeable with the naked eye (from a small pea to a goose egg). Palpation can be painful. In some cases, redness is noted over the enlarged lymph nodes. skin.

It is impossible to detect lymphadenopathy of the visceral nodes (mesenteric, perebronchial, lymph nodes of the hepatic hilum) visually or by palpation, it is determined only during the instrumental examination of the patient.

In addition to enlarged lymph nodes, there are a number of other signs that may accompany the development of lymphadenopathy:

• unexplained loss of body weight;
• increased body temperature;
• excessive sweating, especially at night;
• enlargement of the liver and spleen;
• recurrent upper infections respiratory tract(tonsillitis, pharyngitis).

Diagnostics

Since lymphadenopathy is not an independent pathology, but just a symptom of intoxication in many diseases, its diagnosis is aimed at identifying the causes that led to an increase in lymph nodes. The examination begins with a thorough history taking, which in many cases allows a preliminary diagnosis to be made:

• eating raw meat - toxoplasmosis;
• contact with cats - toxoplasmosis, cat scratch disease;
• recent blood transfusions - hepatitis B, cytomegalovirus;
• contact with patients with tuberculosis - tuberculous lymphadenitis;
• intravenous drug administration - hepatitis B, endocarditis, HIV infection;
• casual sex - hepatitis B, cytomegalovirus, herpes, syphilis, HIV infection;
• work in a slaughterhouse or livestock farm - erysipeloid;
• fishing, hunting - tularemia.

With localized or regional lymphadenopathy, an examination of the area from which lymph flows through the affected lymph nodes is carried out, for the presence of tumors, skin lesions, inflammatory diseases. Other groups of lymph nodes are also examined in order to identify possible generalized lymphadenopathy.

There are about 600 lymph nodes in the human body. However, only inguinal, axillary and submandibular lymph nodes can be palpated.

With localized lymphadenopathy, the anatomical localization of enlarged lymph nodes can significantly narrow the number of suspected pathologies. For example, sexually transmitted infections usually lead to the development of inguinal lymphadenopathy, and cat scratch disease is accompanied by axillary or cervical lymphadenopathy.

An increase in lymph nodes in the right supraclavicular region is often associated with a malignant process in the esophagus, lungs, mediastinum. Left supraclavicular lymphadenopathy signals possible damage to the gallbladder, stomach, prostate, pancreas, kidneys, ovaries, seminal vesicles. A pathological process in the abdominal or pelvic cavity can lead to an increase in paraumbilical lymph nodes.

Clinical examination of patients with generalized lymphadenopathy should be directed towards the search for systemic disease. Valuable diagnostic findings are the detection of inflammation of the joints, mucous membranes, splenomegaly, hepatomegaly, and various types of rash.

In order to identify the cause leading to lymphadenopathy, according to indications, different types laboratory and instrumental research... The scheme of a standard survey usually includes:

• general and biochemical blood test;
• general urine analysis;
• chest x-ray;
• Ultrasound of the abdominal and pelvic organs;
• computed and magnetic resonance imaging.

If necessary, a biopsy of an enlarged lymph node can be performed, followed by histological and cytological examination of the tissue samples obtained.

The highest risk of developing cervical lymphadenopathy in children who have not received timely vaccination against diphtheria, mumps, measles, rubella.

Lymphadenopathy treatment

Treatment of lymphadenopathy is to eliminate the underlying disease. So, if an increase in lymph nodes is associated with bacterial infection, the course is shown antibacterial therapy, the treatment of lymphadenopathy of tuberculous etiology is carried out according to a special DOTS + scheme, the treatment of lymphadenopathy caused by oncological disease consists in anticancer therapy.

Prophylaxis

Prevention of lymphadenopathy is aimed at preventing diseases and intoxications that can provoke an increase in lymph nodes.

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Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.

Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.

The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!

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Retroperitoneal lymphadenopathy: what is it and how to treat it?

Retroperitoneal lymphadenopathy is a pathological enlargement of the lymph nodes and the subsequent development of the inflammatory process in them. This condition is one of the symptoms of many diseases of various origins, but not an independent pathology.

With a protracted course, lymphadenopathy becomes an independent pathology and can lead to severe complications. In the article, we will figure out what it is - retroperitoneal lymphadenopathy, and how to treat it.

Difference from lymphadenitis

Even a slight increase in lymph nodes is a clear signal of an explicit or latent pathological process in the body. The lymph nodes act as a natural filter associated with circulatory system... Their main role is to cleanse the blood of potentially dangerous microorganisms.

When an infection enters the lymph nodes, an inflammatory reaction may develop, involving one of them, several lymph nodes or several groups.

The reaction of the lymph nodes to pathological processes in the body can develop as an independent inflammatory disease or how accompanying symptom other pathology. Inflammation of the lymph nodes is called lymphadenitis, reactive enlargement of the lymph node is called lymphadenopathy.

Lymphadenitis is acute, with symptoms characteristic of an acute process. The affected lymph node increases in size and becomes painful. The skin over the superficial lymph nodes turns red, there is a local increase in temperature.

Watch a video about the causes of inflammation of the lymph nodes:

Superficial lymph nodes harden strongly, with the localization of the lesion in the retroperitoneal space, diagnosis is very difficult due to the lack of characteristic symptoms and the impossibility of external inspection. Over time, the enlarged lymph node may become inflamed.

Causes of the disease

Retroperitoneal lymphadenopathy develops as a result of the ingress of a significant amount of biological or other materials into the lymph node that provoke inflammation. It can be:

• Pathogenic microorganisms and products of their vital activity;
• Fragments of dead cells;
• Foreign solid particles;
• Some tissue breakdown products.

Most often, the introduction of a provoking agent occurs against the background of local inflammatory processes, acute, subacute or chronic, sometimes - with infectious diseases of a general nature. The penetration of the pathogen is possible through direct contact, through the lymph or blood.

Against the background of the pathological process, pathogens enter the lymph nodes in large quantities. In response, the number of lymphocytes increases and the size of the lymph node increases. The degree of enlargement of the lymph node is associated with the activity of the process.

As the underlying disease progresses, inflammation may develop in the affected lymph nodes with a transition to a purulent process.

The rate of progression of lymphadenopathy varies depending on the intensity and duration of exposure to pathogenic factors, as well as their number.

The immediate cause of the development of retroperitoneal lymphadenopathy can be:

• Giardia, Toxoplasma and other protozoa;
• Helminths;
• Fungal infections;
• Pathogenic bacteria;
• Viruses.

An increase in the retroperitoneal lymph nodes can occur as one of the complications of mesenteric adenitis or as part of a symptom complex oncological diseases... In children, such complications can accompany the course of viral mumps, rubella and other childhood diseases. The clinical picture may resemble acute appendicitis.

Abdominal lymphadenopathy (enlarged lymph nodes located in the abdominal cavity) can develop against the background of mesenteric adenitis or lymphoma.

Inguinal localization of the lesion occurs against the background of local infections, in particular, it is a symptom of a number of sexually transmitted diseases.

Classification

According to the duration and characteristics of the flow, they are distinguished:

Additionally, the classification of the pathological process according to the severity of lymph node hyperplasia can be used. This criterion is used relatively rarely, since normal sizes lymph nodes from different groups are very different.

By the number of lymph nodes involved in the pathological process, local, regional and generalized forms of pathology are distinguished.

A local lesion is said with an increase in one lymph node. With the defeat of several lymph nodes located in adjacent groups.

The most severe form of pathology is generalized, in which pathological changes affect three or more groups of lymph nodes located in different areas.

About 70% of cases of lymphadenopathy are local, developing against the background of trauma and limited infectious lesions. The generalized form of pathology testifies to serious dysfunctions of the immune system.

Find out more about the immune system and lymph here.

Symptoms

The main symptom of developing lymphadenopathy is an increase in lymph nodes. An increase in the inguinal lymph nodes can be seen on a superficial examination, with retroperitoneal localization of the lesion, it is possible to identify characteristic changes only on ultrasound or X-ray.

Indirect symptoms of localization of the lesion in the abdominal cavity can be:

• Sweating;
• General weakness;
• Sustained slight increase in body temperature;
• Digestive disorders, in particular diarrhea;
• Enlargement of the spleen and liver.

Short-term attacks of fever and diffuse abdominal pain are possible. Patients may experience weight loss severe pain in the back, caused by mechanical compression of nerve endings or trunks.

At infectious mononucleosis the patient develops a maculopapular rash, a pathology that develops against the background of hepatitis, accompanied by jaundice and dyspeptic symptoms. Possible manifestations of urticaria, joint pain.

Diagnostics

Diagnosis of lymphadenopathy begins with anamnesis. In order to identify the most likely causative agent of the pathological process, the doctor asks questions about the injuries suffered, blood transfusions, organ transplants.

Since lymph node enlargement is one of the symptoms of some STDs in adult patients, questions about the number of sexual partners and likely casual relationships are asked. Lymphadenopathy can indicate very serious health problems, so the patient should be very honest.

It is very important to take into account the age of the patient, since the retroperitoneal localization of the lesions is more typical for children under 12 years of age. The identification of some forms of pathology in adults is a rather rare and potentially life-threatening phenomenon.

During an external examination, the doctor palpates the affected lymph nodes, determining their number, size, consistency, soreness, the presence of interconnections and localization.

Confirmation of the presumptive diagnosis is possible after laboratory and instrumental studies. The patient must be referred for a blood test.

The complex of studies includes:

• General clinical analysis;
• General urine analysis;
• Biochemical analysis;
• Serological analysis;
• HIV test;
• Wasserman test.

With pathology in the retroperitoneal region, carry out:

If the oncological nature of the pathological process is suspected, histological and cytological examinations of the bone marrow and / or tissue sample of the affected lymph node are performed.

Treatment

Painless enlarged lymph nodes are not always taken seriously by the patient. The manifestations of lymphadenopathy at any age are not the case when you can let everything go by itself and self-medicate.

Treatment is prescribed only by a doctor, based on the data obtained during the examination. Tactics are selected individually, therapy is aimed at eliminating the underlying disease.

The course of treatment for lymphadenopathy may include:

Non-steroidal anti-inflammatory drugs;

Antibiotics;

Antiprotozoal drugs;

Antiviral agents;

Antimycotics;

Antihistamines;

Immunomodulators.

With the elimination of the underlying disease, the lymph nodes quickly decrease to normal size.

With a confirmed malignant process, the patient is prescribed a course of radiotherapy or chemotherapy. With no effect from conservative treatment surgical intervention is indicated.

Prophylaxis

Due to the variety of causes and factors that provoke the development of lymphadenopathy, the main preventive measure should be the timely detection and treatment of major pathologies of various origins.

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Attention! The materials on the site are published for informational purposes only and under no circumstances can be considered a substitute for medical advice with a specialist in medical institution... The site administration is not responsible for the results of using the posted information. For diagnosis and treatment, as well as appointment medical supplies and determining the scheme of their reception, we recommend that you consult a doctor. Remember: self-medication is dangerous!

A unique and natural defense system of the human body is the lymphatic system, which covers every part of our body with a shield of its tissues. It consists of lymphoid tissue, a network of lymphatic vessels and its liquid part - lymph. This barrier mechanism plays an important role in the prevention of cancerous tumors and always deserves careful study for correct setting diagnosis for these dangerous neoplasms.

In this article, we will acquaint you with the role of the lymphatic system and the changes in it that occur during the formation and metastasis of cancers.

A bit of anatomy

The lymph nodes are connected to each other by lymph vessels.

The tissue of the lymphatic system is dispersed throughout all areas of the body, even in its smallest areas, in the form of clusters of various sizes, which are called lymph nodes.

• Their role is to produce plasma cells and macrophages, which are protective cells.
• In addition, reproduction and maturation of the main components of immunity - T- and B-lymphocytes occur in the lymphoid tissue.

Lymphatic "filters" are located under the skin layer or deeper - between the muscles, internal organs, in cavities and along blood vessels... They are interconnected by a network of lymphatic vessels.

Such a vascular network begins with the thinnest capillaries, into which interstitial fluid is absorbed, washing the cells of tissues (muscle, bone, nervous, connective, etc.) and organs. This liquid enters through the lumen of the capillary walls and creates another liquid medium - lymph. Pathogenic agents that enter it - bacteria, toxic compounds, mutated cells - are delivered to larger vessels formed by the fusion of lymphatic capillaries, and then reach the lymph nodes. Filtered in them, the lymph is rendered harmless by the protective cells and begins to move further - to the rest of the distant "collectors".

The final collection site for almost all (3/4 of the volume of all lymphatic fluid in the body) lymph is the thoracic lymphatic duct. This large vessel:

• occurs in the abdominal cavity;
• penetrates into the chest;
• located behind the esophagus and the aortic arch.

At level VII vertebra cervical of the spinal column, it enters the neck and flows into the lumen of the inner left jugular vein or in the area of ​​its confluence with the left subclavian vein.

What is the function of lymph nodes in cancer

It is the lymph nodes that act as a kind of filter with active killers of cancer cells, which are able to prevent the spread of mutated cells throughout the body. If these components of the lymphatic system were not there, then tumor cells could freely migrate along the lymphatic and bloodstream, affecting tissues and organs on their way and forming metastases in them. This means that the neoplasm would immediately pass into the very last stage IV, and the fight against cancer would be practically meaningless.

It is the lymph nodes that are able to hold back for some time, so they make it possible to buy time for her effective treatment... Oncologists have found a direct relationship between the size of a cancerous growth and damage to the lymphatic "filters". According to world statistics:

• with a neoplasm up to 2 cm in size, metastases in the lymph nodes are found in 12% of patients;
• with a tumor process up to 3 cm - in 32%;
• up to 4 cm - in 50%;
• up to 6 cm - in 65%;
• at more than 6 cm - in 90% of patients.

How and why lymph node metastases form

The second stage of almost any malignant neoplasm is characterized by metastasis of its cells to the regional (most closely located) lymph nodes.

Almost all malignant neoplasms are capable of metastasizing, that is, spreading their cells into the lymphatic "collectors". During tumor growth - from about stage II of the tumor process - its tissue becomes looser, and the cells are washed out by interstitial fluid, entering the lymphatic vessels. Further, with the flow of lymph, they are sent to those lymph nodes that are located in the closest location to the neoplasm (that is, to the "sentinel" nodes).

In these "filters" part of the cancer cells is rendered harmless, but another part of them remains, multiplies and forms a secondary focus of primary neoplasm - metastasis. This new tumor also begins to grow, but for a period of time, protective cells restrain its spread. This means the temporary localization of the cancer process for about several months or years (depending on the level of malignancy of the cancer cells).

• When this mechanism weakens, the neoplasm becomes loose and its cells spread into the outgoing lymphatic capillaries and vessels.
• Further, the tumor tissue enters the new regional lymph node. In it, the spread of a cancerous tumor is also restrained for some time, but after a certain period the mutated cells migrate to even larger distant lymphatic "collectors".

Such central lymph nodes are located in the mediastinum, retroperitoneal space and along the large vessels.

How, depending on metastasis, the stage of the cancer process is determined

One of the important criteria by which the severity of cancer is assessed is the presence of metastases in the lymph nodes. According to the international classification, this value is expressed by the letter "N" and a number reflecting the number of metastases:

• I - no metastases, designated as N0;
• II - only single metastases are detected in the nearest (sentinel) lymph nodes, N1;
• III - several metastases are found in regional lymph nodes, N2;
• IV - both regional and distant lymph nodes are affected by metastases, N3.

For each type of cancer, oncologists can use a more detailed classification system, which indicates the following values: N2a, N2b, etc. When Nx is formulated, the “x” symbol means that no data on lymphatic system lesions by metastases were obtained during diagnosis.

What are the main groups of lymph nodes are of paramount importance in the diagnosis of cancer

In the human body, a huge number of different-sized lymph nodes are located everywhere - from small to large. Oncologists, guided by the anatomical principle, isolate precisely those group accumulations of lymphoid tissue along which they metastasize cancerous tumors... In general, such "collectors" are classified into:

• subcutaneous;
• deep, that is, localized between the muscles and in the cavities - chest, abdominal and pelvic cavities.

In the spread of the cancer process, the following groups of superficial lymph nodes are of paramount importance:

• cervical;
• axillary;
• inguinal.

The following groups belong to deep lymph nodes:

• intrathoracic;
• abdominal cavity;
• pelvic cavity;
• retroperitoneal.

A group of cervical lymph nodes

On the neck, lymph nodes are represented by the following groups:

• superficial - located directly under the skin;
• deep - located along the sternocleidomastoid muscles and under the fascia;
• back - localized behind the sternocleidomastoid muscles;
• supraclavicular - located in the hollows above the collarbones.

Metastases to the cervical lymph nodes can give cancerous tumors:

• (the so-called Schnitzler metastasis, located on the left side of the neck);
• or squamous cell carcinoma of the skin on the hands;

When metastases appear at the beginning, the cervical nodes do not change in any way in their consistency and do not increase in size. Later, they become large and are defined as round or oval tumors that protrude or do not protrude above the surface of the skin. Their consistency becomes dense and they can move to the sides to a limited extent. Usually, such enlarged lymph nodes do not cause pain, and their size can vary from 2 to 8 cm. In lymphogranulomatosis, the "filters" affected by metastases are able to combine into one conglomerate, reaching an impressive volume.

If a secondary cancer tumor appears in the superficial cervical lymph nodes, then it protrudes above the skin and resembles a quail's egg or beans. In cases where deep lymphatic "collectors" are affected, the node is not contoured, but manifests itself as a thickening or asymmetry of the neck.

Axillary lymph node group

Oncologists distinguish between subcutaneous and deep lymph nodes, and also divide them into groups depending on their location.

The group of lymph nodes in the armpit area is represented by numerous accumulations of lymphoid tissue in the form of 6 groups. One of the axillary nodes adjoins the walls of the armpit itself, while the others are located deeper - along the nerve trunks and blood vessels.

Metastases in axillary lymph nodes can give such cancerous neoplasms:

• breast;
• lymphogranulomatosis;
• melanoma or squamous cell carcinoma of the skin on the hands;
• skin of the shoulder girdle and upper section chest.

The first sign of the defeat of this group of lymph nodes with metastases most often becomes an uncomfortable sensation foreign object in the armpit. In addition, some patients of the oncologist complain of pain that occurs when the metastasis is near the nerve and the enlarged node infringes on its tissue. In some cases, the patient's hand may go numb and the skin may tingle. If the enlarged lymph node begins to squeeze the vessel, then the patient may notice swelling of the arm.

When examining armpits with lymph nodes affected by cancerous tumors, their tuberosity is sometimes noted when raising the hand up. In addition, in this area of ​​the body, the skin is very thin and the formations that have appeared are easily palpable.

Inguinal lymph node group

This group of natural "filters" is localized in the groin fold located between the lower abdomen and upper thighs. Superficial inguinal lymph nodes are located in the subcutaneous fatty tissue, and deep ones - next to femoral vessels under the fascia.

The defeat of this group of lymphatic "collectors" occurs in cancerous tumors:

• external genital organs;
• non-Hodgkin lymphomas;
• lymphogranulomatosis;
• melanoma or squamous cell carcinoma of the skin of the legs, groin, lumbosacral or gluteal region.

Metastases in the inguinal collectors are manifested by the appearance of swelling of the skin, which is similar to a hernia. When a vein or a trunk of the femoral nerve is compressed by an enlarged node, the patient develops swelling lower limbs or pain.

Group of intrathoracic lymph nodes

This group of "filters" is divided into two subgroups:

• parietal - concentrated along the pleura (parasternal, intercostal and pleural) along the inner surface of the cavity;
• visceral (or organ) - located near organs and large vessels (paraesophageal, pericardial, parabronchial).

All organ "collectors" are also divided into lymph nodes of the anterior and posterior mediastinum.

The intrathoracic "filters" of lymph can be affected by the following cancerous tumors:

• esophagus;
• lungs;
• breast;
• thymus gland;
• lymphomas;
• lymphogranulomatosis;
• neoplasms of the neck and head.

Visceral "filters" of the mediastinum can be affected by running malignant tumors organs of the pelvis, abdominal cavity.

When the intrathoracic lymph nodes are affected by metastases, the severity of symptoms depends on the size of these secondary neoplasms. The patient may experience the following manifestations:

• prolonged cough;
• sensations of difficulty in moving food through the esophagus;
• pain in the chest and behind the breastbone;
• voice changes (hoarseness, hoarseness);

With compression of the superior vena cava, the patient develops cava syndrome:

• swelling of the skin in the arms and upper half of the body, neck and head tissues;
• dyspnea;
• signs and respiratory distress.

Group of lymph nodes of the abdominal and pelvic cavity

In the abdominal cavity, lymphatic "collectors" are located in abundance: along the vessels and intestines, in the omentum and mesentery, parietally along the peritoneal leaf, in large quantities near the portal system of the liver and spleen.

In the pelvic cavity, such natural "filters" of lymph are localized parietally, along the iliac blood vessels, in the surrounding pelvic organs(uterus, prostate, bladder and rectum) fiber.

Cancer tumors of such organs are capable of spreading into a group of these lymph nodes.