Every third appeal to an oncologist on social networks or on remote consultation portals is formulated something like this: “save, help, I have enlarged lymph nodes.”
As a rule, young people write, usually from 18 to 25 years old, and I don’t remember a case when it eventually turned out that the situation required treatment from an oncologist. Most often, enlarged lymph nodes were caused by a sore tooth, sore throat, conjunctivitis, and so on.
It is clear that fear and fears for one’s health in such cases force one to immediately run to an oncologist.
However, is everything so simple, and is it worth rolling your eyes about any treatment with an enlarged lymph node?
My personal statistics show: if a person comes for a face-to-face consultation, he is already one of those few whose situation was not limited to the banal “it got sick and went away.”
Let's take a closer look at how the lymphatic system works and understand the nature of enlarged lymph nodes.
Fact #2
Lymphatic vessels are not something abstract.
It is worth crossing or ligating them, for example, during surgery on the axillary lymph nodes for breast cancer, and lymphostasis is likely to develop - swelling of the limb, which, again, most likely will not go away.
The most visible to us from the point of view of examination - the so-called peripheral lymph nodes (in the neck, supraclavicular, axillary and inguinal) can increase, and this is in most cases a manifestation of reactive lymphadenopathy - an inflammatory reaction indicating the fight against infection.
general characteristics
Enlarged lymph nodes are soft, tight-elastic or dense round formations that can be felt under the lower jaw, in the neck, axillary area, groin and other places.
The surface of the lymph nodes can be smooth or bumpy. Often the increase is preceded by acute infectious and inflammatory processes (ARVI, sore throat, pulpitis), trauma with skin damage, vaccination. Sometimes changes in the lymph nodes are detected by chance by the patient or doctor during a preventive or advisory examination. Lymph nodes are said to be enlarged when their density, surface and mobility change, and their dimensions exceed 1 cm (for elbow formations - 0.5 cm, for inguinal formations - 1.5 cm). When palpated, the nodes can be both painful and painless. In addition to lymphadenopathy, skin manifestations (elements of rash, redness of the skin), fever up to 38 ° C and above, prolonged low-grade fever, complaints of fatigue, sweating, heaviness in the left or right hypochondrium caused by an enlarged spleen and liver are possible.
The reason for contacting a doctor is the independent detection of large painless lymph nodes, sharp pain in the lymphoid tissue when trying to palpate, a combination of lymphadenopathy with other pathological signs - rash, hyperthermia, weight loss, fatigue. Particular concern should be caused by lymph nodes measuring 2-3 cm, which have enlarged for no apparent reason, are located in several zones and persist for more than 2 months.
Fact #3
Most often, the cervical and submandibular lymph nodes become inflamed, because in the facial part of the skull there are many open mucous membranes and associated infections.
A sore throat, carious or rotten teeth, and ear and eye bacterial and viral infections are the most common causes of cervical lymphadenopathy. The axillary and inguinal nodes react according to the same principle.
Therefore, if a lymph node is bothering you, first of all you need to go to a therapist, dentist, or ENT doctor.
If the genesis of lymphadenopathy is unclear, the doctor will prescribe an ultrasound, and during this study, attention will be directed mainly not to the size of the lymph node, but to its shape and differentiation of the structure.
Contact our clinic!
“Ear, Nose and Throat Clinic” offers you consultations with doctors of the highest category, constantly developing in their specialization and working with advanced diagnostic and therapeutic equipment. A quick and competent diagnosis of enlarged lymph nodes is a guarantee of successful recovery with minimal risk of exacerbations. To make an appointment, you can leave an online application on our website or call us by phone. You should not postpone a visit to the doctor, as a protracted inflammatory process can lead to negative health consequences.
Fact #5
Lymph nodes enlarge during cancer because cancer cells enter the lymphatic vessels draining a certain area, which then settle in the “filters” (lymph nodes) in the form of metastases and begin to grow there.
Such lymph nodes do not shrink after treatment of infectious diseases, but only increase, merging with other lymph nodes into conglomerates, extending beyond the lymph node and fixing it in the surrounding tissues. Such lymph nodes are rarely painful, they are dense, very dense.
Often in cancer, lymph nodes are affected by a “chain” that is clearly visible on palpation. With lymphomas, conglomerates are often visible from the outside. Of course, with such manifestations you need to go to an oncologist and hematologist.
For suspicious nodes, a biopsy will be performed in the absence of other causes. This is either a puncture with a needle and collection of material, or an operation to completely remove the lymph node for histological examination.
Development mechanism
Enlargement of lymph nodes occurs in several ways, each of which involves the accumulation of a certain type of cell in the lymphoid tissue. The reaction of peripheral lymphatic organs is often associated with increased blood flow, proliferation of lymphocytes and macrophages in response to the appearance of foreign genes. With antigenic stimulation, the node can increase 5-15 times in 5-10 days. Systemic neoprocesses are characterized by active proliferation of degenerated lymphoid cells with an increase in the size of the affected lymph node.
The stroma of lymphatic formations can be infiltrated by inflammatory elements (in infectious diseases), tumor cells located in the lymphatic drainage zone of a given node. Metastatic lesions are often accompanied by proliferation of connective tissue. In some disorders of lipid metabolism (Niemann-Pick disease, Gaucher syndrome), macrophages filled with undigested glycosphingolipids are retained in the lymph node.
Axillary lymphadenitis in a child
It is estimated that every day a person inhales several grams of insoluble fine dust particles. In a year you gain almost one and a half kilograms, and in a lifetime - about 70 kg. Where does such a colossal amount of garbage go? If it were not for the lymphatic system, not for the protective organs and tissues, not for the constant intra- and extracellular confrontation, then all the aggression that is present in our lives every day would not allow a person to exist in principle. Anatoly Georgievich Konevsky, a legendary professor from the Department of Topographic Anatomy and Operative Surgery of Volgograd State Medical University, told how important it is for any doctor, and especially a surgeon, to pay attention to the lymphatics.
Many diseases are treated as if the lymphatic system does not exist. This is nonsense, because it performs a huge number of vital functions for the body. Back in the middle of the 20th century, the famous French scientist Henri Policard Fr. And this thesis is still relevant today. Moreover, the lymphatic system should be almost the most studied system in the body. Why? Anatoly Georgievich Konevsky, an outstanding professor and famous surgeon who gave a considerable impetus to the development of transplantology in Russia, acted as the living Henri Policard and revealed the secrets of lymph circulation to the students.
“You walk along the sidewalk in the morning, cars pass by you, you inhale the dust of the streets, clouds of exhaust gases, you go into a trolleybus, and if suddenly there is at least one patient with an open form of tuberculosis, then you get your package of Koch sticks, and if someone else If you sneeze, you will get a tangle of a wide variety of both non-pathogenic and pathogenic microbes. But you live on. Where does all this go?” - the professor began his story.
When was the mysterious system discovered?
In 1613, the medieval Italian anatomist Gaspare Aselli, while teaching an anatomy class, dissected a dog to show students the internal organs. However, before this the animal was fed. Naturally, the first thing the scientist and his students saw were intestinal loops entangled in many small white vessels with glomeruli, from which, when cut, a white liquid similar to milk oozed. This was not the first experience of meeting the “milky ways” - 50 years before this incident, Bartolomeo Eustachius, also an Italian, isolated the thoracic lymphatic duct on the corpse of a horse, without understanding the significance of the discovered anatomical formation and calling it the “white thoracic vein.” Lymphatic vessels were equated with veins until the advent of the microscope, and in the second half of the 18th century, the German anatomist Johann Lieberkühn finally found out that there are separately existing lymphatic capillaries that originate in the intestinal villi and carry their secretions into the venous bed.
Actually, the comparison of the vessels of the venous and lymphatic systems was not carried out by chance - along with closely related development, they have many common features, such as the movement of fluid from tissues to the heart and the presence of a valve apparatus, as well as some differences (the presence of nodes and the blind end in carriers lymph).
“You all know that half the weight of the human body is liquid,” the professor continued to broadcast. – “Basically, it is cellular and extracellular fluid, and there are 28 liters of it! Just imagine: you walk, run, and there are three buckets of water in you, which does not splash or gurgle...” The fluid of our body is in constant motion. And through the liver, as the main organ of the protective and permeable system, about one hundred liters of blood and lymph pass through in 24 hours.
How does the lymphatic system work?
The lymphatic scientist Bartels in 1909 identified three main types of lymphatic “substances”: lymphatic vessels of various calibers from capillaries to crevices, lymphatic organs and the so-called lymphatic collectors - the cavities of the pericardium, pleura, peritoneum, nervous system (ventricles of the brain and not only) . And all these “substances” are in constant interaction with each other.
The lymphatic capillary is a hollow tube, closed on one side, with a radius of three microns. As a result of plasma filtration in the blood capillaries, the fluid enters the intercellular space and becomes tissue, part of it is reabsorbed back into the blood, and part of it enters the lymphatic capillaries, forming lymph. Thus, lymph is the space of the internal environment of the body, consisting of interstitial (intertissue) fluid.
An interesting fact is that there are about 44 billion vessels of the lymphatic system in the body. Their length is twice as long as the length of the vessels of the circulatory system, and is about 200,000 km. Such a large extent, but almost zero pressure. How then does movement happen, you ask? Simple: pressure forces - oncotic (due to the proteins contained in the lymph) and hydrostatic (due to the gradually expanding diameter of the vessels), as well as due to respiratory movements and the work of the diaphragm. Gradually concentrating, the vessels eventually form the right lymphatic duct and the thoracic duct, which flow into the right and left subclavian veins, respectively, and from there into the superior vena cava.
“When the lymphatic duct is blocked, a person becomes an urn! It turns into a toilet where all sorts of impurities are drained without finding a way out. Therefore, cutting large lymphatic trunks is not compatible with life,” the professor notes.
What are lymph nodes needed for?
Lymph nodes are a storehouse of lymph and the cradle of the immune system and immunocompetent cells. The node itself produces lymphocytes, and here (mainly) the fight against microorganisms carrying foreign genetic information occurs.
“What do microbes think about when they find themselves in a favorable environment? We need to multiply!”
However, tumor cells also enter the lymph nodes and can circulate with the lymph flow. They settle there and also begin to multiply. The knot enlarges and becomes dense, like a stone, often immobile. This is especially noticeable when palpating the supraclavicular groups, groups located along the posterior edge of the sternocleidomastoid muscle and others. Such changes, indicating the beginning of the process of metastasis, can become the only manifestations of formidable and often fatal tumor processes in various organs. To confirm his words, the professor said
Case Study: Smoking Really Kills
When Anatoly Georgievich worked as a surgeon in Kalmykia in the summer together with student interns, a patient came to him - a young, beautiful, blooming girl. She complained of what she called a small swelling above her collarbone. At the district clinic she was told that this swelling could be easily removed, and that the city hospital had a very good surgeon. So she arrived. The future professor, after examining the patient, left the examination room gloomy and gloomy. The students, intrigued by his appearance (the girl was beautiful, and also unmarried), surrounded him and began asking him what was the matter. To which Anatoly Georgievich replied: “I witnessed a real human tragedy... In a month, this young and blooming girl will die, because she has cancer of the left lung in an inoperable stage.” And he noted that the reason for such a sad outcome was smoking - the girl had been smoking almost a pack of cigarettes a day since school.
By the way, Michael DeBakey, a famous American heart surgeon, was one of the first to suggest a cause-and-effect relationship between smoking and lung cancer. In 1951, British scientists proved this connection with the British Doctors Study. So think about it, those who like to smoke in the name of relaxing their nerves...
Various complications with damage to the lymphatic system are also by no means harmless. For example, chylothorax, or a lymph-filled pleural cavity, can be fatal. Or another extremely unpleasant pathology - lymphostasis, the advanced form of which everyone has probably heard of as “elephantiasis” or “elephantiasis”. This is a fairly common postoperative complication precisely because, when restoring the integrity of tissues, surgeons rarely pay due attention to restoring the integrity of the lymphatic vessels. And we must not forget about this!
Instead of a total
“You entered medical university. No one but yourself will make you a knowledgeable and skilled doctor when you receive your diploma. Only you! A month has passed - look back, see what you have acquired during this time for your future profession? Studying at the university is the most difficult period in your life and it then decides your fate. Take it seriously."
Anna Horuzhaya
