Why is lymph node dissection performed?
Malignant tumors are distinguished by their ability to form metastases, spreading beyond the primary focus and beginning to develop in other organs and tissues. Cancer cells separate from the primary tumor and spread throughout the body through the blood and lymph, including the lymph nodes themselves, first the closest ones.
Therefore, removal of the lymph nodes along with the primary tumor makes it possible to stop and even prevent the development of metastases. The results of the study of nodes removed during lymph node dissection help in drawing up an optimal program for further treatment. Thus, lymph node dissection combines directly therapeutic and diagnostic functions.
What symptoms occur?
In a healthy state, the ulnar lymph nodes are not palpable, but they begin to be palpated due to the development of pathological processes. The first symptom of inflammation is pain, which intensifies over time.
The localization of the lymph nodes in the elbow bend affects the functioning of the entire arm, so intense pain at the site of the lymph node lesion may subside with flexion.
Other characteristic signs of cubital lymphadenitis are:
- General weakness
- Increased general and local (in the inflamed area) temperature
- Lymph node enlargement and swelling
- Feelings of weakness in the limbs
- Redness, change in lymph gland density
Severe swelling can limit the motor functions of the limb, which is expressed by contracture (stiffness of the joints) and is strongly felt in the bends. Reducing the range of motion in joints in some cases is complicated by disruption of cellular metabolism and, as a consequence, structural transformations in bone and cartilaginous tissues.
Indications for lymph node dissection
The need for lymph node dissection depends on the aggressiveness of the specific disease and the extent of the tumor, that is, the stage of the cancer.
Some tumors hardly metastasize, so lymph node dissection is not used in their treatment. This is, for example, basal cell carcinoma. For the same reason, lymph node dissection is usually not necessary in the early stages of cancer.
However, for rapidly metastasizing cancers, lymph node dissection is a mandatory component of radical treatment. If it is impossible to carry out this procedure, the tumor is considered inoperable. This applies, for example, to gastric cancer, pancreatic carcinoma, and non-small cell lung carcinoma.
In the case of a number of diseases - for example, breast cancer, melanoma, squamous cell carcinoma of the skin - before performing lymph node dissection, a biopsy of the sentinel lymph node is done to determine the presence of metastases in it.
The sentinel node is the lymph node closest to the path of tumor spread. To detect it, mapping is carried out, isolating the affected tissues using labeled isotopes or a dye. After detection, the sentinel node is removed and submitted for morphological examination. If no traces of damage are detected in this node, then lymph node dissection is not prescribed, since the likelihood of metastases is minimal. If tumor cells are found in the sentinel node, then without lymph node dissection, the prognosis worsens.
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Preventive actions
Since the main cause of the disease is an infection that enters the body through damaged skin, in order to prevent the occurrence of cubital lymphadenitis, you should:
- Avoid injury to the skin
- Use disinfectants in cases of abrasions and wounds to prevent infection
- Don't ignore scratches and bites left by your pet
- Avoid severe hypothermia or heat exposure
In case of timely and effective treatment of the main cause of the inflammatory process, lymphadenitis can go away on its own.
Types of lymph node dissection
Depending on the location of the primary tumor focus, different groups of lymph nodes are removed during lymph node dissection. So lymph node dissection can be:
- mediastinal (for lung cancer, esophageal cancer);
- axillary (for breast cancer);
- pelvic (for cancer of the genital organs);
- inguinal-femoral (for cancer of the external genitalia), etc.
Depending on the scale of the intervention, lymph node dissection is divided into
- regional (deleting the nearest group of nodes);
- selective (selective);
- extended.
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For malignant tumors of internal organs, a classification of lymph node dissection according to the levels of the removed lymph nodes is also used. Within this classification, the types are designated by the letter D with numbers from 1 to 4 next to them, where D1 is the lymph node dissection of the lymph collector closest to the tumor, and D4 is the most distant one. Each cancer disease has its own lymph node dissection standards and level system.
Lymph node dissection for stomach cancer
Already at the 1st stage of gastric cancer, every 10th patient is found to have damage to the nearest group of lymph nodes. On the 2nd, every 3rd patient has damage to several groups of lymph nodes. At stage 3, the number of patients with multiple lesions reaches 90%. And even with non-invasive carcinoma, at stage zero, there is a possibility that the tumor has already spread to the nearest lymph nodes (3% of cases).
It is precisely because of these statistics that for gastric cancer, lymph node dissection is included in the standard of surgical treatment. The affected groups of nodes are removed along with the stomach or part of it. The volume of lymph node dissection performed depends on the number of affected lymph nodes. First of all, the retroperitoneal lymph nodes are removed.
Send documents by email The possibility of treatment will be considered by the chief physician of the clinic Anton Aleksandrovich Ivanov, oncologist-surgeon, kmn
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
How is lymph node dissection performed?
Removal of lymph nodes is carried out with mandatory adherence to certain principles developed in oncology and designed to minimize the risk of new metastases.
Firstly, it is not a separate lesion that is removed, but the tumor along with the surrounding tissue and lymph nodes as a single block, during one operation (monoblock principle).
Secondly, lymph node dissection is performed according to the zonal principle, taking into account anatomical boundaries. This means that it is impossible to remove only individual nodules with metastases from different zones (zoning principle).
Thirdly, metastases must be removed taking into account their relationship with neighboring structures (the principle of casing).
Lymph node dissection can be performed openly or endoscopically under general anesthesia.
If lymph node dissection is performed in the thoracic, abdominal or pelvic cavity, the organ affected by the tumor is first removed, then the lymph nodes and internal tissue. During lymph node dissection, the fatty tissue along with the lymph nodes is separated from the muscles and removed.
After removal of the lymph nodes, ligation and intersection of the vessels are performed, then the surgical wound is sutured.
Often, lymph node dissection takes longer than removal of the primary tumor focus.
After the operation, the obtained material is submitted for morphological examination.
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Rehabilitation and complications after lymph node dissection
The most basic and dangerous complication after lymph node dissection is lymphostasis, or lymphedema. It forms on the torso or limbs on the side where lymph node dissection was performed and is due to the fact that removal of part of the lymphatic vessels inevitably disrupts lymph circulation. The patient begins to experience heaviness, aching, skin changes are observed and mobility is impaired. In particularly severe cases, elephantiasis may develop in the affected limb.
To reduce the risk of lymphostasis, after lymph node dissection, the patient must:
- perform the prescribed therapeutic exercises, strictly following the instructions;
- during sleep, keep the limb on the side of which lymph node dissection was performed elevated;
- avoid damaging the skin (to prevent the development of infection, which increases the production of lymphatic fluid when fighting it);
- avoid stress and do not rush to return to your previous rhythm.
If redness, swelling, or a significant increase in temperature appear on the side of the body where lymph node dissection was performed, you should consult a doctor.
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.