Lymph node cancer: symptoms, diagnosis, treatment

Lymph nodes of the abdominal cavity and retroperitoneal space and pelvis - treatment of advanced cancer

If the tumor was not detected at an early stage, it begins to spread to other parts of the body. One of the most common “targets” of metastasis are lymph nodes. Moreover, most malignant tumors of the abdominal organs give metastases to nearby parts of the lymphatic system.

This means that, with a high degree of probability, the patient, simultaneously with treatment of the primary tumor, will have to treat metastases to the lymph nodes of the abdominal cavity, retroperitoneum and pelvis . In modern conditions, treatment tactics include simultaneous treatment of the primary tumor and metastases to the lymph nodes with CyberKnife ( radiosurgery ), or surgical removal of the affected lymph nodes (if surgical treatment of the primary tumor was performed), as well as radiation therapy of the affected lymph nodes, or those that are highly likely to be affected the tumor process spreads. Chemotherapy is also widely used as a treatment for metastases (including to lymph nodes) .

Classification of lymph node cancer

If there is any inflammatory or infectious process in the body, the lymph nodes react to it with enlargement and sometimes even pain. If this condition does not go away for a long time, then this is a reason to consult a doctor, since it is important to detect the pathology at an early stage.

Lymph node cancer can develop in one of two forms:

Hodgkin's lymphoma (lymphogranulomatosis). The most common variant of the development of lymph node cancer, occurs in 1/3 of cases of detection of such oncology in both adults and children. Hodgkin's lymphoma is considered a more favorable form in terms of cure. Even at stage 4 of the disease, the survival rate is 65%;
non-Hodgkin's lymphoma. This is a more serious form of lymph node cancer, occurring in 2/3 of cases. The disease progresses rapidly, metastases appear early and spread throughout the body.

Increase

The reasons for the increase lie in general infections of the body, which leads to swelling of the lymph nodes, as well as infections of the throat, ear, and mononucleosis. Sometimes these are germs that cause tuberculosis, sexually transmitted infections, syphilis and a parasitic infection (toxoplasmosis) caused by contact with feces of infected cats or consumption of undercooked or raw meat. They are manifested by allergic, autoimmune diseases: lupus erythematosus (chronic inflammatory disease of the joints, skin, kidneys, blood, heart and lungs), rheumatoid arthritis and the AIDS virus.

Less commonly, swollen nodes are caused by cancer, either lymphoma (cancer of the lymphatic system) or leukemia (cancer of the blood involving the bone marrow and lymphatic system). Sometimes lymph nodes react this way to taking medications.

When to Seek Medical Help

Normally, lymph nodes cannot be palpated. They shrink back; this is normal, for example, after a cold. You should visit your doctor's office if the nodes become larger without obvious cause.

Lymph nodes do not hurt for no reason. You should see a doctor if:

The increase in size and swelling lasts more than 4-6 weeks.
There is elevated body temperature and pain.
Continuous growth of inflammation, negative dynamics.
General weakness, symptoms of intoxication.
There is unexplained weight loss.

Causes and risk factors

Lymph node cancer has several age peaks during which the disease is diagnosed more often. This is the period from 15 to 30 years, people over 50 are also at risk. It is during this time that the risk of developing lymphoma is higher. The exact causes of the disease are unknown. Doctors cite only risk factors that increase the likelihood of developing lymphoma:

prolonged interaction with harmful substances;
HIV infection and other types of immunodeficiency;
smoking and alcohol abuse;
radiation exposure;
living in unfavorable environmental conditions;
pregnancy over 35 years of age;
Epstein-Bar virus;
genetic inheritance.

Stages

Different types of lymphomas can have different degrees of spread throughout the body. Taking this into account, there are 4 stages of lymph node cancer.

First. Only one area is affected; cancer develops in the lymph nodes in the armpit, neck, etc.
Second. The tumor process has already spread to 2 or more groups of lymph nodes.
Third. In addition to the lymph nodes, the diaphragm and one organ outside the lymphatic system are affected.
Fourth. At the last stage, tissues outside the lymphatic system are affected, and in several parts of the body at once. The disease invades vital organs, so treatment becomes less effective.

Causes of metastasis to lymph nodes

The mechanisms of metastases are not completely clear. It is known that in this process the activation of the ability of malignant cells to migrate and the structural restructuring of the blood and lymphatic vessels that feed and surround the tumor play a role - they lack a basement membrane and pericytes. Some capillaries are even formed directly by tumor cells. Thus, malignant cells enter the lymphatic vessels and reach the nearest lymph nodes through them.

The ability of cancer to metastasize is determined by several factors:

The degree of malignancy of the cancer. The less differentiated the tumor cells, the more aggressive it is and the earlier it begins to metastasize.
Histological type of tumor. Most often, carcinomas, malignant neoplasms originating from epithelial tissue, metastasize through the lymphogenous route.
Patient's age. In young people, metastases from the same tumors appear, on average, earlier than in older people. This is associated with the characteristics of blood circulation and the activity of the immune system.

The process of metastasis can be accelerated by thermal procedures and physiotherapy on the area where the tumor is localized, as well as non-compliance with the rules of ablastics when removing the tumor. The last point is very important in the surgical treatment of cancer, therefore oncological operations should be performed in specialized hospitals, which have certain conditions for carrying out such interventions and qualified personnel.

Types of lymph node cancer

In addition to division by type of lymphoma, lymph node cancer is classified according to the location of the lesion. Based on this criterion, oncology of different types of lymph nodes is distinguished:

axillary;
cervical;
pulmonary;
ileal;
supraclavicular;
inguinal

In percentage terms, cancer of the lymph nodes most often occurs in the groove area (35%), followed by the neck (31%) and armpits (28%). Other localizations of oncology account for 6%. The most favorable prognosis is observed for cancer of nodes in the groin, armpits and under the jaw.

Symptoms and signs of lymph node cancer

Lymph node cancer can manifest itself differently depending on the form of the disease that the patient develops. With lymphogranulomatosis, the following symptoms are observed:

severe enlargement of the lymph nodes above the collarbone and in the neck;
an increase in mediastinal nodes with a specific cough, shortness of breath and swelling of the veins in the neck;
painful sensations in the lumbar region, most often occurring at night.

The disease causes different symptoms when a specific group of lymph nodes is affected. If the pathology develops in an acute form, then the patient immediately experiences an increased degree of sweating and a sharp increase in body temperature. There is also significant weight loss, which progresses over time. As the disease progresses, more characteristic symptoms of lymph node cancer appear:

feverish condition;
severe itching of the skin;
weakness;
patches of red or dark color on the skin;
diarrhea, tendency to burp;
frequent migraines, dizziness;
pain in the epigastric and navel areas.

Causes of enlarged inguinal lymph nodes

Infections of the genitourinary system

Lymphadenopathy in infectious diseases is caused by increased stimulation of the inguinal nodes and increased differentiation of lymphocytes. Enlarged lymph nodes are determined at the onset of the disease as a reactive reaction. Sometimes patients themselves identify “bumps” or nodes in the groin that are painful on palpation. Lymphoid formations have an elastic consistency, are not welded together and are not attached to the skin. Redness of the skin and an increase in local temperature are detected above the lymph nodes. Most often, lymphadenopathy is caused by:

Genital herpes
. An increase in inguinal lymphatic formations occurs against the background of an increase in temperature and general malaise. With significant hyperplasia of the lymph node tissue, patients independently palpate the lumps located in the superolateral parts of the pubic area. Then multiple small bubbles with transparent contents appear on the skin of the perineum, bursting with the formation of erosions.
Primary syphilis
. With this disease, there is a unilateral increase in lymphoid formation, which can reach the size of a walnut. The node is painless on palpation, sometimes a dense cord is found coming from the lymph node, which is an inflamed lymphatic vessel. A couple of weeks before lymphadenopathy, a red, fleshy erosion appears on the skin of the genital organs - a chancre.
Chlamydia
. Bilateral inguinal lymphadenopathy due to chlamydia infection is more often diagnosed in men, since their infection often occurs in an acute form. Enlarged lymph nodes are sensitive to palpation; the skin over them, as a rule, is not changed. The symptom is accompanied by pain in the lower abdomen and mucopurulent discharge from the urethra. In women, there may be a slight enlargement of the lymph nodes without other manifestations.
Gonorrhea
. Increased antigenic stimulation causes increased differentiation of lymphocytes and an increase in the volume of lymphoid formations in the groin. The damage to the lymph nodes is often bilateral, the formations are sensitive when palpated, and slight hyperemia of the skin is detected above them. With gonorrhea in men, lymphadenopathy is combined with dysuric disorders, purulent urethral discharge in the morning.
Ureaplasmosis and mycoplasmosis.
Moderate enlargement of lymph nodes without signs of local inflammation is possible in both men and women, but an acute course with pronounced clinical symptoms is more typical for males. Against the background of inguinal lymphadenopathy, pain and pain are felt when urinating, and mucopurulent discharge from the urethra is noted. With intense inflammation, the skin over the lymph nodes becomes noticeably red.

Diseases of the female reproductive system

The high frequency of inflammatory processes in women is due to the anatomical features of the genital organs, the proximity of the entrance to the vagina and urethra, which contributes to the spread of pathogenic microorganisms. Exacerbation of inflammation is provoked by hypothermia, stress, and lack of personal hygiene. Enlargement of the inguinal lymph nodes occurs as a reaction of the lymphoid tissue to the inflammatory process, resulting in increased production of mature T- and B-lymphocytes in the antigen-dependent zones of the follicles. Inguinal lymphadenopathy in women is caused by:

Vulvitis
. The acute version of inflammation is manifested by enlarged lymph nodes, itching and burning in the perineum, and moderate pain when urinating. Lymphadenopathy develops several days before the other symptoms of vulvitis; lymphoid formations are painless, so many women do not notice this symptom in time. Then the outer labia become red and swollen, and viscous mucus or pus is released from the vagina.
Bartholin gland abscess
. With massive purulent inflammation, a significant increase in the inguinal lymph node on the affected side is observed. During self-examination, a woman may palpate a large, painful “bump.” A typical sign of the disease is the appearance of a formation several centimeters in diameter in the labia area, which, when touched, causes sharp pain in the perineum.
Colpitis
. Enlarged lymph nodes with inflammation of the vagina are combined with low-grade body temperature and discomfort in the perineum. Inguinal lymphadenopathy during colpitis is characterized by bilateral lesions, small size of formations and mild pain upon palpation. Women note dysuria, moderate pain in the lower abdomen with irradiation to the groin, then vaginal discharge occurs.

Diseases of the male genital organs

Inflammatory processes of the reproductive system occur in men of different ages and are of great importance, since without treatment they cause severe complications and disrupt the quality of intimate life. Inguinal lymphadenopathy is a typical symptom of andrological pathology; regional lymph nodes enlarge due to antigenic stimulation of the paracortical and follicular zones. Hyperplasia of the inguinal nodes occurs in diseases such as:

Balanitis
. With inflammation of the head of the penis, enlargement and tenderness of the inguinal lymph nodes are usually detected on both sides, and sometimes unilateral lymphadenopathy develops. A day or two after the onset of the symptom, the man begins to feel pain and burning in the area of the head and outlet of the urethra. When the inflammatory process spreads to the foreskin, balanoposthitis develops.
Orchitis
. With inflammation of the testicles, inguinal lymphadenopathy is one-sided, manifests itself 2-3 days before the main symptoms, lymphatic formations reach a size of 1.5-2 cm. Enlarged lymph nodes are accompanied by general malaise, myalgia, and increased body temperature. The man pays attention to the swelling and hyperemia of the scrotum, which are more pronounced on one side. There are sharp pains that intensify when walking.
Gangrene of the penis
. Destructive inflammation proceeds relatively slowly, so sometimes the lymph nodes manage to reach the size of a walnut. When palpated, the lymphoid formations are compacted, not fused with the skin and tissue, and moderately painful. Against the background of enlargement of the inguinal lymph nodes, specific changes in the penis are revealed - its skin dries out, turns black, and the process gradually affects the entire organ.

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Enlarged inguinal lymph nodes in a man

Oncological pathology

Typically, metastatic lesions of the inguinal lymph nodes are associated with malignant tumors of the reproductive system, which is due to the characteristics of lymph drainage. Lymphatic formations are slightly painful, immobile, and have a woody density. Patients complain of discomfort when wearing tight underwear and jeans. More often, patients discover lymphadenopathy on their own. Metastasis to the inguinal lymph nodes is also specific for anal cancer and skin neoplasia localized in the perineal area. Inguinal lymphadenopathy occurs with:

Neoplasms of the female genital area
. Inguinal lymph nodes are the most common site of primary metastasis of malignant cells, since lymph from the pelvic organs passes through them. Lymphadenopathy, accompanied by frequent vaginal bleeding and pain in the lower abdomen, is typical of uterine carcinoma and fallopian tube cancer. Enlargement and hardening of the lymph nodes are found in vulvar melanoma and vaginal sarcoma.
Testicular cancer
. This tumor is characterized by early metastasis with damage to the inguinal lymphoid formations. More often, unilateral lymphadenopathy is observed, which corresponds to the affected testicle; with advanced neoplasia, the process becomes bilateral. The formations are dense and immobile. In the early stages, men notice asymmetry and swelling of the scrotum, then a dense, tuberous neoplasm appears.
Penile cancer
. Enlargement of the inguinal lymph nodes is pathognomonic for the edematous form of neoplasia. Lymphoid tissue is affected on both sides; the formations are very dense to the touch and do not move during palpation. The primary tumor is most often localized on the head of the penis: patients first notice a wart, a long-term non-healing ulcer or erosion with sanguineous or purulent discharge. When the form is advanced, phimosis occurs.
Germ cell tumors.
Neoplasms develop from germ cells of the reproductive system and can affect both men and women. Inguinal lymph nodes enlarge and become denser as the disease progresses; general lymphadenopathy indicates massive lymphogenous spread of tumor cells. Patients report urinary disorders, and in women the menstrual cycle is disrupted.

Hemoblastoses

Enlargement of the axillary, cervical, and inguinal lymph nodes is detected in myeloproliferative processes - leukemia, chronic lymphocytic leukemia. Lymphoid formations are dense, mobile, up to several centimeters in size. Generalized lymphadenopathy is accompanied by sweating and spontaneous bleeding. When immunity decreases, infectious diseases manifest. Enlarged lymph nodes are characteristic of T-cell lymphomas: Sezary syndrome, mycosis fungoides. The symptom is also observed in autoimmune lymphoproliferative syndrome.

Parasitic infestations

The increase in lymphoid formations is caused by an increase in local immune reactions in response to the penetration of the pathogen. Isolated damage to the inguinal nodes is possible with local parasitic infections of the perineal area; generalized lymphadenopathy is characteristic of protozoal diseases. Most often, a reaction from the lymphatic system is observed in pathologies such as:

Helminthic infestations
. When a person is infected with tropical biohelminths, a group of helminthiasis similar in clinical picture may occur: filariasis, wuchereriosis, brugiosity. The reaction of the inguinal lymph nodes is caused by the direct pathogenic effect of pathogens. Lymphoid formations can increase in diameter up to 10 cm, the outflow of lymph from the lower extremities is disrupted, pronounced swelling of the scrotum in men and elephantiasis are noted.
Toxoplasmosis.
For the acquired form of infection, generalized lymphadenopathy with predominant damage to the inguinal and axillary lymph nodes is pathognomonic. The formations are moderately dense, mobile, painful when touched. The symptom is accompanied by the appearance of spotty or nodular rashes on the skin of the body, enlargement of the liver and spleen. In chronic toxoplasmosis, the mesenteric lymph nodes are involved.
Pediculosis
. Damage to the inguinal lymphoid structures is observed in the pubic form of the disease. The enlargement of the lymph nodes is bilateral, the formations have an elastic consistency, sizes up to 2 cm. Patients feel intense itching, especially at night, small bluish spots and scratches are found on the pubic skin. The common form of pediculosis pubis must be differentiated from adult pruritus.

When to see a doctor

Lymph node cancer requires timely detection at the earliest stage, since the prognosis of recovery depends on this. If you have risk factors or symptoms of the disease, you should immediately consult a doctor for appropriate diagnostic measures. In the case of cancer of the lymphatic system, the patient requires the help of an oncologist. In our oncology center on 2nd Tverskoy-Yamsky lane. House 10 employs the best specialists who specialize in the diagnosis and treatment of various types of oncology.

Prevention

For cancer with a high risk of lymphogenous metastasis, preventive measures are required. In some cases, preventive removal of lymph nodes is required, even if there is no evidence of their involvement. In others, they are irradiated. Also, in a large number of cases, chemotherapy is prescribed, which is designed to destroy as much as possible the cancer cells that have spread throughout the body.

If we talk about the prevention of metastases in the lymph nodes, it is worth noting that almost any malignant tumor metastasizes sooner or later. Having discovered a neoplasm, you must immediately seek special help and not self-medicate, which can only aggravate the situation and worsen the prognosis.

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Diagnosis of node cancer in the oncology center

If lymph node cancer is suspected, the doctor begins with a general examination to detect characteristic signs of the disease. It is very important to answer all the specialist’s questions, since any complaints and manifestations, as well as previous diseases, can provide the doctor with the necessary information base for prescribing successful treatment in the future.

An important stage of the examination is palpation of the lymph nodes, which makes it possible to identify their enlargement and soreness. Also, oncology practices all modern diagnostic methods, which make it possible to identify the disease with 100% accuracy. The patient may be prescribed:

scintigraphy;
PET/CT;
Magnetic resonance imaging;
lymphography;
blood test for tumor markers;
vacuum aspiration biopsy of neoplasm tissue;
SPECT (single photon emission computed tomography).

How do metastases spread?

Metastases are daughter tumors that originate from malignant tumors. Cancer cells are released from a tumor in the intestine and travel elsewhere in the body through lymph fluid or blood.

Spread through a lymphatic vessel (lymphogenous metastasis): with colon cancer, metastases first appear in the lymph nodes - these are, depending on the location of the tumor, lymph nodes along the large abdominal artery, nodes of the pelvic wall or groin.

Spread through a blood vessel (hematogenous metastasis): If a central colon tumor has invaded the bloodstream, colon cancer metastasizes to the liver and lungs. Blood from the colon first flows through the portal artery into the liver, cancer cells are deposited, and metastases often form first in the liver.

Metastases differ not only in the path of spread of the primary tumor cell, but also in the location where they ultimately settle and form metastases:

Local metastases occur in close proximity to the original tumor.
Regional metastases occur in lymph nodes close to the tumor in the area of the lymphatic flow.
Distant metastases form in other distant organs or tissues of the body, with colon cancer, especially in the liver and lungs.

Diagnosis of metastases

As part of diagnosing cancer, it is important to determine how much the cancer has already spread. Doctors use numerous tests to track metastases. An ultrasound examination is performed, with the help of which the structure and size of the tumor is visible.

X-rays provide a clear picture of the organs and areas of the body. It is useful to take a chest x-ray, this indicates metastases in the lungs. If the result is unclear, computed tomography (CT) is added, which provides cross-sectional images of the body. In addition to computed tomography, magnetic resonance imaging (MRI) is added, creating a cross-sectional picture of the body, but in ideal quality.

Abdominal mirror imaging (laparoscopy) or positron emission tomography (PET) are additionally used to look for metastases.

Treatment and after surgery

Cancer with metastases indicates an advanced stage and is difficult to treat. Depending on the degree of metastasis, the likelihood of recovery increases.

With experienced doctors and innovative methods, there is a great chance of prolonging life and healing. There are special centers with solid experience in treatment.

Metastases of the liver and lungs must be removed surgically. In 30-40% of patients, metastases stop over a long period of time. For example, if an intestinal tumor is operated on, and there are only isolated distant metastases in the liver, the prognosis is positive.

Treatment of lymph node cancer

The treatment regimen for lymphoma depends on many factors: the location of the tumor, its spread throughout the body, size and the presence of metastases in other tissues and organs. The best results are achieved by an integrated approach that combines several treatment methods.

Chemotherapy

Lymph node metastases from cancer require mandatory chemotherapy. It is considered a universal treatment method and is used both independently and in combination with other methods. The essence of chemotherapy is the intravenous administration of special antitumor drugs that destroy cancer cells. Such drugs also act on healthy tissue, which leads to side effects, but when metastases spread, this is the only method of treatment.

Surgery

Surgical treatment for lymph node cancer involves their complete removal. This method is also considered quite effective, since it minimizes the risk of relapse of the disease. Surgery for lymph node cancer is performed with resection of several regional nodes, which is necessary to reduce the likelihood of recurrent cancer.

Cervical, submandibular, inguinal and axillary lymph nodes are removed under local anesthesia, and deeper ones - under general anesthesia. The excised portions can be used for histology and correct diagnosis.

Radiation therapy

The use of radiation therapy is recommended in conjunction with surgical treatment. This method allows you to destroy cancer cells that may have remained after surgery. Radiation therapy is also used at an early stage as preparation for surgery to reduce the size of the tumor.

Bone marrow transplantation

Today, another new method is used in the treatment of lymph node cancer - donor bone marrow transplantation. This operation makes it possible to give very optimistic prognoses, especially at an early stage of the disease.

How do metastases manifest in lymph nodes?

The main clinical symptom of metastatic disease of the lymph nodes is their enlargement. This is a nonspecific manifestation that can develop with inflammatory diseases, some infections, lymphadenopathy, autoimmune pathologies, etc. If the lymph nodes are located superficially, they can be palpated. For cancer, they usually have a soft consistency and are painless to the touch.

If deep lymph nodes become enlarged, they can put pressure on internal organs, disrupt their function and cause pain. Symptoms in this case will depend on the location of the affected lymph nodes. Portal hepatic nodes can compress the portal vein, leading to the development of portal hypertension. Damage to the mesenteric lymph nodes can cause disruption of the intestines, intrathoracic - shortness of breath and disruption of the heart.

How to make an appointment with a specialist in oncology

To get a consultation with a specialist in our oncology center, you need to use any convenient recording method. Fill out the online form on the website, entering all the required data, or call us at the contact number.

Onko is open for you not only on weekdays, but also on weekends, so you can choose an appointment time that is convenient for you. We are located on 2nd Tverskoy-Yamsky Lane, 10, close to the Tverskaya, Novoslobodskaya, Chekhovskaya, Belorusskaya and Mayakovskaya metro stations. Take care of your health and consult a doctor on time, without waiting for your condition to worsen.