Cancer of the lymph nodes (metastases): symptoms, treatment, neck and other organs
Metastasis is the most important feature of any malignant tumor. This process is associated with the progression of the disease, which often ends with the death of the patient. With the defeat of the lymphatic system cancer of another organ, the layman might describe this phenomenon as «cancer of the lymph nodes» from the point of view of medicine is the cancer metastasis, that is, a secondary lesion.
Cells of malignant tumors have a number of differences from the healthy, including not only local destructive effect in a tissue or organ, but also the ability to separate from each other and spread throughout the body. The loss of specific protein molecules, providing a strong link between cells (adhesion molecules), leads to a separation of the malignant clone from the primary tumor and its penetration into the vessels.
Epithelial tumors, i.e., cancers (carcinomas), predominantly metastasize lymphogenous way, through the lymphatic vessels carrying lymph from the body. Sarcomas (connective tissue tumors) can also affect the lymph nodes, although the predominant way of metastasis for them hematogenic.
On the path of lymph flow nature provides «filters» that holds all the «extra» — microorganisms, antibodies, cell fragments destroyed. Tumor cells also fall into this filter, but the disposal of them does not occur, and instead the malignant clone begins to actively share, giving rise to new tumors.
Initially signs of metastases are detected in regional lymph nodes, i.e. those that are closest to the tumor body and are the first to meet the lymph, carrying carcinomatosis elements. With further progression of the disease metastases spread farther, capturing more distant lymph group. In some cases the affected lymph nodes are located in different parts of the body that speaks of an advanced stage tumor and unfavorable prognosis.
Enlargement of lymph nodes in cancer is the result of the reproduction in them of the tumor cells, which displace healthy tissue, filling the lymph node. Inevitably, obstruction of lymphatic drainage.
On histological structure usually correspond to metastases of the primary tumor, but the degree of differentiation in some cases is lower, therefore, the secondary cancer of the lymph node is growing faster and more aggressive. There are cases when the primary tumor manifests itself only metastases, and the search for their source not always bring results. Such failure is referred to as metastasis of cancer from a mysterious source.
Possessing all the characteristics of malignancy, cancer (metastasis) to lymph node poison the body by products of metabolism, enhances the intoxication, causes pain.
Any malignant tumor sooner or later begins to metastasize when this will happen depends on several factors:
- Age – the older the patient, the earlier the metastases appear;
- Comorbidities in the chronic form, weakening the body’s defenses, immune deficiencies contribute to more aggressive tumor growth and early metastasis;
- The stage and degree of differentiation is a large tumour, ingrowing in the wall of the organ and damage the blood vessels, metastasize more active; the lower the degree of differentiation of cancer – the sooner and faster spread metastases.
Not every tumor cell, trapped in the lymph node, will share and give metastasis. With good immunity, this may not occur, or will occur after a long period of time.
In diagnosis indication of any metastatic involvement of lymph nodes is denoted by N: N0 – the lymph nodes are not affected, N1-2 – metastases in regional (nearby) lymph nodes, N3 distant metastasis when metastatic lymph nodes at a considerable distance from the primary tumor that corresponds to a heavy fourth stage of cancer.
Manifestations of nodal metastasis
Symptoms of lymph node cancer depends on the stage of the disease. Usually the first sign of getting their increase. If the affected superficial lymph nodes, they can be felt as a magnified isolated nodules or conglomerates, which are not always painful.
Such metastases in the lymph nodes easily determined in the armpit in breast cancer in the groin for tumors of the genital tract in the neck in diseases of the larynx, oral cavity, above and below the clavicle in the case of stomach cancer.
If the tumor affects the internal organ, and metastasis occurs in the lymph nodes, lying in the depths of the body, then to detect an increase not so easy. For example, enlarged lymph nodes of the mesentery for bowel cancer, the gate of the liver in mechanochemical carcinoma, small and large curvature of the stomach in tumors of this organ palpation inaccessible, and to help the doctor come additional examination methods, ultrasound, CT, MRI.
Large group changed metastatic lymph nodes inside the body can manifest by symptoms of compression of the organs or vessels near which they are located. With the increase of mediastinal lymph nodes, possible shortness of breath, heart rhythm disorders and chest pain, mesenteric enlarged lymph collectors contribute to pain and bloating, indigestion.
When compression of the portal vein arise portal hypertension – increase the liver and spleen, in the abdominal cavity accumulated fluid (ascites). The defeat of the lymph nodes with cancer can tell the signs of difficulty of outflow of blood via the superior Vena cava – swelling of the face, cyanosis.
On the background of the metastasis is changing and the General condition of the patient, increasing weakness and weight loss, progressive anemia, fever becomes continuous, disturbed emotional background. These symptoms are indicative of a strengthening intoxication, which heavily contribute to growth of cancer in the lymph nodes.
Lymphogenous metastasis in certain cancer types
The most common types of cancer are carcinoma of the stomach, breast in women, lung, genital tract. These tumors tend to metastasize to lymph nodes, and the propagation of cancer cells and the sequence of the lesions of the lymphatic apparatus are fairly well understood.
In breast cancer, the first metastasis can be detected in axillary lymph nodes and in the second stage of the disease, and on the fourth they are present in distant organs. Lymphogenous dissemination starts early and is often a pretext for tumor becomes palpable education in my chest and enlarged lymph nodes in the armpit.
Breast cancer manifested by the defeat of several groups of lymph nodes – axillary, allogrooming, over — and subclavian. If the cancer grows in the outer areas of the gland, it is logical to expect the cancer metastases in the lymph nodes in the armpit, the defeat of the internal segments of the leads to hit the cancer cells in the lymph nodes in the course of the sternum. Remote will be considered as metastasis in these lymph node groups are opposite in relation to tumors of the hand, as well as the defeat of the nodes in the mediastinum, abdomen, neck.
In lung cancer identifies a group of regional lymph nodes, affected, first, and remote, involved in advanced stages. Regional considered paratracheal, bifurcation, and peribronchial lymph nodes near the bronchi and trachea, distant – over — and infraclavicular, mediastinal, cervical.
In the lungs lymphogenous spread of cancer occurs early and rapidly, this contributes to a well-developed network of lymphatic vessels, necessary for the proper functioning of the body. Especially prone to such dissemination Central cancer growing out of the large bronchi.
Gastric cancer metastases in the lymph nodes can have a kind of location. The first affects the nodes in the course of great and lesser curvature, antrum, and then the cells reach the celiac lymph nodes (second stage), it is possible to detect gastric cancer in the lymph nodes in the course of the aorta, the portal vein of the liver.
Distinctive varieties of lymphogenic metastases of stomach cancer are named after the researchers who described them or for the first time confronted with them. Metastasis Virchow affects the left supraclavicular lymph nodes, Schnitzler – fiber rectal region, Krukenberg – ovaries, Irish lymph nodes in the armpit. These metastases are talking about distant dissemination of the tumor and severe stages of the disease when radical treatment is not possible or is impractical.
Lymph nodes in the neck are affected in tumors of the floor of the mouth, tongue, gums, palate, jaws, larynx, esophagus, thyroid and salivary glands. In the pathological process involved the submandibular, cervical, occipital lymph node groups. Distant metastasis in cervical lymph nodes is possible in carcinomas of the breast, lung, stomach. In cancer, located in the region of the face, oral cavity lymphogenous spread occurs quickly, which is associated with a great impossibilium this zone.
In addition to metastases in the neck lymph nodes can form primary tumors – lymphoma, Hodgkin’s disease, which the layman is also called cancer of the cervical lymph node. In some cases, to determine the primary tumor or the metastasis was struck by the nodes in the neck, is possible only in case of additional examination, including a biopsy.
Lymph nodes in the neck tend to increase not only in metastases. Probably each of us can find at least one enlarged nodule under the lower jaw or between cervical muscles, but it does not necessarily talking about cancer. To panic it is not necessary, though to find the cause not hurt.
The cervical and submandibular lymph nodes collect lymph from the oral cavity, larynx, pharynx, jaws, which very often have inflammatory changes. All sorts of tonsillitis, stomatitis, dental caries are accompanied by chronic inflammation, it is not surprising, and the increase in regional lymph nodes. In addition, the area of the mouth and upper respiratory tract is constantly found with different microorganisms that flow of lymph are detoxified in the lymph nodes. This enhanced their work can also lead to lymphadenopathy.
Diagnosis and treatment of metastases in the lymph nodes
Diagnosis of metastases in the lymph nodes is based on palpation, if possible. If you suspect a lesion of the axillary, inguinal cervical lymph nodes the doctor will be able to feel them all over, in some cases palpation and internal lymph nodes – celiac, mesenteric.
For confirmation of metastatic lesions use additional methods survey:
- Ultrasound is particularly informative when swollen lymph collectors, which are located inside the body near the stomach, intestines, at the gate of the liver and retroperitoneal space in the chest cavity;
- CT, MRI – determine the number, size and exact location of the changed lymph nodes;
- Puncture and biopsy is the most informative ways to see cancer cells in the lymph node biopsy it is possible to assume the source to clarify the kind and degree of differentiation of cancer.
Molecular genetic studies aimed at establishing the presence of certain receptors or proteins on cancer cells, which with the big share of probability it is possible to judge the type of cancer. Especially indicated such analyses in the detection of metastases from an unknown source whose search was unsuccessful.
Treatment of metastatic cancer in the lymph nodes involves surgical removal, radiation and chemotherapy, which are assigned individually in accordance with the type and stage of disease.
Surgical removal of the affected lymph nodes is performed simultaneously with the excision of the tumor, with lymph node dissection exposed the whole group of regional collectors, which has got or could get cancer cells.
For many tumors is known to the so-called «sentinel» lymph nodes, where most early metastasis occurs. These nodes are removed for histological examination, and the absence of cancer cells in them with high probability says about the absence of metastasis.
When manipulating the tumor itself and the lymph nodes the surgeon operates with extreme caution, avoiding crushing of the tissues, which can cause dissemination of tumor cells. To prevent the penetration of cancer cells into vessels made their early ligation.
Chemotherapy if metastases are almost always assigned. The choice of drugs or their combinations depends on the type of the primary tumor and its sensitivity to specific drugs. Gastric cancer is the most effective 5-fluorouracil, doxorubicin, when breast tumors are assigned to cyclophosphamide, adriamycin, non-small cell lung cancer sensitive to etoposide, cisplatin, Taxol.
If the primary focus of the cancer could not be detected, are assigned to cisplatin, paclitaxel, gemcitabine, etoposide. When nizkoeffektivnyj carcinoma, affecting the lymph nodes, the effective platinum drugs (ziplat in), with neuroendocrine tumors in treatment include cisplatin and etoposide.
The goal of chemotherapy for metastatic tumors is to inhibit the growth and further spread of the malignant process. It is assigned before surgery (neoadjuvant chemotherapy) for the prevention of metastasis and destruction of micrometastases in the lymph nodes and after surgery (adjuvant) for the prevention of further metastasis, the risk is after surgery to the affected body increases.
Radiation therapy has a higher value with hematogenous metastases, rather than nodal, but the lymph nodes may be effective radiosurgery, or CyberKnife, when the cancer is in the lymph node is removed with the aid of a beam of radiation, acting strictly on the affected tissue. This method is justified in case of late isolated metastasis that appear years after treatment, when you can avoid repeated operations.
Metastasis in the lymph nodes with cancer regardless of the primary tumor describes the progression of the disease and the prognosis is the worse the more lymphocollectors involved in cancer growth. Metastases respond to treatment only a fifth of the patients in whom the prognosis may be favorable, the remaining 80% treatment at the stage of metastasis is aimed at relief of symptoms or prolongation of life. With multiple nodal metastases is low and undifferentiated carcinoma life expectancy is on average six months to a year, in the case of highly differentiated cancers, the prognosis a little better.