Symptoms of metastases in the lymph nodes
The International Classification of Malignant Tumors determines the metastases in the lymph nodes by the Latin letter N. The stage of the disease is described by the number of metastases, not the size of the affected tissue. N-0 indicates the absence of metastases, N-1 indicates a single metastasis of the nodes adjacent to the neoplasm, N-2 - a large number of metastases of regional lymph nodes. The designation N-3 means simultaneous damage to close and distant lymph nodes, which is inherent in the fourth stage of the tumor process.
Primary symptoms of metastases in the lymph nodes - a significant increase in size, which is determined by visual examination and palpation. Most often differentiate the changes in cervical, supraclavicular, axillary and inguinal lymph nodes, which have a soft-elastic structure and are painless.
The growth of lymph nodes in size is often accompanied by weight loss, and the patient's condition is characterized by general weakness, anemia. To the warning signs include temperature, frequent colds, neuroses, liver enlargement, migraine, redness of the skin. The appearance of metastases indicates the progression of malignant neoplasm. If you independently detect lymphadenopathy (enlargement of the lymph node), you should consult a specialist without self-medication.
It is important to note that often metastases in lymph nodes are recognized earlier than the source of the problem - a malignant tumor.
Metastases in the lymph nodes of the neck
Tumors of the neck region are combined into a small, but quite diverse in clinical manifestations group. Neoplasms are observed, both in the organ (larynx, pharynx, esophagus, thyroid gland, etc.), and in the soft tissues of the neck not belonging to the organ.
The main lymphatic duct is located on the neck, and the formation of metastases in its nodes occurs due to the defeat of lymphoreticular tissue, as a result of lymphogranulomatosis, hematosarcoma, lymphosarcoma, metastasis of malignant tumors (Virchow metastasis).
Metastases in the lymph nodes of the neck lead to a change in the shape, size, structure and echogenicity of the nodes. Lymphogranulomatosis more often (60% of cases) occurs with metastases to the nodes of the neck. In this case, abnormal processes in the axillary, inguinal, mediastinal, and also lymph nodes of the retroperitoneal zone can be observed. There are cases of simultaneous lesion of the thyroid gland and lymph nodes of the neck, which is clinically similar to a cancer of the thyroid gland with metastasis in the cervical nodes.
Lymphogranulomatosis is more likely to affect 20-30-year-old patients or persons over 60 years (more often male). The primary manifestation of the disease is an increase in the lymph node or a group of nodes with an elastic consistency. Further, splicing of lymph nodes of different density and size into a single conglomerate is noted. Patients complain: general weakness, sweating, itching of the skin, temperature and lack of appetite. The clinical picture varies depending on the individual course and stage of the disease, therefore the described symptomatology can be blurred or completely absent.
Often metastases in the lymph nodes are detected with lymphosarcoma. The nodes are enlarged and have a dense structure, and the rate of internal changes of the affected conglomerate is able to cause a compression of adjacent organs within a couple of weeks. During the examination, the patient can detect the growth of inguinal and axillary nodes.
Along with malignant formations of the head and neck (tumoral processes of the tongue, salivary glands, thyroid gland, larynx) metastases in the lymph nodes of the neck are revealed in breast cancer, lung or abdominal cavity, indicating the fourth stage of the disease.
About 30% of the situations of primary tumor processes remain non-differentiable. Diagnosis with the use of anesthesia is used to examine the patient for the presence of cancerous neck formations. Cancer of the thyroid gland can take a latent form, manifesting itself only metastases in the cervical lymph nodes. The method of palpation and ultrasound does not always reveal dense neoplasms, therefore, puncture biopsy is widely used.
Metastases in the cervical lymph nodes
The defeat of cervical lymph nodes - metastases in the cervical lymph nodes are characterized by common symptoms:
- significant growth of nodes;
- change in shape (contours uneven, fuzzy);
- Anechogenous fate is noted.
Ultrasound examination reveals a violation of the ratio of transverse and longitudinal dimensions of the node or a difference (less than 1.5) between the long and short axes. In other words, if the lymph node acquires a rounded shape, then the probability of its destruction is high.
Cancerous processes in the lymph nodes increase the fluid content in them. The ultrasound scan shows the blurriness of the site outline. The lymph node capsule is still recognized at an early stage of the disease. As the malignant cells grow larger, the contours are erased, the tumor grows into nearby tissues, and it is also possible to connect several diseased lymph nodes into a single conglomerate.
Metastases in the cervical lymph nodes are formed from lymphomas, lung cancers, digestive tract, prostate or breast cancer. Most often, when metastases are detected in the lymph nodes of the neck, the localization of the primary tumor is the upper parts of the respiratory or digestive system.
The enlargement of the lymph nodes of the neck region occurs with the following oncological diseases:
- cancer processes of the larynx, tongue, mucous membrane of the mouth;
- defeat of the thyroid gland;
- lymphogranulomatosis (Hodgkin's lymphoma).
Diagnosis is carried out by puncture or excision biopsy. The treatment methods are irradiation and surgical removal of the affected node.
Metastases in the lymph nodes in the groin
Lymph nodes in the inguinal zone hold up and destroy pathogenic microorganisms that penetrate the lymphatic system from the pelvic organs (more often the genital sphere) and lower limbs. In the inguinal lymph nodes themselves can form primary malignant neoplasms or lymphomas.
Inguinal lymph nodes are divided into deep and superficial. The latter are located in the area of the so-called "femoral triangle" and on the surface of the wide fascia of the thigh, their number varies from four to twenty pieces. Inguinal nodes communicate with the tissues of the lower extremities, the perineal zone, the anterior wall of the peritoneum below the navel. The number of deep lymph nodes in the groin is from one to seven. Their location is below the surface of the plate of the wide fascia of the thigh. These nodes are interrelated with lymphatic vessels located on the surface of the inguinal region and deep in the femoral zone.
A painless symptom with a characteristic increase in nodes in size may indicate metastases in the lymph nodes in the groin. The growth of inguinal lymph nodes occurs with the following oncological diseases:
- lumbar melanoma or skin cancer of the lower extremities;
- malignant neoplasm in the rectum;
- cancer of the genital area;
- lymphogranulomatosis (Hodgkin's lymphoma).
Cases of inguinal nodes require careful examination of the condition of the skin of the legs, as well as organs located in the small pelvis and the cavity of the peritoneum. With the diagnostic purpose apply: a computer tomography (CT), a colonoscopy, a cystoscopy, a hysteroscopy, FEGDS.
Metastases in the inguinal lymph nodes
The lymph nodes of the inguinal zone let lymph come from the genitals, the bottom of the rectum and the abdominal wall, the lower limbs. At the site nodes are divided into superficial and deep.
Malignant neoplasms of legs, sacro-gluteal zone, external genital organs form metastases in the inguinal lymph nodes. Lymph nodes take the form of rounded seals in the area of inguinal folds. The nodes are tightly welded to nearby tissues and are inactive, which is observed when trying to move them.
Types of cancer that cause an increase in lymph nodes in the groin:
- melanoma or cancer of the skin of the legs (lumbar zone);
- oncology of the rectum;
- malignant formations of the genital area;
- Hodgkin's lymphoma (lymphogranulomatosis).
The initial development of lymphogranulomatosis from lesions of the lymph nodes in the groin is quite rare (10%). The disease is characterized by weight loss, unreasonable rise in temperature, excessive sweating at night.
During the examination, the doctor probes the lymph nodes first along and then across the fold of the groin, applying sliding circular motions, and passes into the zone of the wide fascia of the thigh.
Metastases in retroperitoneal lymph nodes
The retroperitoneal space is the abdominal zone behind the peritoneum wall, bounded by the peritoneum, the muscles of the back, the sacrum, the diaphragm and the lateral walls of the abdomen. The lymphatic system of the retroperitoneal space includes regional lymph nodes, vessels and large lymphocytes, from which the lymphatic duct originates.
Localization of malignant neoplasms in the peritoneal zone has the following symptoms: an increase in temperature, a cramping pain in the abdomen (appears paroxysmal), a disorder of stools in the form of diarrhea (less often constipation). Metastases in retroperitoneal lymph nodes are observed in germinogenic tumor processes in the testicle, kidney, cancer of the gastrointestinal tract. An increase in retroperitoneal lymph nodes leads to severe back pain due to compression of the nerve roots, sometimes embracing the lumbar muscle. Gastrointestinal symptoms are common, a sharp decrease in weight is observed.
Evaluation of the condition of the lymph nodes and organs of the retroperitoneal space is carried out by ultrasound, computer and magnetic resonance imaging. Ultrasonic scanning shows nodes with metastases, either round or oblong, characterized by clear contours and uniformity of the structure. By CT, metastases in the lymph nodes are determined by a rounded shape, a soft-tissue structure. Affected lymph nodes of the retroperitoneal cavity have a uniform structure and density, as well as clear contours, can merge into large conglomerates. In the case where arteries of the lymph nodes cover the spine, the aorta in the peritoneum and the lower vena cava, intravenous contrast is used to better recognize the tumor processes.
Metastases in para-aortic lymph nodes
The location of the paraaortic lymph nodes is the anterior part of the lumbar spine, along the aorta.
Metastases in para-aortic lymph nodes are observed in patients with cancer of the genital area, kidneys and adrenal glands, and parts of the gastrointestinal tract. For example, in malignant neoplasms of the stomach in 40% of cases, the affected paraortal lymph nodes are detected. Tumor processes with metastasis in para-aortic lymph nodes are referred to as the third or fourth stage of the disease. Moreover, the frequency of lesions of para-aortic nodes of the third degree of oncology reaches 41%, and the fourth degree - 67%. It should be noted that, for example, metastases in para-aortic lymph nodes of ovarian cancer have a resistance to chemotherapy.
The development of pancreatic cancer has its stages of lymphogenous metastasis:
- the first stage - metastases reach the head of the pancreas;
- the second stage - the retropiloric and hepatoduodenal lymph nodes are affected;
- the third stage - the penetration of metastases into the celiac and upper mesenteric nodes;
- The fourth stage is metastasis in para-aortic lymph nodes.
Physicians note that the malignant tumor of the pancreas is characterized by an aggressive course and has a poor prognosis. Cases of death from pancreatic cancer rank 4-5 among all oncological diseases. High mortality is associated with the recurrence of tumor processes in the postoperative period (K-ras mutations in para-aortic lymph nodes).
Metastases in the lymph nodes of the abdominal cavity
A large number of lymph nodes are located in the abdominal cavity, which represent a barrier to infection and cancer cells. Lymphonoduses of peritoneum are subdivided into parietal (concentrated in the zone of the loin) and intra-wall (located in rows).
The defeat of peritoneal lymph nodes is the result of a lymphoproliferative disease (the primary tumor is formed in the lymph node itself) or a consequence of metastasis. Lymphogranulomatosis and lymphosarcoma are related to lymphoproliferative diseases, causing compaction and growth in the size of the node without pain syndrome. Metastases in the lymph nodes of the abdominal cavity are detected in a number of cancer diseases, when tumor cells enter the lymph nodes from the affected organ with lymphatic flow. So malignant tumors of the peritoneum (for example, the stomach) and small pelvis (for example, the ovary) cause the formation of metastases in the peritoneal lymph nodes.
The main criterion confirming the presence of metastasis in the lymph nodes, is considered to increase the node in size (up to 10cm or more). To help come also CT and MRI studies of the peritoneal cavity in order to obtain visualization of anatomical structures.
Metastasis of melanoma in lymph nodes
Melanoma is a rare malignant tumor, which is more often affected by residents of southern regions. It should be noted that in 70% of cases melanoma is formed on the site of the existing pigment nevus or birthmark.
Development of melanoma occurs in two phases:
- horizontal - proliferation within the epithelial layer (lasting from 7 to 20 years);
- vertical - the growth of layers of the epidermis and the subsequent invasion of the basement membrane in the dermis and subcutaneous fatty tissue.
The vertical stage is characterized by rapidity and the ability to metastasize. Metastases of melanoma in the lymph nodes are primarily due to the biological features of the tumor. Metastasis by lymphogenous way occurs in the skin, regional lymph nodes. Affected lymph nodes become dense in consistency and increase in size.
Diagnostic methods include aspiration biopsy of education, surgical biopsy of lymph nodes, radiography, CT and MRI of the whole organism. Removal of metastasis of melanoma in the lymph nodes is carried out by complete excision of the regional lymphocyte or removal of nearby lymph nodes (if the diagnosis is made on the basis of a biopsy).
Metastases to supraclavicular lymph nodes
Metastases in supraclavicular lymph nodes occur when:
- undifferentiated cancer (the primary tumor is located in the neck or head region);
- neoplastic processes in the lungs;
- cancer of the digestive tract.
The detection of Virchow's nodules (Troyes) in the left supraclavicular area indicates the presence of a malignant neoplasm of the abdominal cavity. The defeat of the supraclavicular nodes of the right side makes it possible to suspect lung cancer or the prostate gland. Metastases in the lymph nodes of the subclavian triangle may indicate lung or breast cancer.
One of the most common tumors - gastric cancer is diagnosed by revealing "Virchow metastases" (more often in the left supraclavicular lymph nodes). Malignant ovarian cells sometimes penetrate through the lymphatic vessels of the diaphragm and lumbar lymph nodes, which causes lymphogenous metastasis above the diaphragm - metastases to the supraclavicular lymph nodes.
The increase in supraclavicular nodes is an alarming symptom, most often signifying tumor processes in the sternum or abdominal region. In 90%, this symptomatology occurs in patients older than 40, with younger cases accounting for 25% of cases. The defeat of the lymph nodes on the right corresponds to the tumor of the mediastinum, lungs, esophagus. The growth of the size of the nodes on the left in the supraclavicular zone indicates the cancer of the ovaries, testes, prostate, bladder, kidneys, stomach, pancreas.
Metastases in the lymph nodes of the mediastinum
Mediastinum is the thoracic cavity, which is bounded from the front by the sternum, costal cartilages and pozagrudinnaya fascia, from the rear - the anterior zone of the thoracic spine, the cervical ribs, the pre-invertebrate fascia, along the sides - the leaves of the mediastinal pleura. The area of mediastinum from below is indicated by a diaphragm, and from above by a conditional horizontal line. In the zone of mediastinum, thoracic lymphoprolling, chest lymph nodes, and mediastinum lymph nodes enter.
In addition to lung cancer, metastases in the mediastinal lymph nodes form tumor processes of the thyroid and esophagus, kidney hypernephroma, testicular cancer (seminoma), pigment malignant formation (melanosarcoma), uterine cancer (chorionepithelioma) and other neoplasms. The defeat of the lymph nodes of the mediastinum takes the third place in the development of malignant processes after lymphogranulomatosis and lymphosarcoma. Cancer cells cover all groups of mediastinal lymph nodes, most often affected paratracheal and bifurcation.
Primary small tumors often produce extensive metastases in the mediastinal lymph nodes. A clear example of this metastasis is lung cancer of the mediastinal form. The clinical picture describes the swelling of the soft tissues of the neck and head, the swelling and interlacing of the veins in front of the chest (the "head of the jellyfish"), dysphagia, hoarseness and breath of the stridorous type are noted. X-ray in most cases reveals the predominance of metastases in the posterior mediastinum.
In breast cancer, the accumulation of affected lymph nodes is localized in the anterior mediastinum. For the refinement method, mammariography (contrast study of the veins of the mammary glands) is used. Interruption of the venous bed, compression, the presence of edge defects serve as evidence of the presence of metastases, which require removal or treatment by irradiation.