Here a Node… There a Node… Everywhere a Lymph Node.

It is estimated that there are 500-700 tiny bean shaped glands, known as lymph nodes, located throughout the body. They constantly and quietly go about their business of filtering fluid. This process often goes unnoticed until something goes wrong. They are part of the immune system so when the body is fighting anything from a minor infection to cancer they will puff up like an animal ready to fight. When swelling or enlargement occur, it can be alarming because about the only time anyone talks about them is when the topic is about cancer.

Normally when they are noticed they are just working hard doing their jobs of fighting off bacteria, viruses and filtering debris. In some circumstances it is a sign of a serious illness, disease, or infection.

Locations In The Body

The nodes that filter lymph are located throughout the body. Some are located near the surface and noticeable if they swell. While others are deep in the body and go unnoticed even when fighting infections or cancer. The drainage system in separated into two parts:

  1. Left drainage – left side of head to arm and left side of torso and chest, plus from the waist down to feet, which includes both legs and pelvic areas.
  2. Right drainage – right side of head to arm and right side of torso and chest.

Image: lymph node locations

Knowledge of the drainage system is important to healthcare workers because each part of the lymph drainage system has groups of nodes that filter specific areas of the body. Massage therapists who do therapeutic message also need to be informed so that they move the lymph in the right direction. As listed in the SEER Training Modules, these are the lymph chains and the regions that they drain:

  • Head and neck – jugular, cervical, facial, surface, and deep lymph nodes
  • Breast and arm – nodes of upper limbs and breast
  • Thoratic – pariental, and visceral nodes of the thorax and trachea
  • Abdominal – deep, visceral, and large intestine nodes of the abdominal cavity and lower abdomen, lumbar
  • Pelvis – nodes of the pelvic area
  • Lower extremities – lower limbs and groin nodes

There are also lymph node chains in the bones, skin, sarcoma, brain, bone marrow, soft tissues, and cartilage. The lymphatic system is constantly filtering fluid throughout the body. More information on the lymphatic system can be found at LymphNotes.com

The Function During Times of Health and Illness

Lymph originates in blood plasma and circulates through the system and is filtered through the nodes. They play an intricate part in the fighting off infection and disease because it is part of the immune system. When the body is healthy the lymph will quietly move its fluid throughout the body removing debris like the following:

Image: Anatomy of a Lymph Node

  • Dead cells
  • Pathogens
  • Toxins
  • Cancer cells

In addition to removing waste from the body, the lymph also absorbs fats and fat-soluble vitamins to transport it to the cells in the body. The lymph system aids in removing fluids and waste from between cells. It leaves the blood vessels and enters the tissues to maintain cell health and then returns to the circulatory system.

The fluid moves one way through the body with the cleansed lymph returning to the body through the subclavian veins in the neck. There are no organs that pump it so gravity and movement are necessary to push the fluid through the system.

When there are pathogens present, the lymph nodes will jump into action to fight, filter, destroy, and remove them. They can swell up due to the production of lymphocytes that destroy pathogens, excess debris, and cancer cells. This can also cause the them to become enlarged, swollen, and inflamed.

Enlarged, Swollen And The Causes

It is common for lymph nodes to swell up when there is an infection near them. For a common infection like strep throat or chicken pox the nearby nodes will swell up to fight the bacteria or virus and then after a couple weeks they will return to normal size. For more serious illnesses, diseases, and cancer they will not return to normal until the cause is treated. Cancer is what most people think of when swelling occurs, but there are other causes like the following:

Injury and medications can also cause them to swell and become enlarged. When they are swollen a biopsy may be done to determine if the cancer has spread.

Cancer, Nodes, Staging, and Treatment

When cancer is present, the nearby lymph nodes may be swollen. To accurately stage the cancer, a biopsy will be done. To do this, they will need to be removed, called a lymphadenectomy. It can cause some side effects but it increase the successfulness and effectiveness of treatment.

When there is lymph node involvement the cancer will be staged differently than if there is none. There is a roman numeral system and the TNM classification system. Stage IV cancer commonly has spread to the lymph nodes (Lymph Images – elsevierimages.com).

The TNM system assigns a letter to describe the cancer. Letters that refer to lymph node involvement include the following:

  • N-node involvement
  • NX-nearby lymph node cannot be evaluated
  • NO-nodes are not cancerous
  • N followed by a number describes size and number of nodes

Treating cancer involves surgery, chemotherapy, and radiation. Lymph nodes that have not been removed may remain swollen until treatment is over. There are at home treatments, over the counter treatments, and prescription medications that can relieve pain and discomfort to the swelling.

Mapping of Lymph Nodes

There are different lymph node maps that have been used the past several decades. The following is a list of the maps and the years that that they were introduced:

  • 1960′s – Naruke map was used North America, Europe, and Japan
  • 1980′s – ATS (American Thoracic Society) map was used mainly in North America
  • 1990′s – AJCC (American Joint Committee of Cancer) was used mainly in North America
  • 1996 – MD-ATS Mountain-Dressler’s modification of the maps to create a single map. The map was used mostly in North America with some use in Europe

Due to the seriousness and possible life threatening risk of some illnesses and diseases that cause lymph nodes to swell, a health care professional should be consulted to determine the cause and to do diagnostic tests to accurately diagnose the reasons behind the swelling.