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Pangasinan State University

Bayambang Campus

Bayambang, Pangasinan

John Paul M. Custodio

BSE Science I-2

Anatomy And Physiology

Principal Groups of Lymph Nodes and Key Medical Terms Associated with the Lymphatic
System

Lymph nodes are small glands that filter lymph, the clear fluid that circulates through the
lymphatic system. They become swollen in response to infection and tumors. Lymphatic fluid
circulates through the lymphatic system, which is made of channels throughout your body that
are similar to blood vessels. The lymph nodes are glands that store white blood cells. White
blood cells are responsible for killing invading organisms.

The lymph nodes act like a military checkpoint. When bacteria, viruses, and abnormal or
diseased cells pass through the lymph channels, they are stopped at the node. When faced with
infection or illness, the lymph nodes accumulate debris, such as bacteria and dead or diseased
cells.

Lymph nodes are located throughout the body. They can be found underneath the skin in many
areas including:

 in the armpits
 under the jaw
 on either side of the neck
 on either side of the groin
 above the collarbone

The key functions of the lymphatic system:


 Drains excess fluids and proteins from tissues all around the body and returns them
back into the bloodstream.

 Removes waste products produced by cells.

 Fights infections.

 Absorbs fats and fat-soluble vitamins from the digestive system and transports these into
the bloodstream.

Humans have approximately 500–600 lymph nodes distributed throughout the body, with
clusters found in the underarms, groin, neck, chest, and abdomen.

Lymph nodes or lymph glands are an important part of the immune system, acting as "nodes"
between the lymphatic vessels that span the body. Immune cells that are "parked" in these
nodes stand ready to attack any bacteria, viruses, or other foreign substances that enter the
body. Like other parts of the body, lymph nodes are also susceptible to diseases, such as
infections, cancer, and trauma.

Structure

Lymph nodes are small, bean-shaped glands that are located along the lymphatic
system (a system of vessels similar to arteries and veins through which lymph fluid travels).
Lymph nodes are classified as "secondary" lymphoid organs, with the primary lymph organs
being the thymus gland, tonsils, spleen, and bone marrow.

If you visualize the primary lymph organs as the courthouse, the lymphatic vessels are
the highways the immune police cells travel to survey the body, and the lymph nodes are like
police stations along the way. There are hundreds of lymph nodes throughout the body, but they
are clustered in certain regions.

Composition

The structure of a lymph node is actually quite complex. Lymph nodes are divided into
lobules, each of which contains an outer cortex, followed by a paracortex, with the medulla
(core) on the inside. Simplistically, B lymphocytes (B cells) are found in the cortex, with T
lymphocytes (T cells) and dendritic cells in the paracortex. Plasma cells and macrophages are
present in the medulla. The entire lymph node is enclosed by a tough fibrous capsule.

Size
Lymph nodes can vary in size from only a few millimeters to up to 2 centimeters in diameter.

Function

Lymph nodes work like filters, or in our analogy security guards to filter bacteria, viruses,
parasites, other foreign material (even cancer cells) that are brought to the nodes via lymphatic
vessels. This is the reason that lymph nodes are evaluated in people with cancer, as this is the
first place where cancer cells may be "caught" on their journey to explore and set up home
elsewhere in the body.

Lymph nodes play an important role in fighting infections in a few ways. Not only do they
"trap" viruses and bacteria so that T cells can attack, but one type of T cells presents the
invader (or an antigen from the invader) to B cells so the B cells can make antibodies against
the invader. In this way, lymph nodes are a place where immune cells can communicate and
work together.

Major Groups of Lymph Nodes (Location and Fuction)

Lymph nodes are well-known as the "swollen glands" people may note in their neck
when they are fighting a cold or sore throat, but these nodes are actually located in many
regions of the body.

Lymph nodes that lie near the surface of the skin, such as in the neck, armpit, groin, and
sometimes those in the arm (elbow) and back of the knee may be felt when enlarged, but others
may only be seen on imaging studies such as a CT scan.

Cervical (Neck) Lymph Nodes

Cervical lymph nodes are the nodes you have likely felt in your neck when fighting an
upper respiratory tract infection, and filter lymphatic fluid coming from the head, scalp, and neck.
Cervical lymph nodes (lymph nodes in the neck) in turn, can be broken down into three primary
regions, and which region is involved can give doctors important information when diagnosing
an illness.

 Anterior cervical lymph nodes: Lymph nodes nearest the front of your neck are referred
to as anterior cervical lymph nodes. It is these nodes that most people have felt at some
time when battling the common cold or strep throat.
 Posterior cervical lymph nodes: Lying behind the band of muscle that runs on the lateral
side of the neck (sternocleidomastoid) lie the posterior nodes. These nodes are
frequently enlarged when people contract mono (infectious mononucleosis).
 Occipital lymph nodes: These nodes lie on the back of the neck at the base of the skull,
and are also frequently enlarged in people who have mono. Lymph nodes may also be
felt in front of and behind the ear and along the jawline.

Axillary (Armpit) Lymph Nodes


Axillary lymph nodes are the lymph nodes located in your armpit. In the movie Terms of
Endearment, it was these nodes that heralded breast cancer, but causes other than breast
cancer are a more common cause of enlargement. There are usually between 20 and 40 lymph
nodes in the axilla, many of which are removed when a person has an axillary lymph node
dissection for breast cancer.

The axillary lymph nodes can be used to describe an important finding with cancer.
When cancer cells are picked up in lymphatic fluid, they first travel to lymph nodes. It's been
found that these lymph nodes are affected in order, and now a sentinel lymph node biopsy may
be done with breast cancer (and melanoma) that can often spare a person from having all
nodes removed. A tracer is injected into the cancer, and only the first few nodes to which the
cancer would travel may be to be biopsied.

Supraclavicular Lymph Nodes (Above the Collarbone)

Supraclavicular lymph nodes, when enlarged, can be felt just above the collarbone
(clavicle). Most of the time, enlargement of these nodes signifies a serious underlying problem
(such as lung cancer or a lymphoma).

Mediastinal Lymph Nodes

Mediastinal lymph nodes reside in the mediastinum, the area in the center of the chest
between the lungs. People cannot feel these nodes, but they can be visualized on imaging
studies such as a CT scan or PET scan. Determining whether cancer is present in these nodes
is important in staging lung cancer and some lymphomas.

Inguinal (Groin) Lymph Nodes

Inguinal lymph nodes are present in the groin region. Since they drain tissues from the
feet to the groin, there are many reasons why these nodes can become inflamed. Most often
they become swollen after an injury or infection in the legs, but may also be a sign of anything
from a sexually transmitted disease to cancer. Keep in mind that most people experience
swollen inguinal nodes at some time, and the vast majority of the time they are not a problem;
they are only doing their job of catching viruses or bacteria that enter your body from a sore on
your feet or legs.

Retroperitoneal Lymph Nodes

Retroperitoneal lymph nodes lie deep in the abdomen and can only be seen on imaging
studies. They are the nodes to which testicular cancer first spreads.

Mesenteric Lymph Nodes

Mesenteric lymph nodes are similar to retroperitoneal nodes, lying deep in the abdomen
in the membranes that surround the intestine. In adolescents, these nodes may become
inflamed (mesenteric lymphadenitis) with symptoms that can sometimes mimic appendicitis.
They may be enlarged with some cancers, but this is much less common.
Pelvic Lymph Nodes

Pelvic lymph nodes lie deep in the pelvis and can only be seen on imaging studies. They
may be involved with cancers such as those of the bladder, prostate, and more.

Cancer Focus

Some cancers cause swelling of the lymph nodes. Cancer may start in the lymph nodes,
or more commonly, it may spread there from somewhere else in the body.

Metastatic spread of cancer via the lymph nodes

Lymph nodes close to the primary tumor are often the first site of metastases (spread of
cancer). Lymph node metastases are rarely life threatening, but their detection is a prognostic
factor for many types of cancer as it shows the tumor has developed the ability to spread.
Tumor cells may travel via the lymphatic system and spread to to lymph nodes and distant
organs.

Sentinel Lymph Node Biopsy

A dye is injected near the primary tumor to identify the position of the sentinel lymph
node (the first lymph node to which cancer cells are most likely to spread as the lympatic
system drains fluid away from the tumor). The sentinel node is surgically removed and a
pathologist checks for the presence of cancer cells. SLNB is most frequently used to help stage
breast cancer and melanoma. It is a less extensive operation compared to standard lymph node
surgery.

Immunosuppression
This is reduced activity or efficiency of the immune system and its ability to fight infections and
other diseases. Certain diseases such as AIDS or lymphoma can cause immunosuppression. It
is also a common side-effect of anticancer chemotherapy, leading to cancer patients having an
increased risk of infections during treatment.

Lymphoma

A general term form for malignant disease of the lymphatic tissue characterized by abnormal,
uncontrolled cell growth. There are a number of types of lymphoma, including Hodgkin
Lymphoma, with most other types classed together as Non-Hodgkin Lymphoma.

Hodgkin Lymphoma

A malignancy of the lymphatic tissue that occurs most often in males, and the peak
incidence is between ages 15 and 35. It is characterised by progressive, painless enlargement
of the lymph nodes, spleen, and general lymph tissue. In Hodgkin Lymphoma Reed-Sternberg
cells (a specific type of lymphocyte) become abnormal and grow in an uncontrolled way.

Non Hodgkin Lymphoma (NHL)

NHL is cancer of the lymphatic tissue, that does not involve abnormal Reed-Sternberg
cells (a specific type of lymphocyte). There are many different types of NHL. Some grow very
slowly, whilst others grow quickly and need aggressive treatment.

AIDS related lymphoma

Incidence of non-Hodgkin's lymphoma has increased in parallel with the AIDS epidemic.
Lymphomas affecting HIV infected people are mostly of the aggressive B-cell types (diffuse
large cell, B-immunoblastic, or small non-cleaved Burkitt's / Burkitt's like lymphoma) which are
less common in non-HIV infected lymphoma patients. The HIV virus is not thought to a direct
cause of lymphoma, rather it weakens the body's defences and may increase susceptibility to
other infections such as the Epstein-Barr and HHV-8 viruses which are associated with these
types of lymphomas.

Waldenstrom's Macroglobulinemia

This is a rare malignant condition, involving an excess of beta-lymphocytes (a type of cell in the
immune system) which secrete immunoglobulins (a type of antibody). WM usually occurs in
people over sixty, but has been detected in younger adults.

Cancer Immunotherapy

This is treatment to stimulate the patient's own immune system to attack the cancer
cells. Different approaches include: 1) cancer vaccination to train the immune system to
recognise the cancer cells as targets to be destroyed, 2) giving therapeutic antibodies to recruit
immune system cells to destroy tumor cells, and 3) cell based immunotherapy which is either
transfusing immune cells (such as Natural killer Cells) or by administering cytokines (such as
Interleukins) which activate the immune cells.
HPV Vaccination and Cervical Cancer

Human papillomavirus (HPV) is a common cause of infection. There are over 100
different sub-types of HPV. HPV types 16 and 18 cause 70% of cervical cancers and are also
linked to cancers of the anus, vulva, vagina, penis, as well as the mouth and throat. Over time
these can cause cells in the cervix to change, leading to precancerous conditions - cervical
intraepithelial neoplasia (CIN), with a higher risk of developing cancer. Vaccination against HPV
16, 18 and other 'high risk' types of HPV reduces the risk of developing cervical and other HPV-
related cancers.

Lymphedema

Lymphedma is an abnormal build up of interstitial fluid due to problems in the lymphatic


system. It can have many causes. In the context of cancer it is often a result of obstruction by a
tumor or enlarged lymph nodes. It can also be a side effect of radiotherapy or surgery, which
has damaged the lymph vessels.

Roots, suffixes, and prefixes

Most medical terms are comprised of a root word plus a suffix (word ending) and/or a prefix
(beginning of the word). Here are some examples related to the Lymphatic and Immune
systems.

component meaning example


aden(o)- gland Lymphadenopathy - disease of, or
swelling/enlarged lymph nodes

immun(o)- Immunosuppression = reduced activation or


Immunity efficacy of the immune system

lymph(o)- Lymph Lymphoma = tumour of lymphoid cells

lymphaden(o)- lymph node Lymphadenectomy = surgical removal of lymph


node(s)

lymphangi(o)- lymphatic Lymphangitis = inflammation or infection of the


vessels lymphatic vessels
splen(o)- spleen Splenomegaly = enlargement of the spleen
thym(o)- thymus Thymectomy = surgical removal of the thymus
tox(o)- poison Immunotoxicity = adverse effects on immune
system function resulting from exposure to
chemical substances

References:

http://www.cancerindex.org/medterm/medtm9.htm

https://www.verywellhealth.com/understanding-the-purpose-of-lymph-nodes-2249122