Every third appeal to an oncologist on social networks or on remote consultation portals is formulated something like this: “save, help, I have enlarged lymph nodes.”
As a rule, young people write, usually from 18 to 25 years old, and I don’t remember a case when it eventually turned out that the situation required treatment from an oncologist. Most often, enlarged lymph nodes were caused by a sore tooth, sore throat, conjunctivitis, and so on.
It is clear that fear and fears for one’s health in such cases force one to immediately run to an oncologist.
However, is everything so simple, and is it worth rolling your eyes about any treatment with an enlarged lymph node?
My personal statistics show: if a person comes for a face-to-face consultation, he is already one of those few whose situation was not limited to the banal “it got sick and went away.”
Let's take a closer look at how the lymphatic system works and understand the nature of enlarged lymph nodes.
Fact #2
Lymphatic vessels are not something abstract.
It is worth crossing or ligating them, for example, during surgery on the axillary lymph nodes for breast cancer, and lymphostasis is likely to develop - swelling of the limb, which, again, most likely will not go away.
The most visible to us from the point of view of examination - the so-called peripheral lymph nodes (in the neck, supraclavicular, axillary and inguinal) can increase, and this is in most cases a manifestation of reactive lymphadenopathy - an inflammatory reaction indicating the fight against infection.
Diagnostics
To establish the true causes of enlarged lymph nodes, you need to undergo a comprehensive diagnostic examination in a clinical setting. First of all, it is necessary to conduct a thorough history taking to establish the cause of the enlarged lymph nodes in the child. Next, a study is carried out to determine the presence of tumor formations, skin lesions, and the presence of inflammatory processes.
In our medical network clinics in Makhachkala, various types of laboratory and instrumental studies are carried out. To identify the causes of lymphadenopathy in children, specialists usually conduct a set of diagnostic examinations, which includes:
- general and biochemical blood tests;
- general urine analysis;
- X-ray of the chest area;
- ultrasound examination of internal organs;
- magnetic resonance imaging (MRI);
- computed tomography (CT);
- lymph node biopsy with histological and cytological analysis.
Fact #3
Most often, the cervical and submandibular lymph nodes become inflamed, because in the facial part of the skull there are many open mucous membranes and associated infections.
A sore throat, carious or rotten teeth, and ear and eye bacterial and viral infections are the most common causes of cervical lymphadenopathy. The axillary and inguinal nodes react according to the same principle.
Therefore, if a lymph node is bothering you, first of all you need to go to a therapist, dentist, or ENT doctor.
If the genesis of lymphadenopathy is unclear, the doctor will prescribe an ultrasound, and during this study, attention will be directed mainly not to the size of the lymph node, but to its shape and differentiation of the structure.
Fact #5
Lymph nodes enlarge during cancer because cancer cells enter the lymphatic vessels draining a certain area, which then settle in the “filters” (lymph nodes) in the form of metastases and begin to grow there.
Such lymph nodes do not shrink after treatment of infectious diseases, but only increase, merging with other lymph nodes into conglomerates, extending beyond the lymph node and fixing it in the surrounding tissues. Such lymph nodes are rarely painful, they are dense, very dense.
Often in cancer, lymph nodes are affected by a “chain” that is clearly visible on palpation. With lymphomas, conglomerates are often visible from the outside. Of course, with such manifestations you need to go to an oncologist and hematologist.
For suspicious nodes, a biopsy will be performed in the absence of other causes. This is either a puncture with a needle and collection of material, or an operation to completely remove the lymph node for histological examination.
Causes of enlarged lymph nodes in children
Lymph nodes belong to the organs of the immune system.
Role of lymph nodes:
Barrier. Lymph nodes (LN) are the “first line of defense” against the penetration of various foreign agents into the child’s body. A natural reaction to this “acquaintance” is an enlargement of the lymph nodes.
Filtration. Various substances, microbial cells, and particles of the body’s own tissues settle in the lymph nodes.
Parents often call enlarged lymph nodes “glands.”
The lymph node itself is a small oval formation (several millimeters in diameter). On the outside it is covered with a special capsule of connective tissue, and on the inside it is divided into separate sections by partitions. These elements of the immune system are located in groups throughout the body at the confluence of several lymphatic vessels. In newborn babies, the capsule of the lymph nodes is still very tender and thin, so it is difficult to feel them under the skin. By the age of one year, lymph nodes can already be felt in almost all healthy children.
The maximum number of lymph nodes appears by 10 years of age. In an adult, their total number is 420-460.
The size and condition of the lymph nodes are assessed by palpation. In this case, it is necessary to palpate the lymph nodes in all groups (there are 15 of them) - from the occipital to the popliteal. If the lymph nodes are significantly enlarged, parents or the child themselves can pay attention to this symptom. When a lymph node becomes inflamed (lymphadenitis) due to the appearance of pain, children clearly indicate the localization of the process.
Normally, in healthy children, no more than three groups of lymph nodes are usually palpable.
Should not be palpable:
- chin;
- supraclavicular;
- subclavian;
- chest;
- elbows;
- popliteal lymph nodes.
Signs of normal lymph nodes:
- their size does not exceed the diameter of a small pea,
- they are isolated
- soft elastic consistency.
- mobile,
- not connected to the skin and to each other (doctors say “not fused”),
- painless.
An increase in the size of lymph nodes with a change in their consistency is called lymphadenopathy, a quantitative increase in lymph nodes is called polyadenia (from aden- gland, since previously lymph nodes were mistakenly considered glands).
Causes of enlarged lymph nodes in children:
- infections;
- tumor processes;
- a special metabolic disorder called “storage diseases”.
Local (regional) isolated enlargement of lymph nodes is always caused by changes in the corresponding zone (region) of the body from which lymph comes.
In all cases of unusual local enlargement of lymph nodes, a thorough examination of the child is necessary to determine the extent to which the process has generalized (spread).
Stages of diagnosis for isolated enlarged lymph nodes:
Clinical diagnosis. It consists in the fact that the doctor first makes a diagnosis based on the complaints of the child or parents, clinical data and the results of blood, urine, x-ray, etc. tests.
Tuberculin diagnostics. Necessary to exclude the possibility of tuberculosis.
Special (serological) blood tests (performed if another infection is suspected).
Usually, with an isolated increase in any group of lymph nodes, antibacterial agents are prescribed for 8-10 days. An improvement in the child's condition and a decrease in swelling of the lymph nodes is regarded as confirmation of the bacterial nature of the disease.
Biopsy of a lymph node or puncture with examination of the lymph node tissue under a microscope. It is carried out in the most difficult diagnostic cases.
Features of damage to lymph nodes in certain areas:
Enlarged occipital lymph nodes: found in inflammatory processes of the scalp (purulent rash, boils, osteomyelitis of the calvarial bones, fungal infection). With rubella, in addition to the occipital ones, other groups of lymph nodes are enlarged to a lesser extent.
Enlarged parotid lymph nodes: characteristic of inflammation of the middle and outer ear, purulent inflammation of the scalp (pyoderma), lice, furunculosis. Often these groups of lymph nodes react to infection of an allergic rash in atopic dermatitis and eczema, especially when it is localized behind the ears.
Enlarged lymph nodes behind the angle of the lower jaw and along the posterior muscles of the neck. Develops during inflammatory processes in the nasopharynx or after them: tonsillitis, infectious mononucleosis (as a manifestation of a generalized process), with chronic tonsillitis and adenoid growths, with tuberculosis of the tonsils.
Enlarged lymph nodes behind the angle of the lower jaw and in the middle triangle of the neck: severe forms of tonsillitis, scarlet fever. With diphtheria of the tonsils, there is a symmetrical increase in lymph nodes to the size of an apple. At the same time, they are elastic and painful. Swelling of the surrounding tissues develops with an increase in the size of the neck. In the case of severe angina, acute inflammation of the lymph nodes can develop - lymphadenitis and even purulent lesions. In case of cat scratch disease (caused by a special microorganism), this group of lymph nodes may increase. The combination of sore throat, lymphadenitis and peeling of the palms and feet is characteristic of streptococcal infection (streptococcal tonsillitis, scarlet fever). Several more reasons for the reaction of this group of lymph nodes: Kawasaki syndrome (combined with damage to the eyes, skin, coronary arteries, fever, rash), toxoplasmosis, tumors of the blood and lymphatic system (Hodgkin's disease - lymphogranulomatosis, non-Hodgkin's lymphoma - lymphosarcoma).
Enlarged lymph nodes in the lateral triangle of the neck may be a sign of infection in the nasopharynx, tuberculosis of the lymph nodes, or tumors.
Enlargement of the lymph nodes in the mental area develops with an abscess in areas of the jaw, with damage to the front teeth - incisors, stomatitis, inflammation of the lower lip.
Enlarged submandibular lymph nodes are characteristic of inflammation of the jaw due to dental damage, stomatitis and gingivitis (inflammation of the gums). After treatment with antibiotics, the lymph nodes shrink and restore their mobility when palpated.
Enlargement of the axillary lymph nodes occurs with infectious diseases of various causes in the arm and shoulder area (purulent skin lesions, chicken pox). Unilateral lymph node enlargement can develop after vaccination or injury to the arm, such as cat scratch disease.
Enlarged ulnar lymph nodes are a sign of infection in the hand or forearm.
Enlarged inguinal lymph nodes indicate an infection in the lower extremities, localized in the bones, muscles or skin. This symptom appears with inflammation of the joints, with severe diaper dermatitis, with furunculosis in the gluteal region, inflammation of the genitals, after BCG vaccination when the vaccine is administered to the thigh area. Moreover, an isolated increase in lymph nodes for 3 months after BCG is normal, and a longer persistence of the symptom is regarded as an indirect sign of a decrease in the activity of the immune system or high virulence of the vaccination material, or as an individual feature of the child’s reactivity. A biopsy of such lymph nodes may reveal large numbers of blood cells called macrophages. After BCG, LNs can be soaked in lime and palpated through thin skin for many years. In case of infection penetration through the skin of the leg in cat scratch disease, the group of inguinal lymph nodes also reacts.
Frequent wounds to the skin of the legs and feet, infection of these wounds in children of preschool and school age lead to the fact that in most of them significantly enlarged lymph nodes are clearly palpable in the groin area. Such children are not considered sick in the absence of other signs of pathology.
Many diseases begin with an increase in lymph nodes in any one zone, and then the lymph nodes increase in almost all groups. This picture is observed with influenza, measles, rubella, infectious mononucleosis, viral pneumonia, viral hepatitis, widespread eczema, congenital syphilis, toxoplasmosis, etc.
In addition to the lymph nodes, other formations can also raise the skin and be palpated under the skin. One of the reasons for this is lymphangioma (parents are more familiar with a nearby formation of blood vessels - hemangioma), a soft swelling under the skin without clear boundaries. Lymphangioma is localized mainly in the neck and can cause difficulties during childbirth, swallowing and breathing. Often requires surgical treatment.
It must be remembered that LNs are located both in the chest and in the abdominal cavity.
Signs of enlarged lymph nodes in the chest:
- breathing problems;
- difficulty swallowing;
- prolonged hiccups.
The reaction of lymph nodes in the abdominal cavity to a viral or bacterial infection can manifest itself as very severe abdominal pain, which sometimes requires a differential diagnosis with appendicitis.
Parents should know that if one or more enlarged lymph nodes are detected in one group, they need to carefully examine the child and palpate lymph nodes in other areas. Before consulting a doctor and having a blood test, you should not heat the lymph nodes. Children who have enlarged glands in most groups must be examined using ultrasound of internal organs to assess the condition of the liver, spleen and abdominal lymph nodes.
May our children be healthy!
Doctor T.A. Konon
