Lymph nodes are components of the lymphatic system. They are sometimes informally called lymph glands but, as they do not
secrete substances, such terminology is not accurate. They are found throughout the body.
Lymph nodes are filters or traps for foreign particles and contain white blood cells.

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The lymph node is a tinny bean-shaped node, located in many different areas of the body. The main locations are the neck, under
the arms, and in the groin. The body has over 300 filtering selected white blood cells and foreign elements. The lymph node is a
component of the lymphatic system. The lymphatic system moves lymph node fluid, waste substance, and nutrients through out
your body bloodstream and tissues. Each lymph node is also an important part of your immune system. Your lymph node filters
fluids, catching viruses, bacteria, and other unknown materials. Then your unique white blood cells destroy the unwanted
materials.
A lymph node may be found alone or in a group through out your body. The main groups can be felt in the following areas:
•
In the neck
•
under the arms
•
In the groin
Normally, a healthy lymph node is not sensitive or sore to touch.
Children between the ages of 10 to 12 years old usually have larger lymph nodes, which can be twice the normal size, compared
to adults .
Neck Lymph Node These are found on either side of the neck, behind your ears, or under your chin.
Painful lymph node Placing a heating pad (on low) or a warm towel on your painful lymph node may reduce the soreness. It
may have negative effects so use with caution.

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The lymph that is drained from the body passes through structures called lymph nodes. Lymph nodes are
specialized dilations of lymphatic tissue which are supported within by a meshwork of connective tissue called
reticulin fibers and are populated by dense aggregates of lymphocytes and macrophages. Lymph nodes occur
along the entire length of the lymphatic system and tend to increase in size as they become closer to the thoracic
duct. They are also organized in chains or clusters which drain exclusively a particular organ or region of the
body. Becasue Lymph Nodes are imbedded deeply in connective tissue, they are rarly seen. However, lymph
nodes are found in larger clusters in the axillary (arm pit area), inguinal (pubic region), and cervical regions of
the body.

Swollen lymph node What is a Swollen Lymph Node? Lymph node enlargement is not limited to lymphoma at all. In fact, there are
several more common reasons for lymph node enlargement than lymphoma. Some other immune diseases like sarcoidosis or SLE can
also cause lymph node enlargement all over the body. Some medicines and allergies can occasionaly cause enlarged nodes. Cancers
other than lymphoma are also a common cause of lymph node enlargement. Many cancers of the throat or mouth, and cancers of the
lung or breast often spread to nodes in the neck. Breast or lung cancer can spread to nodes in the armpits. Cancers in the pelvis like
the uterus or ovary, and those of the rectum and anus can spread to the groin. Cancers like leukemia can also cause enlarged nodes in
different parts of the body. Children with some diseases that affect the body metabolism (called storage diseases) can have enlarged
nodes. Thus lymphoma is only one of the many possible causes of enlarging lymph nodes over the body. A doctor will test you for
many of these diseases before calling your enlarged lymph nodes a lymphoma. The most common cause of enlarged lymph nodes is
infection. As lymph nodes are a part of the immune system that fights infections in the body, the presence of infection often causes
lymph nodes to increase in size. All kinds of infections can cause node enlargement. As infections are far more common than cancers,
enlarged nodes in the neck or groin are more often a sign of infection than a cancer.
Swollen neck lymph node. The following could be some causes of swollen neck lymph node as a possible symptom.
• Throat infection
• Tonsillitis
• Ear infection
• Skin infection
• Hodgkins Disease
A swollen neck lymph node can be related to a swollen tonsil

Expert Quote
"The arteries are like a two-lane highway bringing nutrients, oxygen and fluid to the breast. The vein is a one-lane highway
taking away the used blood, and the lymphatic channels are the other one-lane highway draining away the lymph fluid.
Two lanes in together, but two separate lanes out." —Marisa Weiss, M.D.
Lymph is a clear fluid that travels through your body's arteries, circulates through your tissues to cleanse them and keep
them firm, and then drains away through the lymphatic system.
Lymph nodes are the filters along the lymphatic system. Their job is to filter out and trap bacteria, viruses, cancer cells,
and other unwanted substances, and to make sure they are safely eliminated from the body.

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Lymph Node Areas Adjacent to Breast Area
A Pectoralis major muscle B Axillary lymph nodes: levels I C Axillary lymph nodes: levels II

D Axillary lymph nodes: levels III E Supraclavicular lymph nodes F Internal mammary lymph nodes
Also traveling through the arteries is fresh blood, which brings oxygen and other nutrients to all parts of the body—
including your breasts. Used blood leaves the breasts through the veins and is pumped back to the heart and lungs to be
refreshed. Lymph must also be refreshed and recycled. Lymph drains away from your breasts through the lymphatic
system, which is made up of lymphatic channels and lymph nodes.
Because breast cancer often spreads first to the axillary (underarm) lymph nodes from the breast, determining whether
the lymph nodes contain cancer is an essential part of the breast cancer diagnostic process. The status of the lymph
nodes helps physicians stage breast cancer, and in turn, determine treatment.
If a woman is diagnosed with invasive breast cancer (cancer that has invaded past the wall of the breast duct or lobule
and into surrounding breast tissue), it is necessary to examine the axillary lymph nodes to determine whether they contain
cancer.
Non-Invasive Breast Cancer
Invasive Breast Cancer
Cancer cells that are confined to the
Cancer cells that break through the
ducts and do not invade surrounding duct and lobular wall and invade
fatty and connective tissues of the
the surrounding fatty and
breast. Ductal carcinoma in situ
connective tissues of the breast.
(DCIS) is the most common form of
Cancer can be invasive without
non-invasive breast cancer (90%).
being metastatic (spreading) to the
Lobular carcinoma in situ (LCIS) is
lymph nodes or other organs.
less common and considered a
marker for increased breast cancer
risk.
Determining whether the lymph nodes are free of cancer or not is an essential part of the breast cancer staging process
and will help determine treatment and prognosis. Tumor size and the extent to which breast cancer has metastasized
(spread) to other regions of the body is also examined.
Staging Breast Cancer
Stage Tumor Size
Lymph Node Involvement
Metastasis (Spread)
I
Less than 2 cm
No
No
II
Between 2-5 cm No or in same side of breast
No
III
More than 5 cm
Yes, on same side of breast
No
IV
Not applicable
Not applicable
Yes
The standard way to examine the lymph nodes is to perform an axillary node dissection. This procedure is often done
during the same operation as a lumpectomy or mastectomy and involves removing 10 to 30 lymph nodes for pathological
examination under a microscope. The most common side effect of an axillary node dissection is lymphedema (chronic
swelling) of the arm, which may affect up to 10% of patients. Lymphedema occurs when the normal process of draining
lymph from the arm is disrupted or blocked, causing fluid to build up in the arm.
Another surgical option called a sentinel node biopsy is now being used on select breast cancer patients to determine
whether breast cancer is present in the lymph nodes. A sentinel node biopsy involves removing only one to three sentinel
lymph nodes (the first nodes in the lymphatic chain).

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Studies continue to show that removing fewer lymph nodes may decrease the chance of developing lymphedema, though
research on sentinel node biopsy is ongoing. The degree to which sentinel node biopsy is effective in determining
whether the lymph nodes contain cancer has been shown in research to be directly related to the experience of the
surgeon who is performing the procedure. If the sentinel node(s) is found to be cancerous upon removal, a complete
axillary node dissection is usually performed.
The axillary (underarm) lymph nodes may become enlarged or swollen any time they produce additional white blood cells
to ward off an infection. These infections are often benign (non-cancerous). For example, lymph nodes may swell from
the formation of an abscess (closed pocket filled with pus) in the nodes. However, lymph nodes may also swell if they
contain cancer cells.
Unfortunately, there is no perfect way of determining whether a lymph node is enlarged because it contains cancerous
cells or if it is enlarged due to other, non-cancerous causes unless a biopsy is performed. However, there can be some
indications from examination that a lymph node is more likely to be benign. For example, if a lymph node is less than one
centimeter in diameter and soft, rubbery and tender, it is more likely to have swollen due to a benign cause, such as
recently shaving under the arm, using a new deodorant, having a manicure, or slightly injuring the skin on the side of
surgery (called the ipsilateral side).
Because of a higher risk of lymph node infection and inflammation, surgeons usually recommend that a patient avoid
having blood drawn, blood pressure measurements taken, or perform unprotected work with the hand/arm on the side of
surgery since these activities have been shown to increase the chances of lymphedema (chronic swelling) of the arm.
Many physicians feel that in a patient who has been diagnosed with breast cancer, it is usually wise to be cautious and
biopsy any enlarged lymph nodes if the swollen node persists for beyond a month or two since it may contain cancerous
cells. It is important for patient and physicians to work out a plan regarding how long a lymph node should persist before it
must be removed. In some instances, the enlarged node may be sampled by an ultrasound-guided needle biopsy.
However, there may be a higher risk of missing cancer cells if a needle biopsy is performed rather than surgically
removing the entire node. Click here to learn more about breast biopsy.
Exercising After Mastectomy and Lymph Node Removal
It is important that a patient ask her physician when it is safe to begin exercising and using the surgery-side arm again
after a mastectomy. While there are no contraindications to performing any number of exercises after full recovery from
mastectomy, there are certain precautions that should be taken by any person who has undergone a mastectomy,
especially those who have had accompanying lymph node dissection.
Any minor injury to the skin on the side of the mastectomy may become infected more easily than an injury on the other
arm. This is because the lymphatics have been disrupted and lymph nodes have been removed, leaving the arm more
vulnerable to invading organisms such as bacteria. The lymphatics normally serve to drain fluids from the limb and the
lymph nodes act, in some sense, as a filter, removing harmful substances from the lymph fluid.
Up to 20% of women who have undergone mastectomy and axillary lymph node dissection experience some edema
(swelling) in the arm and report a higher incidence of irritation to minor skin trauma for this reason. Click here for more
information on lymph nodes and breast health.
In addition, there may be a higher chance of axillary vein thrombosis (a clot in the deep vein in the armpit) in women who
have undergone surgery in that area; especially if a more complete axillary dissection with the removal of 30 or more
lymph nodes is performed. This is because the lymph nodes are normally located near blood vessels, and (unavoidable)
scarring at or near the axillary vein may result from surgery. This scarring may tether, kink, or narrow the blood vessel and
make it more susceptible to further injury.

While an increased incidence of deep vein thrombosis has not been reported in the medical literature after axillary
surgery, it has been, in rare cases, associated with strenuous upper body exercise, since overdeveloped musculature
may affect nearby nerves, veins, and arteries (thoracic outlet syndrome). Therefore, many physicians recommend
tempering upper extremity exercise after surgery with periods of rest and keeping the arm elevated above the level of the
heart for a few hours, to avoid undue swelling. Mastectomy patients should be careful not to exercise too intensely in
order to avoid preventable injury.

On a positive note, regular use of the muscles after mastectomy will keep joints limber, stretch and soften scar tissue,
help recruit (open up) new lymphatics, and promote blood flow and actually help reduce clot formation. These benefits

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generally outweigh the risks of a careful exercise program after mastectomy.

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Document Outline

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