LYMPH NODE - A DISEASE MARKER

Lymph nodes are a disease marker, its size, shape, consistency, number and its area will provide mirror for diagnosing disease.

Lymph node enlargement is often used synonymously with lymphadenopathy, which is not strictly correct. Lymphadenopathy is, if anything, a broader term, referring to any pathology of lymph nodes, not necessarily resulting in increased size. Indeed abnormal number of nodes, or derangement of internal architecture (e.g. cystic necrotic nodes). In addition, increase in size is not always pathologic; some nodes are bigger than other normally (e.g compare jugulodigastric nodes, to mesenteric nodes), and reactive nodes are a healthy response and do not imply pathology of the node itself.

Characteristics of different types of lymphadenopathy

Tender node:                    

Tender node Signifies Inflammatory or Infective pathology with acute stretching of the capsule.

Lymphangitis:

Superficial lymphatic vessels appear as red streaks running between the nodes and sites of original Infection, e.g. filarial lymphangitis.

Fixity of lymph node:

Indicates inflammatory pathology

Deep fixity suggests malignancy.

Fluctuation of a lymph node:

Suggests abscess forming conditions like sepsis or TB

Lymphoma node:

Discrete, mobile, non-tender, firm or rubbery (elastic) in consistency, May be symmetrical

Malignant lymph node:

Hard, non-tender fixed nodes which progressively enlarge.

Bubo:

Inflammatory swelling of one or more lymph nodes in the inguinal region. Masses of lymph node may suppurate and drain pus.

E.g. Chancroid

Lymphogranuloma venereum

Tuberculosis node:-

Cervical vertical group of lymph nodes enlarge start with single, Soft, non tender, discrete then due to periadenitis, each lymph nodes mate each other forming cold abscess, later on cold abscess burst form collar stud abscess (small opening with wide base), sinus or scar of previous suppuration of untreated cases may be present.

Syphilitic lymphadenitis

      Painless, firm. Discrete & snotty glands which do not suppurate. VDRL +ve

LOCALIZED LYMPHADENOPATHY

Enlargement of lymph nodes in a single anatomical area.

Cervical lymphadenopathy:

Causes:

URTI

Viral illness

Oral or dental lesions

Tuberculosis

Secondaries from primary head, neck, breast, lung and thyroid malignancy

 Lymphoma and leukemias

 All causes of generalized lymphadenopathy.

Scalene node:

Node is present deep to sternomastoid muscle on the scaleneus anticus muscle,

Significance- secondary involvement of lymph node due to bronchial carcinoma.

  Virchow's node (Troisier s sign):

Enlargement of left supraclavicular node occurs due to metastatic lesion from GIT or testicular malignancy, Occipital lymphadenopathy occurs in scalp infection, Pre-auricular lymph nodes enlargement can occur with conjunctival infection.

Axillary lymphadenopathy:

 Causes:

 Infection or injury to the Ipsilatera! Upper limb

Breast and chest wall disease

 Lymphoma

Part of generalized lymphadenopathy

 Epitrochlear nodes:

Causes:

 Infection and inflammation of Ipsilatera! hand

Secondary syphilis

Non - Hodgkin's lymphoma

Inguinal nodes:

Palpate -Horizontal nodes - just below the inguinal ligament, Vertical nodes - along the saphenous vein

Causes of inguinal lymphadenopathy

Infection/ trauma to the lower extremities

Sexually - transmitted diseases

Lymphomas

 Metastatic cancer from primary in the rectum, genitalia and lower extremities.

Popliteal glands:

Palpate deeply into the popliteal fossa with both hands with the knee partially flexed.

Causes of enlargement of popliteal glands

Knee joint disease

Infection and trauma to the lower limb,

All causes of generalized lymphadenopathy

Intra- abdominal nodes:

Para - aortic nodes

Palpate deeply in the umbilical region along the aortic pulsation.

They are felt as round firm, confluent masses and are felt only when significantly enlarged

Causes of intra - abdominal lymphadenopathy

Tuberculosis

Lymphoma

 Intra-abdominal malignant disorder - Germ cell tumors

 Intra-thoracic lymphadenopathy:

Mediastial and hilar  lymphadenopathy

Causes:

 Bronchogenic carcinoma with secondaries

Lymphomas

Tuberculosis (usually unilateral)

Sarcoidosis

Histoplasmosis

                  

GENERALISED LYMPHADENOPATHY:

Enlargement of three or more non - contiguous areas of lymph nodes.

Causes:

Infection: Infectious mononucleosis (Glandular fever), HIV infection, Kala azar, Leptospirosis, Plague, Histoplasmosis   etc…..

Disseminated tuberculosis

Immunologic: Rheumatoid arthritis, SLE, Sjogren’s syndrome

Malignancies: Hodgkin's and non - Hodgkin’s lymphoma ,CLL,ALL

Storage diseases: Gaucher’s and Niemann - pick’s disease

 Endocrine disorders: Graves' disease

Drug - induced:e.g. phenytoin sodium .carbazepine, allopurinol

NOTE:

1.       Soft, flat lymph nodes of < 1cm size are usually benign and require follow up.

2.       Inguinal lymph nodes of less than 2 cm size are not abnormal

3.      Lymph nodes size > 2cm or size of 1.5X1.5 cm are significant and to be evaluated.

Herbal Treatment:

Echinacea, garlic and cleavers are effective options for treating and healing the lymphatic system. With antibacterial and cleansing properties, herbs treat infection and flush the system.

Echinacea

Echinacea is a frequently used herb with strong healing properties. Used as a treatment, Echinacea is capable of healing and strengthening the lymph system. Likewise, this herb

eliminates infection by purifying the blood and lymph nodes.

Garlic

Similar to Echinacea, garlic is an antibacterial herb that cleanses the system. Garlic is also anti-inflammatory, so it naturally helps reduce swelling. Eating two garlic cloves or taking six garlic supplement capsules daily will help alleviate swollen glands and any associated illness.

Cleavers

Cleavers is an herb that is typically thought to be one of the best lymphatic draining tonics. Also known as clivers, goosegrass and stickyweed, the herb stimulates the function of the lymphatic system and other organs to reinforce proper functioning. The herb also helps to cleanse and purify the blood

.

Homoeopathic drugs according to the nature and affection of the gland

Ailments of LYMPHATIC glands, bapt. bar-c. bar-m. bufo CALC. carc. echi. Lap-a. Merc. phyt. pyrog. Sulph. Tub.

 Indurated LYMPHATIC glands - am-c. Carbn-s.

 Indurated LYMPHATIC glands- felt like hard cords under skin, painful – Apis

 Palpable LYMPHATIC glands - tub.

 LYMPHATIC glands - redness and swelling along course, after wounds – Bufo

 Scrofula affections in LYMPHATIC glands  -  bar-c. BAR-M. Merc-i-r.

 Suppurated LYMPHATIC glands - calc-s. Carb-v.

 Swelling of LYMPHATIC glands - am-c. anthraci. astac. bar-c. bar-m. berb. CALC. Carb-v. Carbn-s. Con. dulc. kali-br. merc. nat-p. phyt.

 Swelling of LYMPHATIC glands due to uterine cancer  - Graph.

 Chronic swelling of  LYMPHATIC glands - Nat-m.

 Swelling of LYMPHATIC glands due to diphtheria - Nat-m.

 Swelling of LYMPHATIC glands with heat and soreness - med.

 Painless Swelling of LYMPHATIC glands - Sep.

 Swelling of LYMPHATIC glands due to scarlatina - am-c.

 Ulcerated  LYMPHATIC glands - Rhus-v.

 Lymphatic swelling  in arms - berb.

 Lymphatic enlargements with delayed bone development - bar-c. Calc.

 ADENITIS -  crot-h. Hep. hippoz. kali-m. Sil.

 Malignant Lymphoma - ars. Ars-i. aur-m. Bar-i. bufo buni-o. Calc-f. carb-an. carc. cist. Con. cund. ferr-pic. iod. ph-ac. Phos. Phyt. saroth. SCROPH-N. syph. thuj. tub.

 Lymphatic swelling behind the ear - apis Bar-c. dig. Nit-ac.

 Inflamed swollen lymphatic glands in male genitalia - lact. Merc.

Some Homoeopathic remedies which help in lymphoma treatment are

Homoeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach. This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering. The aim of homoeopathy is not only to treat lymphoma but to address its underlying cause and

individual susceptibility. As far as therapeutic medication is concerned, several homoeopathic remedies are available for lymphoma treatment that can be selected on the basis of cause, symptoms, sensation and modalities of the complaints. For individualized remedy selection and treatment, the patient should consult a qualified homoeopathic doctor in person. Some important remedies are given below for lymphoma treatment:

Arsenic Album – pallor, debility, shortness of breath, action of heart weak, profound blood changes, glandular enlargements. Its characteristics are restless – after noon, and after midnight aggravation, nervous apprehension and anxiety.

Ferrum Phos – anaemia with hemorrhage and general debility and constipation. Chlorosis in young girls with delayed menses.

China – when the periodicity of fever and chill with enlargement of spleen is marked. Bowels disturbed and the skin is hot and dry.

Phosphorous – remarkable medicine for lymphoma treatment in cases where the patient is very much relaxed and debilitated. Palpitation of heart and shortness of breath on; least exertion. Loose and offensive stools with complete exhaustion thereafter.

Natrum Mur – very well marked medicine for lymphoma treatment where the complexion is pale, earthy; skin greasy; anaemia with chilliness, cold feet and chills down the back.

Calcaria Carb – excellent medicine for lymphoma and especially indicated when the lymphatic glands especially cervical glands are involved. Exhaustive

sweat and perspiration.

Ceanonthus – excellent medicine for disease like lymphoma. Enlargement of spleen resulting in anaemia.