There are hundreds of lymph nodes in the human body. They are located deep inside the body, such as around the lungs and heart, or closer to the surface, such as under the arm or groin, according to the American Cancer Society
The spleen, which is located on the left side of the body just above the kidney, is the largest lymphatic organ, according to the U.S. National Library of Medicine (NLM). It controls the amount of red blood cells and blood storage in the body, and helps to fight infection. If the spleen detects potentially dangerous bacteria, viruses, or other microorganisms in the blood, it — along with the lymph nodes — creates white blood cells called lymphocytes, which act as defenders against invaders. The lymphocytes produce antibodies to kill the foreign microorganisms and stop infections from spreading. Humans can live without a spleen, although people who have lost their spleen to disease or injury are more prone to infections.
The thymus is located in the chest just above the heart, according to Merck Manual. This small organ stores immature lymphocytes (specialized white blood cells) and prepares them to become active T cells, which help destroy infected or cancerous cells.
Tonsils are large clusters of lymphatic cells found in the pharynx. According to the American Academy of Otolaryngology, they are the body’s “first line of defense as part of the immune system. They sample bacteria and viruses that enter the body through the mouth or nose.
Lymph is a clear and colorless fluid; the word “lymph” comes from the Latin word lympha, which means “connected to water,” according to the National Lymphadema Network.
Plasma leaves the body’s cells once it has delivered its nutrients and removed debris. Most of this fluid returns to the venous circulation through tiny blood vessels called venules and continues as venous blood. The remainder becomes lymph, according to the Mayo Clinic.
Unlike blood, which flows throughout the body in a continue loop, lymph flows in only one direction — upward toward the neck. Lymphatic vessels connect to two subclavian veins, which are located on either sides of the neck near the collarbones. and the fluid re-enters the circulatory system, according to the Mayo Clinic.
Diseases and disorders of the lymphatic system
Diseases and disorders of the lymphatic system are typically treated by immunologists. Vascular surgeons, dermatologists, oncologists and physiatrists also get involved in treatment of various lymphatic ailments. There are also lymphedema therapists who specialize in the manual drainage of the lymphatic system.
The most common diseases of the lymphatic system are enlargement of the lymph nodes (also known as lymphadenopathy), swelling due to lymph node blockage (also known as lymphedema) and cancers involving the lymphatic system, according to Dr. James Hamrick, chief of medical oncology and hematology at Kaiser Permanente in Atlanta.
When bacteria are recognized in the lymph fluid, the lymph nodes make more infection-fighting white blood cells, which can cause swelling. The swollen nodes can sometimes be felt in the neck, underarms and groin, according to the NLM.
Lymphadenopathy is usually caused by infection, inflammation, or cancer. Infections that cause lymphadenopathy include bacterial infections such as strep throat, locally infected skin wounds, or viral infections such as mononucleosis or HIV infection, Hamrick stated. “The enlargement of the lymph nodes may be localized to the area of infection, as in strep throat, or more generalized as in HIV infection.
Inflammatory or autoimmune conditions occur when a person’s immune system is active, and can result in enlargement of lymph nodes. This can happen in lupus, according to Hamrick.
Lymphoma is cancer of the lymph nodes. It occurs when lymphocytes grow and multiply uncontrollably. There are a number of different types of lymphoma, according to Dr. Jeffrey P. Sharman, director of research at Willamette Valley Cancer Institute and medical director of hematology research for the U.S. Oncology Network.
“The first ‘branch point’ is the difference between Hodgkin lymphoma and non-Hodgkin lymphoma (NHL),” Sharman said. Non-Hodgkin lymphoma is more common of the two, according to the Lymphoma Research Foundation.
When a person has had surgery and/or radiation to remove a cancer, the lymphatic flow back to the heart and can result in swelling or lymphedema, Hamrick noted. This most commonly occurs in women who have had surgery to remove a breast cancer. Part of the operation to remove the breast cancer involves removing lymph nodes in the armpit.
The more lymph nodes removed the higher the risk of chronic bothersome swelling and pain due to lymphedema in the arm, Hamrick explained. “Fortunately modern surgical techniques are allowing for fewer lymph nodes to be removed, and thus fewer cases of severe lymphedema for breast cancer survivors.”
Castleman disease is a group of inflammatory disorders that cause lymph node enlargement and can result in multiple-organ dysfunction, according to the Castleman Disease Cooperative Network. While not specifically a cancer, it is a similar to a lymphoma and is often treated with chemotherapy. It can be unicentric (one lymph node) or multicentric, involving multiple lymph nodes.
Lymphangiomatosis is a disease involving multiple cysts or lesions formed from lymphatic vessels, according to the Lymphangiomatosis & Gorham’s Disease Alliance. It is thought to be the result of a genetic mutation.
Diagnosis and treatment
Diseases of the lymphatic system are usually diagnosed when lymph nodes are enlarged, Hamrick noted. This may be discovered when the lymph nodes become enlarged enough to be felt (“palpable lymphadenopathy”) or are seen on imaging studies such as CT scans or MRIs.
The majority of enlarged lymph nodes are not dangerous; they are the body’s way of fighting off an infection, such as a viral upper respiratory infection. If the lymph nodes become significantly enlarged and persist longer than the infection then they are more worrisome. There is no specific size cutoff, but typically nodes that persist at larger than a centimeter are more worrisome and warrant examination by a doctor.
Common symptoms of any lymphatic disorder include swelling of the arm or groin, weight loss, fever and night sweats, according to Stephanie Bernik, chief of surgical oncology at Lenox Hill Hospital in New York. “A PET or CAT scan is usually ordered to further investigate.”
The diagnosis of lymphadenopathy depends on the location of the abnormal lymph nodes and other things that are going on with the patient. If the patient has a known infection, then the lymph nodes can simply be followed to await resolution with treatment of the infection. If the nodes are growing quickly and there is no obvious explanation then typically a biopsy is warranted to look for a cancer or an infection.
Sometimes the biopsy needs to be done by a surgeon in the operating room. This is often where the most tissue can be obtained to make a diagnosis, he said.
With many types of lymphoma and leukemia, there are unique treatment options for each type, according to Sharman. “There is no one ‘summary’ of treatment options. Treatment options can include traditional chemotherapy, immunotherapy (such as using antibodies or immune modulating drugs), and even radiation.”