Neck nodes, also known as lymph glands, are key components of the body immune system. They store immune cells called lymphocytes and macrophages that help protect the body against infection and kill cells that may become cancerous. There are between 500-600 lymph nodes in the body (Fig. 1 500-600 Lymph Nodes in the Body) and approximately half of them are located in the neck (approximately 150 on each side of the neck). They receive lymph fluid, a clear, watery fluid that leaks out of blood vessels circulates throughout the tissue of the entire body and like a slow moving river ,washes away and carries foreign material to the lymph nodes. It acts to remove bacteria, viruses, and waste products from the tissues. Lymph also allows the white blood cells to circulates throughout the body for surveillance purposes. As the lymph node receives infectious agents from the lymph fluid, the node becomes activated, swells, becomes filled with white blood cells and may become painful. An activated node is producing new cells and antibodies to help fight infections.
Fig. 2 Lymph Fluig Diagram
Fig. 3 Normal & Abnormal Lymph Nodes
Neck Nodes and Cancer
When patients are diagnosed with cancer, many times they are asked if the cancer is in the “nodes”. In the same way that lymph nodes drain fluid from tissues in the neck, they may drain cancer cells. This appearance of cancer cells to the surrounding lymph nodes is the first sign of spread of the cancer, and only occurs when the cancer has sufficiently changed it’s character to be able to leave the site of origin (for example the tongue, or thyroid). Suspicious signs of a cancerous lymph node are slowly enlarging neck nodes or there may be signs the doctor can see on advanced radiological imaging (Table 1). Cancer that has not spread to the lymph nodes has a higher rate of cure. Therefore, if the cancer has spread to the lymph nodes in the neck, the treatment may be more aggressive to included treating not only the area of the cancer, but also the lymph nodes that may be involved with the region of the cancer.
|Table 1||Normal Lymph Nodes||Suspicious Lymph Nodes|
|Size||Less then 1cm||Greater then 1.5cm|
|Shape||Oval||Round or Irregular|
|Growth Pattern||Get large & then small again (with infection)||Continuously get larger|
|Tenderness||Usually when infected||Usually non-tender|
|Accompanying Symptoms||Fevers & Chills when infected||Weight Loss, Poor Appetite, or Night Sweats|
Neck Node Biopsy
When a lymph node shows signs that are suspicious for a cancer or in a patient whom has previously had cancer, a biopsy of the lymph node must be done to look at the lymph node under the microscope and see what is in it, wether it’s normal, infectious, inflammatory, or cancerous. There are several ways to do this: (1) Fine Needle Aspiration (FNA) which means placing a needle into the lymph node to get some small sample to look at under the microscope. This is a very simple in-office procedure that is routinely done at the Center. (2) Open biopsy (Incisional Biopsy) which involves making a very small incision in the skin over the lymph node, to remove a portion to be reviewed by the pathologist. This can be done either in the office or the operating room, based on location, size and depth of the lymph node. This is a very quick procedure as well.
The neck is divided into 6 areas called levels. The levels are identified by Roman numeral, increasing towards the chest (Fig. 1 The 6 levels of the neck).
Region I: Submental and submandibular triangles. Ia is the submental triangle bound by the anterior bellies of the digastric and the mylohyoid. Ib is the triangle formed by
the anterior and posterior bellies of the digastric and body of mandible.
Region II, III, IV: nodes associated with the lateral neck around the internal jugular vein. The nodes are located in tissue medial to the sternocleidomastoid muscle and lateral to the border of the sternohyoid.
Region II: upper third including the upper jugular and the upper cervical nodes. Region bound by the digastric muscle superiorly and the hyoid bone, or the carotid bifurcation inferiorly. IIa contains nodes in the region anterior to the spinal accessory nerve (shoulder nerve) and IIb posterior to the nerve.
Region III: middle third jugular nodes extending from the carotid bifurcation superiorly to the inferior edge of cricoid cartilage, or omohyoid muscle.
Region IV: lower jugular nodes extending from the omohyoid muscle or inferior edge of cricoid cartilage superiorly to the clavicle inferiorly.
Region V: posterior triangle group of lymph nodes located along the lower half of the spinal accessory nerve (shoulder nerve) and the transverse cervical artery. The supraclavicular nodes are also included in this group. The posterior boundary is the anterior border of the trapezius muscle, the anterior boundary is the posterior border of the sternocleidomastoid muscle, and the inferior boundary is the clavicle.
Region VI: anterior compartment group comprises lymph nodes surrounding the midline structures of the neck extending from the level of the hyoid bone superiorly to the suprasternal notch inferiorly. On each side, the lateral boundary is the medial border of the carotid sheath. Located within this compartment are the perithyroidal lymph nodes, paratracheal lymph nodes, lymph nodes along the recurrent laryngeal nerves, and precricoid lymph nodes.