Lymph node metastasis

A lymph node metastasis is a colony of malignant cells growing within a lymph node but originating from another site. They are multiplying uncontrollably, not dying when they should, and demonstrating an ability to travel down the lymphatic system. As the cells grow they expand the lymph node which appears as a lump in the drainage pathway of that area. A lump in the neck of an adult over the age of 40 (particularly a smoker) must be considered to be a malignancy within a node until proven otherwise .

The cells in our bodies are constantly in a cycle of life of their own. They are formed from the division of other cells. They grow, divide to produce new identical cells and die .... and as they die they are replaced by the division of local cells. It is a finely regulated system. Only so many cells are produced and therefore the various components of our bodies look the same. Cancer develops when the new cells being produced are not quite the same as the parent cell and they don't obey the rules. They divide into other cells when they shouldn't and they don't die when they should. Thus we start to look different in some way eg. a lump develops (from a marked increase in number of cells at a specific site). If these cells also demonstrate an ability to separate and move off to other places they can form colonies of similarly abnormal cells growing in an uncontrolled manner. Such a colony growing at a separate site from the original is a metastasis....more than one are called metastases.

level of node

Cancers of the skin of the head and neck, and of the lining of the nose, mouth and throat may spread to lymph nodes in the neck where they appear as lumps usually under the jaw, or in the upper or mid-neck. The stomach and chest drain to nodes next to them but also to nodes in the lower neck. Thus, lumps in the lower neck occasionally represent lymph node metastases from these organs.

diagnosis

If the primary cancer is obvious eg. a tongue cancer or a skin cancer, it may not be necessary to biopsy the node as the diagnosis can be obtained by a biopsy of the primary.

If a primary cancer is not obvious or if there is some doubt about cancer in the lymph node, generally a needle biopsy will be performed. This is done in the clinic under local anaesthetic and is usually only slightly uncomfortable. Often it is done with the aid of ultrasound to guide the needle accurately into the node.

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