About the lymphatic system
The lymphatic system is made up of thin tubes that branch out to all parts of the body. The lymph system carries lymph, a colorless fluid containing lymphocytes (a type of white blood cell). Lymphocytes are part of our immune system and help fight germs in the body. B-lymphocytes (also called B cells) make antibodies to fight bacteria, and T-lymphocytes (also called T cells) kill viruses and foreign cells and trigger the B cells to make antibodies.

Groups of tiny, bean-shaped organs called lymph nodes are located throughout the body at different sites in the lymphatic system. The largest areas of lymph nodes are found in the abdomen, groin, pelvis, underarms, and neck. Other parts of the lymphatic system include the spleen, which makes lymphocytes and filters the blood; the thymus, an organ under the breastbone; the tonsils, located in the throat; and the bone marrow, the spongy red tissue inside bones that makes white blood cells (cells that fight infection), red blood cells (cells that carry oxygen throughout the body), and platelets (cells that help the blood to clot).

Lymphoma begins when B cells or T cells in the lymphatic system change and grow uncontrollably, which may form a tumor. Hodgkin lymphoma is a specific type of lymphoma that is covered in another section of this website. Non-Hodgkin lymphoma (NHL) is a term that refers to many types of cancer of the lymphatic system, which can have different symptoms and signs, physical findings, and treatments.

Because lymph tissue is found in so many parts of the body, NHL can start almost anywhere and can spread to almost any organ in the body. It most often begins in the lymph nodes, liver, spleen, or bone marrow, but it can also involve the stomach, intestines, skin, thyroid gland, brain, or any other part of the body.

It is very important to know which type and subtype has been diagnosed because the type and subtype help doctors determine the best treatment and a patient’s prognosis (chance of recovery).

The reason lymphoma patients frequently end up beng diagnosed by Ear Nose and Throat physicians is the because of the frequency of a neck mass as the presenting symptom of lymphoma. There is an abundance of lymph nodes concentrated in both sides of the neck, about 300 in total. Since the accumulation of abnormal malignant cells causes the enlargement of a lymph node, the appearance of a mass in the neck especially in an adult is suspicious and warrants a biopsy.

A biopsy may either be done under local anesthesia in the office or under general anesthesia in the hospital depending on how deep and how complicated removing the lymph node may be.

A small incision is usually performed in the neck along the lines of tension of the skin to minimize a scar. The procedure usually lasts no more than 30 minutes and results in removal of a lymph node. Generally, the procedure is performed to diagnose the mass and not to necessarily remove all the tissue present.

The tissue is sent to a pathology lab which will normally take between several days to a couple of weeks depending on the number of tests necessary to diagnose the tissue. Occasionally, because of the complexity of diagnosing certain lymphomas, the processed tissue microscope slides are sent to one or two additional lymphoma centers to confirm a diagnosis.

The type of cells present help to determine what treatment will eventually be tailored and what the prognosis of the disease will be.

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