- Is It Cancer?
- Biopsy & Diagnosis
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When the lymph nodes in the mediastinum become enlarged, it is called mediastinal lymphadenopathy. Mediastinal lymph node enlargement can occur from a wide range of diseases, either on its own or in association with other lung conditions. It usually stays less than 10 mm in diameter.
- The mediastinum is a bag-like area located in the thorax. It contains the heart, lungs, esophagus, and other connective tissue.
- Lymph nodes are small structures located in clusters throughout the body through which toxins and pathogens can be filtered.
- There are several non-cancerous conditions that can cause mediastinal lymphadenopathy, such as infections (e.g., tuberculosis, fungal infections), autoimmune diseases (e.g., sarcoidosis), and other inflammatory conditions (e.g., histoplasmosis).
- Mediastinal lymphadenopathy generally suggests a problem related to the lungs. It is usually associated with tuberculosis and most commonly associated with lung cancer and chronic obstructive pulmonary disease (COPD).
- Mediastinal lymph nodes are typically the first ones that cancer cells from the lungs will trap, providing doctors have the means to know if cancer is spreading.
What causes mediastinoscopy and FNA?
When the cause of mediastinal lymphadenopathy is uncertain, the doctor may order a procedure known as mediastinoscopy with biopsy. The procedure is performed in a hospital under general anesthesia.
- In this, a small surgical cut is made just above the sternum or breastbone.
- A fiber-optic instrument called a mediastinoscope is then inserted through the incision and passed into the mid-part of the chest to obtain a sample of one or several lymph nodes.
- The results are usually ready within five to seven days.
Fine needle aspiration (FNA): It is a less-invasive procedure in which a long needle is inserted through the chest cavity into the lymph node to extract cells for further diagnosis.
What is the role of mediastinal lymphadenopathy in lymphoma?
Lymphomas are a type of cancer that begins in the white blood cells called lymphocytes (part of your immune system that protects from germs). Lymphoma is further divided into Hodgkin's lymphoma (HL) and non-Hodgkin's lymphoma (NHL). Mediastinal lymphadenopathy occurs in over 85% of people with HL, whereas it occurs in only 45% of people with NHL.
How is mediastinal lymphadenopathy treated?
Most enlarged lymph nodes are caused by an infectious process. The treatment of mediastinal lymphadenopathy depends on the underlying cause. Here are some of the most common treatments:
- Doctors initially treat mediastinal lymphadenopathy with antibiotics.
- Anti-inflammatory medications: If the cause is inflammation, nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to reduce inflammation and swelling.
- Steroids: If the cause is an autoimmune disorder, corticosteroids may be prescribed to reduce inflammation and swelling.
- Chemotherapy or Radiation therapy: If the cause is cancer, such as Hodgkin's lymphoma or non-Hodgkin's lymphoma, chemotherapy or radiation therapy may be recommended to shrink the tumor and control the spread of cancer cells.
- Surgery: If the lymph nodes are large and causing symptoms, such as difficulty breathing or swallowing, surgery may be necessary to remove the affected lymph nodes.
- If malignancy is suspected due to symptoms such as persistent fevers or weight loss, a biopsy may be considered.
It's important to note that the specific treatment plan will depend on various factors, including the cause and severity of the mediastinal lymphadenopathy, and the overall health of the individual. A healthcare provider can provide more specific recommendations based on an individual's situation.
Why is a mediastinal lymphadenopathy biopsy performed?
A mediastinal lymph node biopsy can help doctors to
- Determine if lung cancer has metastasized.
- Structure an appropriate treatment plan.
- Diagnose certain conditions such as tuberculosis or other lung diseases.
Is a mediastinal lymphadenopathy biopsy safe and beneficial?
Mediastinal lymph biopsies are often performed using non-invasive techniques, which pose fewer risks to the patient. However, any surgical procedure comes with at least minor risks. The risks associated with mediastinal lymph node biopsy include:
- Puncture of certain organs and/or structures such as the esophagus, blood vessels, or trachea that can lead to bleeding
- Pneumothorax (a collapsed lung)
- Anesthesia complications such as vomiting and dizziness
The common benefits of mediastinal lymphadenopathy biopsy include:
- A shorter hospital stay after surgery
- Smaller incisions compared with those in open surgical techniques
- Less postoperative pain
- Earlier return to daily activities compared with that in open surgical techniques
Patients who experience no complications immediately after surgery are typically allowed to return home a few hours after the procedure. The doctor may give instructions on how to clean the site of the cut to prevent infection.
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