Swollen Lymph Nodes In The Neck 

Introduction

Swollen lymph nodes are your body's natural response to illness or infection, often presenting as soft, tender, and occasionally painful lumps. While upper respiratory infections are the most common causes, these swellings can have various causes. In this article, we will delve into the reasons behind swollen lymph nodes, methods of diagnosis, when to seek medical attention, and the available treatment options. Additionally, I had the privilege of interviewing Dr Ahmed Ragab, an Assistant Lecturer in Head and Neck Surgery and a Fellow of the Royal College of Surgeons, who specialises in Endocrine Surgery at University College London Hospitals (UCLH) in London. He provided valuable insights from his extensive experience in the field.

Definition of swollen lymph nodes

When you're not feeling well, you might notice some lumps on the sides of your neck. These lumps can be soft, tender, and a little painful. They are called swollen lymph nodes. Swollen lymph nodes, also known as adenopathy or lymphadenopathy, are a sign that your body is fighting off an infection or illness.

These small pea- or bean-sized lumps are part of your lymphatic system, not actual glands. Your lymphatic system helps balance the fluids in your body. Swollen lymph nodes act like filters that help remove germs, cells, or foreign substances from your lymph fluid, which is a clear or slightly yellowish fluid containing white blood cells, proteins, and fats.¹

According to assistant lecturer Ahmed Ragab, “The most common swelling we can examine in the neck is lymph nodes. Interestingly, we can come across swollen lymph nodes even when examining the thyroid gland, even if the patient doesn't complain of it.” Professor Ragab's insight underscores the importance of paying attention to lymph nodes during neck examinations, as they can reveal vital information about a patient's health.

You might associate swollen glands with those in your neck, but you can also have painful swollen lymph nodes in your armpits, known as axillary adenopathy. They can be moved slightly with your fingers. Swollen lymph nodes can be found under your jaw and in your groin as well.

In fact, you have many more lymph nodes throughout your body, around 600 of them, although the exact number varies from person to person. They're located in your jaw, chest, arms, abdomen, and legs.²

Importance of lymph nodes in the body

Lymph nodes have an important function– they act like filters for a special fluid called lymph. Lymph is a collection of fluid that comes from your cells and tissues. This fluid contains various things like proteins, minerals, fats, nutrients, white blood cells (called lymphocytes), damaged cells, cancer cells, and even harmful stuff like bacteria and viruses.

The lymph fluid flows through lymph nodes, where the nodes filter and clean the fluid. Inside the nodes, there are cells that attack, destroy, and remove waste to help keep your body healthy.

Your lymph nodes work closely with two important body systems:

1. Immune system: This is your body's defence team. It protects you from invaders such as bacteria and viruses to keep you from getting sick.
2. Lymphatic system: This is part of your immune system. It protects your body from harmful invaders, maintains the right fluid levels, takes in nutrients, gets rid of waste from your cells, and keeps you healthy.

Think of lymph nodes as filters that clean up the fluid that flows through your body, getting rid of the bad stuff that can make you sick and keeping the good stuff that keeps you healthy.³

Causes of swollen lymph nodes

Swollen lymph nodes are usually a sign of infection, often due to viruses such as the common cold. However, they can have various other causes:

Bacterial infections

These are often caused by bacteria such as Staphylococcus aureus or Streptococcus pyogenes. They can lead to lumps on the face or scalp, earaches, sore throats, and sometimes infections of the skin, ear, or upper respiratory tract. The affected lymph nodes are often tender and may contain pus, and the skin above them can be warm and red. Patients usually have a fever and an obvious source of infection.

Viral infections

These infections, often resulting from rhinoviruses, parainfluenza viruses, influenza viruses, and others, can lead to multiple and bilateral swollen lymph nodes. These nodes are typically small, not tender, and rarely contain pus. Patients may have low-grade fevers and symptoms like cough, runny nose, conjunctivitis, or a skin rash.

Infectious mononucleosis (IMN)

IMN is common in children and caused by the Epstein-Barr virus. It leads to enlarged lymph nodes, especially in the neck's posterior group, as well as in the armpits and groin. The diagnosis is based on specific criteria and confirmed through blood tests.

Chronic infectious lymphadenopathy 

Some infections may persist despite treatment, resulting in chronic swollen lymph nodes.

Syphilis

A sexually transmitted disease caused by Treponema pallidum, syphilis can lead to multiple, firm, mobile, and non-tender lymph nodes. Diagnosis is usually made through blood tests.

Tuberculosis (TB)

TB can affect lymph nodes, with cervical nodes often involved. The source of infection usually determines which group of nodes is affected. The diagnosis involves specific histological features and tests.

Toxoplasmosis

Toxoplasmosis is a zoonotic disease and can lead to cervical lymphadenopathy, which is often solitary, mobile, and painless.

Malignancy

While benign causes are more common, malignant processes can also lead to swollen lymph nodes. Evaluating for malignancy is a crucial part of diagnosis, 

Drug-induced lymphadenopathy

Certain medications, like phenytoin, can cause widespread lymph node swelling. Drug-induced lymphadenopathy typically occurs a few months after starting the medication and often resolves when the drug is stopped.⁴

Common symptoms and signs of swollen lymph nodes 

When your lymph nodes swell, it's a sign that something might be amiss in your body.

Initially, when your lymph nodes swell, you might experience:

1. Tenderness and pain in those swollen lymph nodes.
2. The nodes can enlarge to the size of a pea, kidney bean, or even larger.

Depending on what is causing your lymph nodes to swell, you might also notice other signs and symptoms:

1. If you have a runny nose, sore throat, fever, or other symptoms of an upper respiratory infection, it could be the cause.
2. Swelling of lymph nodes all over your body may indicate an infection like HIV or mononucleosis, or an immune system disorder such as lupus or rheumatoid arthritis.
3. If the nodes become hard, fixed, and start growing rapidly, it could be a sign of possible cancer or lymphoma.
4. You might experience fever and night sweats as well.

Swollen lymph nodes are your body's way of letting you know that something needs attention, and the specific symptoms can help your doctor figure out what might be going on.⁵

When to seek medical attention

Sometimes, swollen lymph nodes can go back to their normal size when the underlying issue, like a minor infection, improves. However, it's essential to consult your doctor if you're worried or if your swollen lymph nodes:

1. Seem to have appeared without any obvious reason
2. Keep getting bigger or have been there for two to four weeks
3. Feel hard, rubbery, or don't move when you touch them
4. Are accompanied by a persistent fever, night sweats, or unexplained weight loss.

If you're experiencing difficulty swallowing or breathing, it's crucial to seek immediate medical care. These signs may indicate a more serious issue that requires prompt attention.⁶

Diagnosis of swollen lymph nodes

Historical clues

• Age and duration: Swollen lymph nodes are quite common in children and often result from infections. Malignant causes are rarer in children but become more likely with age. Short-term (less than two weeks) or very long-term (over a year) lymphadenopathy with no size increase is usually not cancerous, although there can be exceptions.
• Exposures: Knowing a person's history of exposure is crucial. This includes contact with animals, insect bites, medication use, infectious encounters, and travel history. Exposure to things like tobacco, alcohol, and sunlight could raise concerns about certain types of cancer. Occupational exposure to substances like silicon or beryllium can also cause lymphadenopathy. Family history can be a red flag for specific cancer-related causes.
• Associated symptoms: Pay attention to other symptoms associated with swollen lymph nodes, like fatigue, fever, night sweats, and unexplained weight loss. Some symptoms can indicate specific diseases, like joint pain, muscle weakness, or skin rashes, which might suggest autoimmune conditions. Specific questions about alcohol-induced pain in the area of lymphadenopathy could hint at rare but specific conditions like Hodgkin's lymphoma.⁷

Physical examination

• Skin: Examine the skin for unusual lesions that could indicate cancer. Look for signs of injury or infection around the swollen nodes.
• Splenomegaly: This is an enlarged spleen and can be associated with specific disorders, such as infectious mononucleosis, lymphomas, and sarcoidosis.
• Node characteristics: The characteristics of the swollen lymph nodes matter. Hard, painless nodes often raise concerns for cancer or granulomatous diseases. Viral infections usually lead to soft, painless, and mobile nodes. Tender nodes could indicate nodal inflammation from an infection.
• Size: The classic definition of lymphadenopathy is nodes larger than 1 cm, but this can vary by their location. Some locations, around the collar bone, in the groin or behind the knee, are considered abnormal even if they are smaller. Increasing size over time is more concerning than the initial size

Laboratory tests

Blood tests, including a complete blood count (CBC), are commonly used to check for underlying issues. A CBC can help identify infections and disorders such as leukaemia.

Imaging

Chest X-rays or CT scans may be necessary to investigate possible sources of infection or tumours in the affected area.

Lymph node biopsy 

In some cases, your doctor may recommend a biopsy to confirm the diagnosis. This involves removing a sample or even an entire lymph node for microscopic examination.⁷

Treatment options for swollen lymph nodes 

When swollen lymph nodes are due to a viral infection, they typically return to normal once the viral infection is resolved. It's important to note that antibiotics are not effective in treating viral infections.

Treatment for swollen lymph nodes depends on the underlying cause:

• Infection: If the cause of your swollen lymph nodes is a bacterial infection, the most common treatment is antibiotics. If the swollen nodes are a result of an HIV infection, you will receive specific treatment for HIV.
• Immune disorder: When swollen lymph nodes are linked to immune disorders like lupus or rheumatoid arthritis, the treatment focuses on managing and treating the underlying condition itself.
• Cancer: Swollen nodes caused by cancer necessitate treatment for the cancer. The type of treatment can vary and may involve surgery, radiation therapy, or chemotherapy, depending on the specific type of cancer and its stage.⁸

Summary 

• Swollen lymph nodes are a response to illness or infection, explored with causes, diagnosis, and treatments.
• Nodes filter lymph fluid, removing harmful substances
• Infections (viral and bacterial), immune disorders, and cancer can lead to swollen nodes
• Consult a doctor for persistent, unexplained, hard nodes or accompanied by specific symptoms
• Diagnosis involves history, physical exams, tests, and potential biopsies. Treatment varies based on the cause