03/14/2014
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Swollen Lymph Nodes
Medical Author: Siamak T. Nabili, MD, MPH
Medical Editor: Melissa Conrad Stöppler, MD
What are lymph nodes?
Lymph nodes are an important component of the body's immune system and help in fighting infections.
They are small, soft, round or oval structures that are found throughout the body and are connected to each other in chain-like (lymphatic chains) fashion by channels similar to blood vessels. Each individual lymph node is covered by a capsule made up of connective tissue.
Within the capsule, lymph nodes contain certain kinds of immune cells. These cells are mainly lymphocytes, which produce proteins that capture and fight viruses and other microbes, and macrophages, which destroy and remove the captured material.
Where are the lymph nodes located in the body?
Lymph nodes are located throughout the body. Some are directly under the skin while others are deep inside the body. Even the most superficial (close to the skin) lymph nodes are usually not visible or palpable (felt by touching), unless they are swollen or enlarged for some reason.
They are connected to each other by loosely bound lymphatic vessels. Lymph nodes generally coalesce in different regions in the body where they are responsible for filtering the blood and performing their immunologic function for that particular area of the body. Fluid from the lymphatic vessels eventually feeds into the venous system (veins) in the body.
What are the causes of swollen lymph nodes?
There are may causes for swollen lymph nodes, sometimes referred to as "swollen glands" (lymphadenopathy or lymphadenitis). In general, lymph nodes become swollen when they are active either due to an infection, inflammation, or cancer.
Infections
Infections are the most common causes of swollen lymph nodes. Common infectious causes of swollen lymph nodes are viral, bacterial, parasites, and fungal.
Viruses
• infectious mononucleosis (mono),
• chickenpox
• measles
• HIV
• herpes
• common cold viruses
• adenovirus
• many other viruses
Bacteria
• streptococcus
• staphylococcus
• cat scratch disease
• syphilis
• tuberculosis
• chlamydia, and
• other sexually transmitted diseases
Parasites
• toxoplasmosis
• leishmaniasis
Fungal:
• coccidiomycosis
• histoplasmosis
Inflammation
Inflammatory and immunologic causes of swollen lymph nodes include diseases such as rheumatoid arthritis and lupus as well as sensitivity to some medications.
Cancer
Many cancers can also cause swelling of lymph nodes. These may be cancers that originate from the lymph nodes or blood cells such as lymphomas and leukemias. They may also be cancers that spread from another organ in the body (metastatic cancers). For example, breast cancer may spread to the nearest lymph nodes in the axilla (underarm), or lung cancer may spread to the lymph nodes around the collar bone.
Other causes of swollen lymph nodes
There are many other less common causes of swollen nodes, such as genetic lipid storage diseases, transplant graft rejections, sarcoidosis, and many other conditions.
It is also important to mention that swollen lymph nodes are not always a sign of an underlying disease. Sometimes they can be normal. For example, small (less than 1 centimeter), flat lymph nodes under the jaw (submandibular lymph nodes) in healthy children and young adults or small (up to 2 centimeters), groin lymph nodes (inguinal lymph nodes) in young individuals may be normal.
In many instances, a definitive cause for swollen lymph nodes may not be determined even after performing through examination and testing.
What are the symptoms of swollen lymph nodes?
Symptoms of swollen lymph nodes vary widely. A person could be completely free of symptoms (asymptomatic) and only found when they are noted by a doctor during a general physical examination.
Sometimes, swollen lymph nodes can be extremely tender, painful, and disfiguring.
More importantly, other symptoms related to an underlying disease that accompany the lymph node swelling may be more significant and clinically relevant than the lymph node swelling alone. For instance, symptoms such as fever, night sweats, weight loss, or evidence of local infections (toothache, sore throat) may provide valuable clues in determining the cause of lymph node swelling.
How are swollen lymph nodes diagnosed?
Swollen lymph nodes closer to the surface of the body are generally diagnosed by a doctor's examination and feeling for areas known to have coalescence of lymph nodes, for example, swollen lymph nodes under the arms (axillary lymph nodes), swollen lymph nodes in the sides of the neck (cervical lymph nodes), or swollen lymph nodes in the groin (inguinal lymph nodes). These swollen lymph nodes can be seen and felt easily.
Other times, deeper lymph nodes could be seen on imaging studies, such as CT scan (computed tomography), of different parts of the body.
Tonsils in the back of the throat are also lymph nodes, and they are the most visible ones in the body.
Diagnosing the cause of swollen lymph nodes may be challenging at times. The most important component of evaluating a swollen lymph node is a thorough medical history and a complete physical examination by a doctor. The doctor may ask you about symptoms such as sore throat, fever and chills, fatigue, weight loss, a complete list of medications, sexual activity, vaccination history, recent travels, the patient's own and his/her family's previous history of cancers if any, and so forth.
A group of lymph nodes in a particular area of the body react to disturbances in that general region. If there is a specific infection in the region of the swollen lymph nodes, that may be the most likely cause of swelling. For instance, an infection of the leg or some sexually transmitted diseases can cause swelling of the lymph nodes in the groin area.
Physicians usually examine the lymph nodes by feeling them and characterize them based upon what the lymph nodes feel like. They could be characterized, for example, as:
• large or small
• tender or non-tender
• fixed or mobile
• hard or soft, or
• firm or rubbery.
These characteristics can be useful in suggesting the cause of the lymph node swelling. For example, a hard, nontender, nonmoveable lymph node may be more characteristic of a cancer spread to that node. On the other hand, a soft, tender, moveable lymph node could more likely represent an infection.
If the enlarged lymph nodes are suspected to be related to a cancer, then a biopsy of the lymph node may determine the cancer type. For example, a swollen lymph node around the collar bone (supraclavicular lymph node), may signify lung cancer in a person who may have other clinical clues suggestive of lung cancer.
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