Lymph NodeI noticed a hard, painless swelling on the neck near the left collar bone in August, 2011. It was gradually increasing in size. I was really scared because hard, painless swelling in that area is a typical symptom of some cancer in the body, usually lymphoma. Then I went to the hospital in September and they diagnosed me with Lymph node tuberculosis. The surprising thing is I never had any symptoms like fever, night chills or weight loss; only the swelling on my neck. The diagnosis showed there were more such lymph node swellings near the abdomen inside my body.’

It isn’t uncommon to find such revelations online, making us realize that this could happen to anyone. Would you pay attention to a few innocuous-looking enlarged nodes in your body? Would you know if you need to visit a doctor? In this post, we tell you more about lymph nodes – what they exist, when they are enlarged, what they indicate and why you need to take them more seriously.

Lymph nodes are round- or bean-shaped structures found in clusters in various parts of the body – neck, armpit, groin, and inside the centre of the chest and abdomen. Whenever the lymph fluid detects foreign material such as bacteria, these nodes produce the white blood cells to help fight the infection. They also filter the lymph fluid and remove foreign material, such as bacteria and cancer cells.

When fighting an infection, lymph nodes become painful. They become enlarged and sore. The soreness usually goes away in a couple days, without treatment, though, it might take up to several weeks to return to its normal size. When swollen, inflamed or enlarged, lymph nodes can be hard, firm or tender. 

Swollen lymph nodes can be caused by infections such as cold and flu, abscessed or impacted tooth, gum disease, mouth sores, ear infections, skin infections, and sexually transmitted diseases. Inflammation of tonsils, soft glands similar to lymph nodes, can give you an idea of enlarged lymph nodes caused due to infection. Here’s a detailed account of tonsillitis, inflammation of tonsils. 

However, at times, they could even indicate something more serious. Here are a few such reasons you shouldn’t ignore enlarged lymph nodes:

HIV infection

The human immunodeficiency virus (HIV) infection gradually destroys the immune system, making it harder for the body to fight infections. It can be spread through sexual contact, through blood transfusions or needle sharing, and from a pregnant mother to her foetus. Read a few more facts about HIV that you didn’t know.

Symptoms – Other than swollen lymph glands, the symptoms may also include headache, mouth sores, muscle stiffness or aching, mouth sores, rashes of different types, and sore throat.

Treatment – HIV is a chronic medical condition that can be treated, but not yet cured. It is treated with a combination of anti-viral drugs. Read more about testing for HIV and other STDs

Read more about causes, symptoms, diagnosis and treatment of hiv/aids.

Pulmonary tuberculosis

Pulmonary tuberculosis (TB) is a contagious bacterial infection, caused by Mycobacterium tuberculosis that involves the lungs. It may spread to other organs.

Symptoms – One of the symptoms of pulmonary tuberculosis is swollen or tender lymph nodes in the neck or other areas. Although it doesn’t show any symptoms initially, later stages are characterized by cough (usually with mucus and coughing up blood), excessive sweating at night, fatigue, fever, and weight loss.

Treatment – Treatment involves a combination of many drugs (usually four drugs). All of the drugs are continued until lab tests show which medicines work best. The patient may need to stay at home or be admitted to a hospital for 2 – 4 weeks to avoid spreading the disease to others. Here’s some information on vaccine development for prevention of tuberculosis.

Lymph node tuberculosis

Lymph node tuberculosis, also known as tuberculous lymphadenitis, usually affects nodes in the neck, but swelling can occur in nodes throughout your body.  Over time, the swollen nodes can release fluid through the skin.

Symptoms – The disorder usually presents as a gradually increasing painless swelling of one or more lymph nodes of weeks to months duration. Some patients, especially those with extensive disease or a co-existing disease, may have systemic symptoms i.e. fever, weight loss, fatigue and night sweats. Distressing cough may be a prominent symptom in mediastinal lymphadenitis,’ says Dr P R Gupta, Professor of Chest & TB, SMS Medical College, Jaipur, in his review article ‘Difficulties in managing lymph node tuberculosis’.

Treatment – The treatment normally depends on the type of bacterial infection. Generally, the conventional treatment of tuberculosis with antibiotics is resorted to. Some infections may need surgical excision. For example, nontuberculous mycobacterium (NTM) responds well to surgery but Mycobacterium tuberculosis is treated with antibiotics. Read more about the causes, symptoms and diagnosis of tuberculosis.

Mononucleosis

Mononucleosis is a viral infection. It is more common in older teenagers and young adults.

Symptoms – In addition to a severe throat and fatigue, its symptoms often include weakness, aches, dizziness, enlarged spleen and swollen lymph nodes in the neck.

Treatment – There’s no specific therapy available to treat infectious mononucleosis. Antibiotics don’t work against such viral infections. So, treatment mainly involves bed rest and drinking plenty of fluids, according to Mayo Clinic experts. Secondary infections such as a strep infection or tonsillitis are however treated with antibiotics or corticosteroids.

Hodgkin’s lymphoma

Cancer of the lymph tissue in the lymph nodes, spleen, liver, bone marrow, and other sites, is called Hodgkin’s lymphoma. It is one of the most curable cancers, especially if it is detected early. 

Symptoms – The first sign of Hodgkin lymphoma is often a painless swelling of the lymph nodes in the neck, armpits, or groin that appears without a known cause. The disease can spread to nearby lymph nodes. Later it may spread to the spleen, liver, bone marrow, or other organs. Other symptoms include fatigue, fever and chills that come and go, itching all over the body that cannot be explained, loss of appetite, night sweats, and unexplained weight loss

Treatment – Treatment involves chemotherapy or radiotherapy or both. In some cases, stem cell transplant has to be done.

Non-Hodgkin lymphoma

Non-Hodgkin lymphoma (NHL) is cancer of the lymph tissue. Although the exact cause of this cancer is not known, it has been observed to develop in people with weakened immune system, including people with HIV.

Symptoms – Apart from the swollen lymph nodes in the neck, armpits, or groin and other symptoms of Hodgkin lymphoma, this cancer also shows signs and symptoms of coughing or shortness of breath, abdominal pain or swelling, headache, concentration problems, personality changes, or even seizures if the brain is affected.

Treatment – Treatment involves chemotherapy or radiotherapy or both or no treatment at all. In some cases, stem cell transplant has to be done. Blood transfusions or platelet transfusions may be required if blood counts are low.

Leukaemia

Leukaemia is cancer of the white blood cells that begins in the bone marrow.

Symptoms – Signs and symptoms include painless swollen lymph nodes in the neck or armpit, fevers or night sweats, frequent infections, fatigue, easy bruising, swelling or discomfort in the abdomen, unexplained weight loss, and pain in the bones or joints.

Treatment – Treatment depends on the age of the patient, type of leukemia (acute or chronic) and whether leukemia cells are found in the cerebrospinal fluid. Treatment options include chemotherapy, radiation therapy, biological therapy, drugs, and stem cell transplant. Sometimes, surgery to remove the spleen may be required. Here’s a detailed account on leukemia.

Significance of enlarged lymph nodes

It is evident from the above conditions, that the nature of enlargement and the type of swelling of the lymph nodes is important in diagnosis and prognosis of the condition. For example, in cancers, the condition of lymph nodes is so significant that it is used for cancer staging, which decides the treatment to be employed, and for determining the prognosis.

Read more about causes, symptoms, diagnosis and treatment of blood cancer.

 When to see a doctor

 Contact a medical professional if your lymph nodes –

  • Do not get smaller after several weeks or continue to get larger
  • Are red and tender
  • Feel hard, irregular, or fixed in place
  • Are swollen and accompanied by fever, night sweats, or unexplained weight loss.

See a doctor if your child’s lymph nodes become larger than 1 centimetre (a little less than 1/2 inch) in diameter. Very importantly, seek immediate medical care if you’re experiencing severe symptoms such as difficulty breathing or swallowing.

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