Swollen lymph nodes

Overview

Swollen lymph nodes usually occur as a result of infection from bacteria or viruses. Rarely, swollen lymph nodes are caused by cancer.

Your lymph nodes, also called lymph glands, play a vital role in your body's ability to fight off infections. They function as filters, trapping viruses, bacteria and other causes of illnesses before they can infect other parts of your body. Common areas where you might notice swollen lymph nodes include your neck, under your chin, in your armpits and in your groin.

In some cases, the passage of time and warm compresses may be all you need to treat swollen lymph nodes. If an infection causes swollen lymph nodes, treatment depends on the cause.

Symptoms

Your lymphatic system is a network of organs, vessels and lymph nodes situated throughout your body. Many lymph nodes are located in your head and neck region. Lymph nodes that frequently swell are in this area, as well as in your armpits and groin area.

Swollen lymph nodes are a sign that something is wrong somewhere in your body. When your lymph nodes first swell, you might notice:

• Tenderness and pain in the lymph nodes
• Swelling that may be the size of a pea or kidney bean, or even larger in the lymph nodes

Depending on the cause of your swollen lymph nodes, other signs and symptoms you might have include:

• Runny nose, sore throat, fever and other indications of an upper respiratory infection
• General swelling of lymph nodes throughout your body. When this occurs, it may indicate an infection, such as HIV or mononucleosis, or an immune system disorder, such as lupus or rheumatoid arthritis
• Hard, fixed, rapidly growing nodes, indicating a possible cancer or lymphoma
• Fever
• Night sweats

When to see a doctor

Some swollen lymph nodes return to normal when the underlying condition, such as a minor infection, gets better. See your doctor if you're concerned or if your swollen lymph nodes:

• Have appeared for no apparent reason
• Continue to enlarge or have been present for two to four weeks
• Feel hard or rubbery, or don't move when you push on them
• Are accompanied by persistent fever, night sweats or unexplained weight loss

Seek immediate medical care if you're having difficulty swallowing or breathing.

Causes

Lymph nodes are small, round or bean-shaped clusters of cells. Inside lymph nodes are a combination of different types of immune system cells. These specialized cells filter your lymphatic fluid as it travels through your body and protect you by destroying invaders.

Lymph nodes are located in groups, and each group drains a specific area of your body. You may be more likely to notice swelling in certain areas, such as in the lymph nodes in your neck, under your chin, in your armpits and in your groin. The site of the swollen lymph nodes may help identify the underlying cause.

The most common cause of swollen lymph nodes is an infection, particularly a viral infection, such as the common cold. Other possible causes of swollen lymph nodes include:

Common infections

• Strep throat
• Measles
• Ear infections
• Infected (abscessed) tooth
• Mononucleosis
• Skin or wound infections, such as cellulitis
• Human immunodeficiency virus (HIV) — the virus that causes AIDS

Uncommon infections

• Tuberculosis
• Certain sexually transmitted infections, such as syphilis
• Toxoplasmosis — a parasitic infection resulting from contact with the feces of an infected cat or eating undercooked meat
• Cat scratch fever — a bacterial infection from a cat scratch or bite

Immune system disorders

• Lupus — a chronic inflammatory disease that targets your joints, skin, kidneys, blood cells, heart and lungs
• Rheumatoid arthritis — a chronic inflammatory disease targeting the tissue that lines your joints (synovium)

Cancers

• Lymphoma — cancer that originates in your lymphatic system
• Leukemia — cancer of your body's blood-forming tissue, including your bone marrow and lymphatic system
• Other cancers that have spread (metastasized) to lymph nodes

Other possible but rare causes include certain medications, such as the anti-seizure medication phenytoin (Dilantin) and preventive medications for malaria.

Risk factors

Many conditions increase the risk of swollen lymph nodes. Factors that increase the risk of having these conditions include:

• Older age. Aging increases the risk of getting infections, immune system disorders and cancer.
• High-risk behaviors. Having sex without protection and injecting illicit drugs increases the risk of infections such as HIV and other sexually transmitted infections.
• Weakened immune system. This can be from an illness or a medicine that suppresses the immune system. Having a weakened immune system increases the risk of infections.

Complications

If infection is the cause of your swollen lymph nodes and isn't treated, an abscess may form. Abscesses are localized collections of pus caused by infections. Pus contains fluid, white blood cells, dead tissue, and bacteria or other invaders. An abscess may require drainage and antibiotic treatment.

Diagnosis

To diagnose what might be causing your swollen lymph nodes, your doctor may need:

• Your medical history. Your doctor will want to know when and how your swollen lymph nodes developed and if you have any other signs or symptoms.
• A physical exam. Your doctor will also want to check lymph nodes near the surface of your skin for size, tenderness, warmth and texture. The site of your swollen lymph nodes and your other signs and symptoms will offer clues to the underlying cause.
• Blood tests. Certain blood tests may help confirm or exclude any suspected underlying conditions. The specific tests will depend on the suspected cause, but most likely will include a complete blood count (CBC). This test helps evaluate your overall health and detect a range of disorders, including infections and leukemia.
• Imaging studies. A chest X-ray or computerized tomography (CT) scan of the affected area may help determine potential sources of infection or find tumors.
• Lymph node biopsy. Your doctor may have you undergo a biopsy to secure the diagnosis. He or she will remove a sample from a lymph node or even an entire lymph node for microscopic examination.

Treatment

Swollen lymph nodes caused by a virus usually return to normal after the viral infection resolves. Antibiotics are not useful to treat viral infections. Treatment for swollen lymph nodes from other causes depends on the cause:

• Infection. The most common treatment for swollen lymph nodes caused by a bacterial infection is antibiotics. If your swollen lymph nodes are due to an HIV infection, you'll receive specific treatment for that condition.
• Immune disorder. If your swollen lymph nodes are a result of certain conditions, such as lupus or rheumatoid arthritis, treatment is directed at the underlying condition.
• Cancer. Swollen nodes caused by cancer require treatment for the cancer. Depending on the type of cancer, treatment may involve surgery, radiation or chemotherapy.

Self care

If your swollen lymph nodes are tender or painful, you might get some relief by doing the following:

• Apply a warm compress. Apply a warm, wet compress, such as a washcloth dipped in hot water and wrung out, to the affected area.
• Take an over-the-counter pain reliever. These include aspirin, ibuprofen (Advil, Motrin, others), naproxen (Aleve) or acetaminophen (Tylenol, others). Use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 2, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. Talk to your doctor if you have concerns.
• Get adequate rest. You often need rest to aid your recovery from the underlying condition.

Preparing for your appointment

If you have swollen lymph nodes, you're likely to start by first seeing your family doctor. When you call to set up your appointment, you may be urged to seek immediate medical care if you're experiencing severe symptoms such as difficulty breathing or swallowing.

Here's some information to help you get ready for your appointment.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, ask if you need to do anything in advance.
• List any symptoms you've been experiencing, and for how long. Among other symptoms, your doctor will want to know if you've had flu-like symptoms, such as a fever or sore throat, and may ask whether you've noticed changes in your weight. Include on your list every symptom, from mild to severe, that you've noticed since your lymph nodes began to swell.
• Make a list of all recent exposures to possible sources of infection. These may include travel abroad, hiking in areas known to have ticks, eating undercooked meat, being scratched by a cat, or engaging in high-risk sexual behavior or sex with a new partner.
• Make a list of your key medical information, including other conditions you're being treated for and the names of the medications that you're taking. Include every prescription and over-the-counter (OTC) drug you use, as well as any vitamins and supplements.
• List questions to ask your doctor.

For swollen lymph nodes, some basic questions to ask your doctor include:

• What's causing my symptoms?
• What are other possible causes for my symptoms?
• What kinds of tests do I need?
• What treatment do you recommend?
• How quickly will I start to feel better?
• Am I contagious? How can I reduce the risk of infecting others?
• How can I prevent this from happening in the future?
• I have these other health conditions. Do I need to change the treatments I've been using?
• Is there a generic alternative to the medicine you're prescribing for me?
• Do you have any brochures or other printed material that I can take with me? What websites do you recommend?

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

• What are your symptoms?
• When did you first begin experiencing symptoms?
• Have your affected lymph nodes gotten larger over time?
• Are your affected lymph nodes tender?
• Have you been experiencing a fever or night sweats?
• Have you lost weight without trying?
• Do you have a sore throat or difficulty swallowing?
• Have you experienced any difficulty breathing?
• Have your bowel habits changed?
• What medications are you currently taking?
• Have you recently traveled to another country or to tick-inhabited regions? Did anyone who traveled with you get sick?
• Have you recently been exposed to new animals? Were you bitten or scratched?
• Have you recently had sex with a new partner?
• Do you practice safe sex? Have you done so since you became sexually active?
• Do you smoke? For how long?

What you can do in the meantime

While you wait for your appointment, if your swollen nodes are painful, try easing your discomfort by using warm compresses and an OTC pain reliever, such as ibuprofen (Advil, Motrin IB, others) or acetaminophen (Tylenol, others).