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Swollen Glands


Edythe A. Albano, M.D.

Associate Professor of Pediatrics

University of Colorado Health Sciences Center

Pediatric Oncologist

The Children's Hospital, Denver, CO




What are swollen glands?



The lumps that you feel in your neck or under your jaw when you have a cold or a
sore throat are called lymph nodes. Lymph nodes are part of the body's immune system.
They help to destroy infectious germs, such as viruses (e.g., the common cold virus)
and bacteria (e.g., strep). The lymph nodes make antibodies that will help keep
you from being infected with a particular germ in the future.



Lymph nodes are located in the areas beside the head and the neck region. They can
be found in the armpits, the groin, above the elbow, and deep inside the chest and
the abdomen (belly). Their function is the same regardless of their location.



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What causes enlarged lymph nodes?



When lymph nodes are active in fighting infection, they may become swollen and painful.
Usually, the pain is mild, and the lymph node does not get much bigger than 2 centimeters
(slightly under 1 inch) in size.



While lymph nodes are the most common cause of a lump or a bump in the neck, there
are other, much less common causes, e.g., cysts from abnormalities of fetal development
or thyroid gland enlargement. Usually, us can tell the difference on a physical
examination.



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Who gets enlarged lymph nodes?



Frequently, children have enlarged lymph nodes. The immune system of a child is
constantly being exposed to germs that it has never seen before, and the lymph nodes
may swell in reacting to those germs. In contrast, the immune system of an adult
has seen most of the common germs, and has developed immunity to them.



Therefore, the lymph glands do not need to work so hard, and they are much less
likely to become swollen. In fact, a study published in 1975 showed that 100% of
children who are under 12 years of age had lymph nodes that could be felt in the
neck.



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What are the common findings?



In children, once a lymph node becomes enlarged, it may stay enlarged for a long
time. Sometimes, several lymph nodes can become enlarged at the same time. Usually,
the lymph node will begin to decrease in size within two to three weeks, but a little
bump (less than 1 centimeter, or 1/4 to 1/2 inches, in size) may be present for
months.



However, lymph nodes should not continue to grow in size (especially grow greater
than 1 inch in diameter). If they do, you should contact us. Your doctor may want
to measure the lymph node and record the findings in your chart for accurate comparison
on your next examination.



Typically, a fever accompanies enlarged nodes when it is part of an infectious process.
You also may have a sore throat, enlarged tonsils, an earache, a dental problem,
or skin irritation or infection. Often, the problem that caused the swollen gland
will bring you to us and not the swollen lymph node.



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How is an enlarged lymph node diagnosed?



Generally, enlarged lymph nodes are evaluated by a physical examination. Your doctor
will note:



  • the size and the location of the enlarged lymph node;

  • if one or more lymph nodes are involved;

  • if the node is tender

  • if it is associated with redness of the overlying skin; and

  • how it feels, e.g., soft, firm, rubbery, or hard.



Your doctor will examine the areas that the lymph node drains. For example, a lymph
node under the jaw should prompt a careful examination of the mouth and the throat.
Your doctor also will look for abnormalities that often are seen with enlarged lymph
nodes, such as a skin rash or a swollen liver and/or spleen.



Enlarged lymph nodes that grow progressively or are very large in size (generally
more than 3 centimeters, or 1 1/4 inches) may require more extensive evaluations,
to include a blood count; blood tests for infections, e.g., mono; a skin test for
TB; or an x-ray. This is particularly true if you have been losing weight, have
joint pain or swelling, have persistent fevers and/or night sweats, or have other
abnormalities that are found on a physical examination.



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How is an enlarged lymph node treated?



Sometimes, an enlarged lymph node needs no treatment at all, particularly if it
is enlarged because it is fighting a viral infection. Occasionally, antibiotics
will be prescribed if the lymph node is infected with a bacterial germ or is enlarged
due to a bacterial infection (e.g., strep throat). If the lymph node tenderness
is a problem, acetaminophen or ibuprofen can be taken to ease the discomfort.



Although steroids (prednisone) will cause the lymph nodes to decrease in size, regardless
of the cause of the enlargement, it is strongly discouraged because it could mask
a serious underlying cause of the enlarged nodes, delay the correct diagnosis, and,
possibly, complicate the treatment.



Rarely, us may recommend surgery to remove the lymph node so that it can be examined
under the microscope for the presence of cancer or unusual infections. Usually,
a course of antibiotics is administered first, before surgery is recommended. However,
surgery is most likely to happen if:



  • the lymph node is large (greater than 3 centimeters, or 1 1/4 inches);

  • there are other abnormal physical examination findings, e.g., an enlarged liver
    and/or spleen;

  • the blood count is abnormal; or

  • the chest x-ray shows enlarged nodes.



Most people worry that a persistently enlarged lymph node is something very serious,
like cancer. In children, this is rare. Even if us recommends a lymph node biopsy,
it is not very likely to show cancer. In fact, in one study of 239 children who
underwent lymph node biopsy, only 13% of the removed lymph nodes showed cancer.



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What are the complications?



The lymph node itself may become infected (called lymphadenitis), which can be very
painful, and is associated with redness and swelling. Usually, it requires antibiotics
for treatment. Infrequently, the lymph node may have a pus pocket inside of it (i.e.,
an abscess) that requires an operation to drain it.



An enlarged lymph node that is felt immediately above the collarbone is unusual
and seldom is associated with infection. If it occurs, you should contact us, as
it may be a sign of a more serious condition. For example, in teenagers, swollen
glands felt right above the collarbone could be the first sign of Hodgkin's disease,
a type of cancer that occurs in the lymph nodes.



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How can enlarged lymph nodes be prevented?



Enlarged lymph nodes cannot be prevented. The lymph node helps the body to fight
infection, and, in the process, the lymph gland may increase in size. This is normal.
The lymph tissue decreases in size after puberty, and it becomes less noticeable.
However, you should contact us if:



  • the lymph nodes are larger than 3 centimeters, or 1 1/4 inches;

  • there are signs or symptoms of an infection, such as a sore throat, a fever, or
    an earache;

  • the lymph nodes are felt above the collarbone, regardless of their size; or

  • you have persistently enlarged nodes, lasting three or more weeks.



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About the Author



Dr. Albano is a board certified pediatric hematologist/oncologist.



She graduated summa cum laude from Loyola University, Stritch School of Medicine
and did both her pediatric residency as well as hematology/oncology fellowship at
The Children's Hospital National Medical Center in Washington, DC.



Besides a full time practice in clinical oncology, Dr. Albano is actively involved
in research in infections that occur in immunocompromised patients and their treatment.


Copyright 2012 Edythe A. Albano, M.D., All Rights Reserved