Lymph Nodes: Big or Swollen?

Lymph Nodes: Big or Swollen?

I’ll bet when you go into see your doctor for all or part of a physical examination, you wonder why he probes and presses around your neck, under your arms, maybe around your elbow, in the left-sided spleen area, perhaps in the groin or behind the knee. He is looking for any swelling of lymph nodes which may represent some underlying medical condition. The lymph nodes can give a lot of clinical information about the state of the body. For instance, let’s say that your throat has been very sore for the last day or two. The doctor looks at your tonsils, which are really a large lymph node. He sees areas of pus on the tonsils. The lymph nodes on your anterior neck are swollen, knotty, and tender. He probably knows you have a strep throat. Or let’s say you have a swollen node under one side of your jaw. He looks in your mouth and finds a carious tooth on the same side. He knows for pretty sure that you have a dental abscess. Let’s imagine a different scenario. You have a sore throat. Your lymph nodes are swollen on the front and back of your neck, and under your arms, and your spleen is swollen. If you are a young adult he has a good idea that you have mononucleosis.
A lymph node is a small bean shaped organ that is interconnected to other nodes in the body by lymphatic channels. There are about six-hundred nodes in your body. The lymph, which is the fluid in the lymphatic system, enters the node by what is called afferent channels. The interior of the node is divided into compartments which house B lymphocytes, T lymphocytes and the plasma cells (which specifically make antibodies.) If there is a bacterium or a virus, or an abnormal body cell, the lymphocytes are mobilized and programmed to meet the abnormal substance. They drain out of the nodes through efferent channels and go to other nodes to mobilize more lymphocytes. The lymph channels get larger as they come together and approach the heart, near which they enter the general blood system.
Let’s talk about other conditions which may present with swollen lymph nodes. Let’s say you have a kitten which scratches your hand a lot. He has a litter box which you change frequently. You develop swollen lymph nodes around your elbow and under your arm. You generally don’t feel good, may have some fever and headache. Well, knowing about the kitten and finding the swollen nodes helps your physician a lot. He is pretty sure you have either cat scratch disease or Toxoplasmosis, another infection carried by cats, and he institutes proper antibiotic treatment. You promptly get well.
Let’s say you have another wound to your hand, perhaps a puncture. You have red streaks up your arm leading to a swollen lymph node. The red streaks are actually infected lymph channels, and the infection has spread to your lymph node. Treatment would consist of warm compresses and intense antibiotic treatment, along with a tetanus booster. The hand wound may need to be surgically explored.
Disorders of the immune system, which is what we are talking about, can occur for other reasons. One, unfortunately common these days, is a presentation of diffusely swollen lymph nodes, anemia, and weight loss, perhaps with another type of infection. A T cell lymphocyte test shows low T cells, and an HIV test is positive. This would start the complex use of specific antiviral medications used to treat the HIV virus which infects and destroys the T cell lymphocytes.
Other types of chronic immune system disorders can cause swollen lymph nodes. In more advanced cases of rheumatoid arthritis, lymph nodes can be swollen. This can be true in lupus, which in both cases, the body makes antibodies to its own tissue.
Another area of lymph node swelling is in the case of cancer situations. If one looks at the underlying anatomy of the breasts, lymph drainage is directly to the nodes under the arms. The presence of cancer cells in these nodes is used to stage the disease and to plan anticancer treatment. The same is true for most cancers. The lymph nodes which drain them are usually biopsied to see if the cancer has spread that far. This knowledge is critical in establishing prognosis and planning treatment. One particular type of cancer is one that actually starts in lymph nodes. This is called a lymphoma. Since all of the lymph nodes in the body are interconnected, this requires special combinations of surgery, chemotherapy, and radiation. Treatments for lymphoma are increasingly successful these days.
So, this is the situation with lymph nodes. They can be extremely useful in the diagnosis of disease, or may be a central part of the disease itself. It would be desirable for a patient to familiarize himself with the most palpable nodes, for example those around the neck and over the shoulders, under the arms, and in the groin. If a node enlarges for no apparent reason, or persists for more than two weeks, or is very tender, it would be wise to seek medical attention. It would be good also to categorize any accompanying symptoms like fever, night sweats, or weight loss. Putting all this together, formulating a diagnosis, and either reassuring you or formulating a plan of treatment is what the doctor should be able to do.

John Drew Laurusonis M.D.
Doctors Medical Center