When to worry about enlarged lymph nodes

Swollen lymph nodes present as lumps in the neck, armpit, groin or by the elbow area. Although very common and mostly innocent, they often lead to anxiety. To a worried parent it may represent cancer until proven otherwise.
These enlarged lymph nodes are often discovered when a young child is given a bath; when the hair is combed or the neck is rubbed.
Enlarged lymph nodes can have many causes, but essentially they all fit into three broad categories: infections, cancers such as lymphomas and rarely medications (penicillin or some anti-seizure medications)
The most common cause, by far, for enlarged nodes, especially in the neck area, are reactive nodes related to a viral infection of the throat, or upper airways. These are innocent and they can be observed conservatively without any fear of cancer.
The role of kittens in causing enlarged nodes is rarely missed by a Sherlock -Holmes -type of a clinician. A kitten may scratch a child’s skin and anywhere between 5 days and 2 months later a lymph node may manifest in the armpit area. This condition is known as cat scratch disease.
Another innocent and yet worrisome condition for parents is when there are enlarged neck nodes nodes is a child who presents with periodic fevers, oral ulcers, pharyngitis. These symptoms cycle every 2 to 9 weeks. It presents in children around age 5 and resolves by age 10. The cause is unknown, but while it runs its course parents can get quite concerned.
Many years ago parents were told their teen has “kissing disease” when the teen presented with enlarged nodes, sore throat and fever. It was thought that teens only started to kiss when they went to college. Sharing the saliva of their kissing mate set teens up for infectious mononucleosis which was also know as glandular fever. The incubation period of mononucleosis caused by the Epstein Barr virus can be as long as 30 to 50 days and by that time a kiss in the past may have been forgotten!
Generally it is normal for a node in the neck and armpit areas to be as big as 1cm; in the groin area up to 1.5cm is considered normal and in the inner elbow area we allow a size of 0.5cm to be normal. A node that is bigger than 2cm requires closer attention.
If the node gets bigger and bigger over 2 weeks and if it lasts longer than 4 weeks or fails to get smaller during that time, despite treatment it may be a reason to get alarmed.
Although lymph nodes can be found in various parts of the body, if it is found in the area just above the clavicle it should never be ignored. This area reflects drainage from chest and abdomen and whenever nodes are felt by the clavicle one has to get concerned about something more serious.
If the lymph nodes are associated with generalized symptoms it may also be more worrisome. Symptoms to look for are: fevers lasting more than one week, night sweats, loss of weight, fatigue, becoming pale, having bruises, experiencing joint and bone pains, rashes, and a persistent cough.
The consistency of a node tells a doctor whether to be concerned or not. If a node is hard, rubbery or matted (stuck together with other nodes) it may be a reason to run more tests.
The most basic test that often leads to peace of mind is a complete blood count. It will screen for abnormalities such as low hemoglobin, low platelets, leukemia or a chronic infection. Inflammatory markers may also be done as a screen for inflammation (The latest update on which test to do suggest that a C-reactive protein is better than a sedimentation rate; traditions die hard and some doctors still rely only on the sedimentation rate instead of running a C-reactive test)
If a node has been picked up by the clavicular area, or if it is associated with many nodes in other parts of the body, a chest x-ray becomes very helpful. Inside the chest there are nodes known as hilar nodes—these can be enlarged when there are chronic chest infections or lymphomas.
Ultrasounds of enlarged lymph nodes can be a useful non-invasive and non- radiating way to get additional information as to the nature of a node.
A review of biopsy results confirmed that the vast majority of nodes end up being due to a reaction to a viral infection. Close to one third may be due to other infections such as chronic mycobacteria, fungal infections or cat scratch disease. Only 13 % of biopsied nodes are due to cancer / malignancies. Of these 67% of the time it is due to Hodgkin lymphoma.
DR NIEMAN HAS WORKED AS A COMMUNITY PEDIATRICIAN SINCE 1987. HE HOSTS WWW.DRNIEMAN.COM AND CONTRIBUTES BIWEEKLY TO CTV MORNING LIVE. DR NIEMAN HAS COMPLETED 86 MARATHONS IN HIS QUEST TO REACH 100 MARATHONS.