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Updated 28 May 2014

Swollen glands

There are approximately 500 - 600 lymph nodes in the body, some of which are arranged in clusters in the abdomen, chest, neck, groin and under-arm (axilla).

Description and alternative names

"Swollen glands" is a term used to describe the enlargement of one or more lymph nodes.

  • a single node or group of nodes, for example only those under the chin, or those under the armpit or
  • several groups of nodes - this is called a generalised lymphadenopathy.

  • bacterial infections such as streptococcal pharyngitis, skin infections, cat scratch disease, typhoid, diphtheria and sexually transmitted diseases.
  • viral infections - infectious mononucleosis, mumps, HIV, herpes virus, hepatitis B
  • mycobacteria - tuberculosis
  • fungus/protozoan/spirochaetal infections

  • primary, for example lymphoma or Hodgkin's disease, implying a cancer of the lymphatic system itself. This may appear as a generalised gland enlargement. Leukaemia which arises in the bone marrow may also first appear as a generalised lymphadenopathy.
  • secondary, in which the enlargement is due to the node-trapping cancerous cells being drained from another part of the body, and which then multiply within the node. This form is usually seen as enlargement of nodes in a single region of the body, and indicates spread of the disease beyond the site of the original cancer, for example spread of a malignant melanoma on an arm or leg.

  • serum sickness, a particular type of allergic response
  • drug reactions - some drugs know to cause node enlargement are
    • allopurinol
    • atenolol
    • captopril
    • carbamazepine
    • cephalosporins
    • penicillin
    • phenytoin
    • quinidine
    • sulfonamides

  • sarcoidosis
  • systemic lupus erythematosus
  • rheumatoid arthritis
  • dematomyosists
  • lipid storage diseases
  • hypothyroidism
  • Castelman's disease and Kawasaki disease

  • location - regional nodes drain known areas, indicating where the problem may lie. If several regions are involved, it is more likely to be a systemic disorder/disease
  • size - most nodes larger than 1cm in diameter are abnormal
  • consistency - fibrosis causing hard nodes may be due to previous inflammation, or to some cancers which induce fibrous change in the nodes. The generalised node enlargement of leukaemia is usually soft, whilst lymphoma and chronic leukaemia are associated with firm, rubbery nodes
  • fixation - unlike the normal mobile node, abnormal nodes tend to become fixed to each other, or to the tissues around them. This may be due to inflammation, or to invasion by cancer cells
  • tenderness - any sudden enlargement of a node causes stretching, which may be painful. The enlargement may be due to inflammation, bleeding, cancer or merely due to increased activity of the node.

  • a full blood count and peripheral smear - this gives the total cell count as well as a report on any abnormal (malignant or infective) forms of cells present
  • chest X-ray - this will reveal internal gland enlargement (hilar adenopathy) and may also show underlying lung disease such as tuberculosis, or even secondary cancer deposits.
  • HIV testing may be appropriate
  • Any suggestion of malignancy must be followed up with a biopsy of an enlarged node, to give an unequivocal tissue diagnosis.
  • Other imaging studies, such as scans, are not generally helpful in diagnosis, but may help in certain selected cases.

 
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2019-11-18 06:57
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