Lymph nodes are small, bean-shaped glands throughout the body that play an important role in the immune system. Lymph nodes help filter lymph fluid and trap bacteria, viruses, and other causes of illness. Swollen or enlarged lymph nodes are a common sign that the body is fighting an infection or inflammation.
What causes lymph nodes to become enlarged?
There are many potential causes of swollen or enlarged lymph nodes, including:
- Infection – Bacterial infections, viral infections, and fungal infections can all cause lymph nodes to swell as they activate the immune response. Infections that commonly lead to swollen lymph nodes include strep throat, tonsillitis, ear infections, tooth abscesses, colds, sinusitis, mononucleosis, rubella, chickenpox, and shingles.
- Inflammation – Conditions that cause inflammation in the body can lead to swollen lymph nodes even without an infection present. This includes autoimmune diseases like rheumatoid arthritis and lupus.
- Cancer – One of the warning signs of cancers like lymphoma and leukemia is swollen lymph nodes. The cancerous cells accumulating in the lymph nodes cause them to enlarge.
- Immunizations – Swollen lymph nodes can occur after immunizations as the immune system responds. The swollen lymph glands indicate the vaccine is working.
- Injury or trauma – Injuries, wounds, piercings, tattoos, and other trauma to an area of the body can make the nearby lymph nodes swollen as they filter out damaged cells and infectious agents.
What does a normal lymph node feel like?
When healthy and normal in size, lymph nodes can be difficult to feel at all. Normal lymph nodes are typically:
- Less than 1 centimeter (cm) in size – Lymph nodes larger than 1 cm are considered swollen or enlarged.
- Smooth – The surface feels rounded, oval, or bean-shaped.
- Soft – They feel soft and rubbery on palpation rather than hard.
- Mobile – Normal lymph nodes will glide smoothly under the skin when pressed.
- Non-tender – There is no pain or discomfort when palpating normal lymph nodes.
What does a swollen hard lymph node feel like?
Swollen lymph nodes are typically visible or palpable on physical exam. The characteristics of swollen lymph nodes compared to normal include:
- Enlarged – Swollen nodes are over 1 cm in diameter, some may be several centimeters large.
- Firm or hard – The texture changes from soft and rubbery to firm or hard on palpation.
- Fixed – Hard lymph nodes tend to be fixed or stuck in place rather than smoothly gliding under the skin.
- Tender – There may be pain, discomfort, or sensitivity when pressing on swollen lymph nodes.
- Clustered – Multiple enlarged nodes grouped together is common with infections.
In some cases, enlarged lymph nodes may still feel rubbery rather than hard as the texture can vary. But a distinct firmness or hardness on palpation is common with conditions like cancer or tuberculosis.
Location of swollen hard lymph nodes
The location of swollen hard lymph nodes can provide clues to the underlying cause:
| Location | Possible Causes |
|---|---|
| Neck (cervical lymph nodes) | Strep throat, ear infection, tooth abscess, rubella, shingles, colds, mononucleosis, smoking, tuberculosis, cancers of the mouth, thyroid or neck area |
| Underarm (axillary lymph nodes) | Inflammation or infection of hand, arm, breast or skin in underarm area, lymphoma |
| Groin (inguinal lymph nodes) | Genital infections, skin infection of leg, sexually transmitted infections, lymphoma |
| Above collarbone (supraclavicular lymph nodes) | May signal cancer spreading from other sites like the lungs, breasts, or abdomen |
When to see a doctor
It’s a good idea to get evaluated by a healthcare provider if you notice any of the following:
- Lymph node larger than 1 cm that persists longer than 2 weeks
- Hard, fixed lymph node that does not improve with time
- Continued enlargement of lymph nodes
- Presence of multiple swollen nodes, especially clustered together
- Swollen nodes accompanied by fever, weight loss, fatigue, and night sweats
- Redness, warmth, and tenderness around nodes suggesting an abscess
Evaluation generally involves discussing your symptoms, medical history, and performing an exam of your lymph nodes and other body systems. Your doctor may order blood work, imaging tests like an ultrasound or CT scan, or even a lymph node biopsy if cancer is suspected.
What does a cancerous lymph node feel like?
While many causes of swollen lymph nodes are benign, cancer is a possible cause that must be ruled out. Lymphoma and metastatic cancers are the most common cancerous causes of enlarged lymph nodes. The characteristics of cancerous lymphadenopathy may include:
- Nodes over 2 cm that continue to enlarge
- Very firm, rubbery, or hard texture
- Grouped or clustered nodes (matted lymph nodes)
- Fixed nodes that feel stuck in place
- Rapid growth and enlargement of nodes
- Presence of systemic symptoms like unexplained weight loss, fever, and night sweats
However, it is important to note that enlarged lymph nodes due to infections or inflammatory causes can sometimes exhibit these same features. There is no way to know for certain the cause of swollen lymph nodes by palpation alone. Imaging tests and sometimes a lymph node biopsy are needed to confirm cancer.
Types of cancers that spread to lymph nodes
The cancers that most commonly spread to the lymph nodes include:
- Lymphoma – Cancer starting in the lymph nodes like Hodgkin’s or non-Hodgkin’s lymphoma.
- Breast cancer – Metastasis to the lymph nodes under the arm is common.
- Melanoma – Advanced melanoma spreads to lymph nodes.
- Head and neck cancers – Cancers of the mouth, throat, tongue and jaw spread to cervical nodes in the neck.
- Lung cancer – Can spread to lymph nodes in the chest like the mediastinum.
But almost any cancer, including solid tumors, can potentially spread to lymph nodes as the disease advances. Prostate, testicular, ovarian, uterine, pancreatic, stomach cancers, and others can involve lymph nodes when metastatic.
Can lymph nodes return to normal size?
In many cases, swollen lymph nodes will return to normal when the underlying condition or infection resolves. However, some key points about lymph node enlargement:
- Acute infections – Swollen nodes from short-term infections like a cold or strep throat often resolve within 2-4 weeks.
- Chronic infections – Long-standing infections like tuberculosis may cause persistently enlarged nodes that shrink slowly with treatment.
- Cancers – Cancerous lymphadenopathy does not resolve without treatment with chemotherapy, radiation, or surgery.
- Scarring – Severely enlarged lymph nodes can scar and remain palpable after the infection resolves.
- Recurrence – Swelling may come and go with recurrent infections or cancer activity.
Even when lymph nodes return to a normal size, they can sometimes feel slightly firmer, rubbery, or differently textured compared to before. See your doctor promptly if the nodes remain enlarged or continue to grow.
How to check your lymph nodes
It’s easy to check your own lymph nodes, especially those in the neck, underarms, and groin. Identifying any abnormalities can help you determine if a doctor visit is needed.
Steps to check lymph nodes:
- Use your fingertips to gently press in circular motions feeling for nodes under the skin surface.
- Start near where lymph nodes cluster like the jawline, clavicle, armpits, and groin.
- Compare swelling, texture, tenderness on each side.
- Note general size, shape, firmness versus softness.
- Check for mobility by gently pushing the node across underlying tissues.
- Involve a partner to help check hard to reach places.
- Use a mirror to inspect the neck area visually as well.
Notify your doctor if you find any enlarged, painful, or abnormal feeling lymph nodes. Keep track of any changes you notice when periodically rechecking the areas.
What to expect with lymph node biopsy
If enlarged lymph nodes do not improve with observation and basic lab tests, a lymph node biopsy may be recommended. This involves removing an entire abnormal node or a piece of node tissue for examination under a microscope. Some things to expect with this procedure include:
- Local anesthetic – The skin over the node and surrounding tissues will be numbed with a shot of lidocaine.
- Small incision – The surgeon makes a 1-2 cm incision in the skin to access the lymph node.
- Node removal – An entire lymph node or a representative portion will be removed.
- Stitches – The incision is closed with dissolvable stitches and steri-strips.
- Bandage – A pressure bandage is applied to control bleeding and reduce swelling.
- 1-2 hour procedure – Removing the node tissue takes less than an hour, but prep and recovery time is additional.
- Pathology analysis – The removed tissue is examined by a pathologist to identify abnormal cells.
- Overnight stay – Hospital observation for 12-24 hours is typical to monitor for complications like bleeding or infection.
- Results in 3-5 days – The final pathology report confirms or rules out cancer within a few days.
Risks and complications
Potential risks of a lymph node biopsy include:
- Pain – Mild incisional discomfort, bruising, and soreness are common.
- Numbness – There may be temporary or permanent numbness around the biopsy site if nerves are damaged.
- Bleeding – This is controlled during surgery but small amounts of drainage are common.
- Infection – Antibiotics reduce this risk, which occurs in less than 5% of procedures.
- Arm swelling – Removing axillary lymph nodes can lead to fluid build up and swelling in the arm called lymphedema.
- Inconclusive results – In rare cases a biopsy does not provide definitive cancer diagnosis.
Talk to your doctor in detail about the benefits and potential complications before consenting to lymph node biopsy.
Treatment for swollen lymph nodes
Treatment depends on the suspected cause of the lymphadenopathy. Typical treatment approaches may include:
- Antibiotics for bacterial infections
- Antiviral or antifungal medications for specific infections
- Draining an abscessed lymph node if pus accumulates
- Steroids and NSAIDs to reduce inflammation
- Chemotherapy, radiation, or surgery for cancers
- Treating the underlying condition, like RA or HIV/AIDS
- Observation over 2-4 weeks for reactive lymph nodes after vaccination
Enlarged lymph nodes often resolve once the underlying trigger or infection is successfully treated. Getting rest, drinking fluids, warm compresses, and over-the-counter pain medication can provide symptom relief.
It is critical to follow up closely with your doctor for swollen lymph nodes that persist or continue to enlarge to determine if additional testing or biopsy is needed.
Conclusion
Swollen lymph nodes are a common occurrence and often point to a relatively benign underlying cause like a minor infection. However, it is important to familiarize yourself with your own lymph nodes through periodic self-exams. Seek prompt medical advice for any nodes that feel enlarged, hard, fixed, or tender and last longer than 2-4 weeks without improvement. With an appropriate work up and treatment, most causes of lymph node enlargement can be managed effectively.