Enlarged lymph nodes: what to do?

By Cristiano Antonino On Feb 22, 2023

Enlarged lymph nodes are an immune defence reaction against external attacks by pathogens such as viruses, bacteria, fungi or parasites

Why do lymph nodes become enlarged?

Lymph nodes become enlarged because lymphocytes begin to multiply within them, which will subsequently destroy pathogens either directly or with the help of the antibodies they produce.

This in a very basic and schematic way is the representation of an immune response that causes lymph node enlargement.

So if the entry of the bacterium or virus occurred e.g. from the ear, the first lymph nodes to become enlarged will be the lymph nodes in the neck; in fact, it is said that the lymph nodes draining the lymph from a certain part of the body, such as the inguinal lymph nodes for the legs, are the ones that become enlarged.

What are lymph nodes?

Lymph nodes are organs that are scattered throughout the body and function as ‘control stations’ of the lymphatic circulation.

In addition to the blood circulation, the body also has a lymphatic circulation that carries ‘lymph’, a yellowish-white liquid within which we find white blood cells.

The main function of the lymph and the lymphatic system is to protect the body from external pathogens, such as bacteria and viruses.

Once in the circulation, these must pass through control stations, which are precisely the lymph nodes.

Within these glands, known as lymph glands or lymph nodes, the micro-organisms are ‘presented’ to the body’s controllers, which are the white blood cells, specifically the lymphocytes, which, if they recognise the micro-organism or even small pieces of its surface as foreign and ‘pathogenic’, then trigger the actual immune defence reaction.

This can manifest itself by many means of defence, e.g. by fever, which let us not forget is one of the body’s defence mechanisms that tries to inactivate viruses and bacteria with heat, or by the swelling of the lymph nodes involved.

How are enlarged, swollen and/or inflamed lymph nodes treated?

The problem arises when the increase in lymph node volume does not occur in response to any infectious/inflammatory stimulus.

But how can one tell when this occurs?

This pathway is often multi-disciplinary and involves the general practitioner together with the infectivologist and haematologist.

Let’s say very simplistically that before ‘worrying’, the specialist excludes the so-called ‘reactive’ or benign causes of inflammatory or infectious lymphadenomegaly (this is what we call it when a lymph node enlarges).

Diagnostic tests

To do this, it is useful to carry out some more in-depth blood tests such as a blood count, ESR, PCR, urine test, protein electrophoresis, or some serological tests to look for certain types of viral infection.

Next we need both a good ultrasound scan, which will already give us an indication of the nature of the enlarged lymph node by evaluating certain morphological as well as dimensional parameters, and finally we need to do the most important thing of all, what? A specialist examination.

Enlarged lymph nodes? The importance of the haematological examination

The haematologist, by collecting the personal history but above all, thanks to his own experience, by examining and then touching the lymph node in question, will be able to form an idea of the course to be followed.

After the examination, the haematologist may prescribe further radiological or haematochemical tests, or may even recommend surgically removing the affected lymph node for a histological test.

It is worth remembering that, when haematological disease is suspected, total excision of the lymph node is preferable to lymph node aspirates for cytological tests or needle biopsies.

In fact, it is necessary to histologically assess the lymph node in its entirety, in its global structure (among other things) to understand whether or not we are dealing with a haematological disease.

I would like to emphasise that sometimes the best strategy is to wait and re-evaluate the enlarged lymph node after some time, but this indication should be given by the specialist and only after at least viewing the supporting ultrasound.

In my opinion, a valuable piece of advice, which I also address to many of my colleagues, is not to use cortisone in the initial stages of the diagnostic approach to lymphadenomegaly, because not only benign inflammatory diseases respond to steroids but also some haematological neoplasms do, so it may not be decisive that cortisone has made the lymph node ‘disappear’ or shrink.

This approach only risks confusing the picture and delaying the correct diagnosis. Antibiotics, on the other hand, can only be used if there is a well-founded clinical suspicion, for example if there is fever in addition to lymphadenomegaly, and if it is localised in areas with a high frequency of infections (e.g. neck draining ear, teeth, throat).

The advice therefore is to face the presence of enlarged lymph nodes with serenity, we must remember that most of the time this process occurs for our own good and for our own defence.

In any case, I recommend that in the case of lymphadenomegalies you always contact your general practitioner, who will be able to direct you to a haematologist specialist to evaluate second-level tests and a more in-depth examination.

I hope I have been of help to readers in this very broad field of medicine that is not easy to summarise.

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