Lymph nodes in the head and neck area, commonly referred to as cervical lymph nodes, are present in everyone and can be felt by any practitioner performing a careful examination. They are part of the body’s immune system, which includes these and other nodes, the spleen, the bone marrow, and many other organs. The presence of a node in and of itself does not necessarily indicate a sign of an underlying illness.
However, many disease processes do result in lymphadenopathy, the medical term for swollen or enlarged lymph nodes, and such nodes can be the presenting symptoms of a variety of illnesses and ailments. A concern of many patients seeking treatment is that the nodes may represent a sign of a serious infection or cancer.
There are many possible sources of lymphadenopathy, including:
- Bacterial infection; often streptococcal or staphylococcal
- Viral infection, including mononucleosis, influenza, and mumps
- Sarcoidosis, an illness that mimics TB
- Reactive adenopathy, a benign reaction from inflammation in the area that drains to the node
- Malignant tumors of the lymph nodes
- Malignant tumors that spread to the node from elsewhere
Patients can present with a variety of symptoms ranging from a painless lump in the neck to a hot, tender, inflamed mass associated with fever and chills. Often it may not be the node itself that prompts medical attention; as an example, an individual with a severe sore throat from tonsillitis may have enlarged nodes as well. The nodes may be single or multiple, and involve one or both sides of the neck.
Many times, the nodes are nothing to worry about, and are just accompanying results of a common cold or upper respiratory infection. However, a patient should see an otolaryngologist if the lymph nodes become swollen without any apparent reason, if the lymph nodes feel hard, grow progressively, or are sore and
are present for more than two weeks. The same applies when the enlarged lymph nodes occur associated with a fever, night sweats, or unexplained weight loss.
A careful history is always necessary to obtain a correct diagnosis. A child with an enlarged node following a respiratory infection is unlikely to have a malignant node, whereas an adult with a smoking history and a hard fixed node most likely does. An otolaryngologist at York ENT will begin his evaluation with a thorough review of the patient’s medical history, and will perform a comprehensive head and neck examination, palpating the lymph nodes, thyroid gland, and examining the oral cavity and pharynx utilizing a fiberoptic laryngoscope.
Appropriate blood tests, looking for an elevated white blood count, EBV titers, signs of bacterial, viral, or parasitic infection, and tumor markers are obtained. CT scan or MRI imaging studies are frequently helpful. Fine needle aspiration biopsy or open lymph node biopsy are performed when indicated.
Treatment is directed at the underlying source of the adenopathy (enlargement). For benign reactive processes, often only supportive measures are required.