Cervical Lymphadenopathy

Question 1

Lymph node located in the neck = cervical lymph node.

What is the function of the lymph nodes?

Answer 1

Lymph nodes are small units part of lymphatic system. They filter lymph.

Lymph = fluid that transports lymphotcytes through the body’s lymphactic vessel system.

Lymph node functions:

1. Key role in infection control - they destroy pathogens brought to the lymph nodes via lymph fluid. Afterwards, left over fluids, salts and proteins re-enter the bloodstream.
2. Filter lymphatic fluid
3. Manage inflammation
4. Trap cancer cells
   * In pathology, lymph nodes can swell but they’re essential to proper immune functioning

Question 2

What causes cervical lymphadenopathy?

Answer 2

Generally, cervical lymphadenopathy is non-threatening and is in response to infection, injury or cancer around the neck region => infection near the neck area filtered through cervical lymph nodes

Common conditions causing cervical lymphadenopathy:

=> Bronchitis

=> Common cold / flu

=> Ear / sinus infection

=> Mononucleisis / glandular fever / EBV

=> Scalp infection

=> Skin infection

=> Strep throat

=> Tonsilitis

*Most common cause of cervical lymphadenopathy = infection/inflammation

Question 3

What sinister symptoms are important to take into account with cervical lymphadenopathy?

What pathology might these indicate toward?

Answer 3

=> Prolonged tenderness and pain

=> Continual swelling for more than a week

=> Fever

=> Weight loss

These symptoms might point towards:

=> Tuberculosis

=> Syphilis

=> HIV

=> Lymphoma

=> Malignant lymphadenopathy - firm & non-tender (>20yrs)

Question 4

How do you treat lymphadenopathy?

Answer 4

Common, mild swelling:
=> Antibiotics
=> Anti-virals
=> NSAIDs i.e. ibuprofen
=> Rest
=> Warm and wet compress

Cancerous lymphadenopathy:
=> Chemotherapy
=> Irradiation therapy
=> Surgery to remove the lymph nodes

Question 5

<20 yrs => self-limiting lymphadenopathy

> 20yrs => malignant lymphadenopathy

Answer 5

INFO CARD

Question 6

Don’t biopsy lumps until tumours of the head and neck have been excluded by an ENT surgeon

CULTURE ALL biopsied lymph nodes for TB

Answer 6

INFO CARD

Question 7

What investigations may be done for lymphadenopathy?

Answer 7

=> Virology + TB test

=> Ultrasound : lump consistency i.e. cystic, solid, complex, vascular

=> CT : shows masses in relation to anatomy

=> Chest X-ray : may show malignancy or in sarcoid show hilar lymphadenopathy

Question 8

If lymphadenopathy hasn’t resolved in 2-4weeks, urgently refer to ENT for further investigation

Answer 8

INFO CARD

Question 9

How do you manage unexplained lymphadenopathy?

Answer 9

=> Urgent FBC within 48h to assess leukaemia in generalised lymphadenopathy

=> 2 week cancer referral pathway to exclude diagnosis of lymphoma if >24yrs or within 48h for children and young people aged upto 24yrs

=> Urgent x-ray (within 2wks) for people aged >40yrs with supraclavicular lymphadenopathy or persistent lymphadenopathy to exclude lung cancer, TB, sarcoidosis

=> 2week cancer referral if persistent lymphadenopathy with unexplained ulcers in mouth (oral cancer) or unexplained hoarseness (laryngeal cancer)