Swollen lymph nodes

and Sabine Schrör, medical journalist

Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.

Brief overview

Description: The body's 600 to 700 lymph nodes are part of the immune system. They filter the lymph fluid and "fish" out pathogens or cancer cells, for example. When the lymph nodes swell, they are particularly active at the moment, for example during an infection.
Causes: Swollen lymph nodes are found in viral infections (such as the common cold, flu, glandular fever, measles, rubella), bacterial infections (such as tonsillitis, diphtheria, tuberculosis, borreliosis), rheumatoid diseases and cancer.
When to the doctor Whenever the swelling does not go away on its own after three weeks at the latest or there is no harmless flu-like infection behind it. A visit to a doctor is also advisable if there is unilateral swelling of the lymph nodes or if additional symptoms occur (such as unwanted weight loss, fever, night sweats, fatigue).
Special feature in children: In the first years of life, persistently swollen lymph nodes are often observed, as the child's immune system is still in its learning phase. A visit to the doctor is advisable if there is a loss of performance and stunted growth and the swelling persists for more than four weeks.
Diagnosis: taking a medical history (anamnesis), physical examination including palpation of the affected lymph nodes, blood test. If cancer is suspected: tissue removal (biopsy). Once the cause of the lymph node swelling has been determined, appropriate therapy is initiated.

Swollen lymph nodes: description

In healthy people, the lymph nodes are usually not noticeable. But if you have a cold or another infection, for example, you will often notice a swelling on the side of the neck. These are swollen lymph nodes - a sign that the immune system is currently fighting vehemently against the infectious agents. The lymph nodes can then swell to two centimeters or more.

But how do such "bumps" develop under the skin? Answers are provided by looking at the anatomy, tasks and location of the lymph nodes in the body.

Anatomy and tasks

The lymphatic system is part of the body's defense system (immune system). It is divided into the lymphatic organs (such as the spleen, lymph nodes) and the lymphatic system.

Everyone has around 600 to 700 lymph nodes (singular: Nodus lymphoideus). These can be found all over the body, for example in the armpit and groin, on the neck and near internal organs. They filter the tissue water, the so-called lymph. The lymphatic system is thus a kind of "sewer network" that transports fluid out of the tissue via the lymphatic vessels. The lymph nodes clean this "waste water" before it gets back into the bloodstream.

The almond-shaped lymph nodes are usually five to ten millimeters in size and are encased in a solid capsule. Inside there are numerous immune defense cells, so-called B and T lymphocytes. Their task is to track down foreign intruders (pathogens such as bacteria and viruses) in the lymph fluid and destroy them. Each lymph node is responsible for cleaning the lymph from a specific region of the body or an organ.

The so-called sentinel lymph nodes play a particularly important role as the first filter station in the lymphatic drainage area of a certain organ. If they have cancer, they are always checked for tumor cells. If cancer cells are detectable in the sentinel lymph node, this shows that the cancer cells have already “wandered” and may have already settled in other organs (metastases).

Location of the lymph nodes

The area of the body where the lymph nodes are swollen is always important for the doctor. In this way, the location of the disease can be narrowed down. In some places the lymph nodes are so far on the surface that you can clearly feel an enlargement through the skin. Lymph nodes are called, depending on their location in the body, for example:

cervical - on the neck, along the large veins
axillary - in the armpit
inguinal - in the groin
popliteal - in the hollows of the knees
abdominal - on the front of the abdomen

Swollen lymph nodes: causes

The body fends off many viruses, bacteria and other invaders every day. At the latest when an infection breaks out, a swelling of the lymph nodes becomes visible. Many people remember the "thick" neck with swollen lymph nodes typical of a cold from their childhood days. Some teething troubles are also expressed, among other things, by swollen lymph nodes with sometimes severe swallowing difficulties. The causes of swollen lymph nodes are usually harmless. But sometimes there is also a serious illness behind it. Swollen lymph nodes are often the first sign of cancer.

Here is an overview of the main causes of swollen lymph nodes:

Viral infections

Pfeiffer's glandular fever (Epstein-Barr virus, mononucleosis): Young adults in particular become infected with the Epstein-Barr virus through contact with infectious saliva. The disease is also known as "kiss sickness". Swollen lymph nodes, sore throat from inflamed tonsils, fatigue, headache and an enlarged spleen are typical symptoms.
Cytomegaly: This virus is particularly dangerous for pregnant women because it can damage the unborn child. In otherwise strong defenses, symptoms such as a mild fever and swollen lymph nodes can appear up to a few weeks after infection.
Measles: Severely reddened skin rashes, fever, swollen lymph nodes and a general feeling of illness are among the typical complaints. You can get vaccinated against this childhood disease.
Rubella: The typical red rashes are accompanied by fever and swollen lymph nodes. A vaccination also protects against rubella.
HIV / AIDS: Infection with the HI virus destroys important cells of the immune system, resulting in permanent immune deficiency. Flu-like symptoms may develop shortly after being infected. These include headache and body aches, fever, and swollen lymph nodes in the neck.

Bacterial infections

Tonsillitis: Purulent tonsillitis in particular causes locally swollen lymph nodes, sore throats and difficulty swallowing.
Diphtheria: There is now a vaccination against this serious disease, in which the lymph nodes are also swollen. If the throat is affected, symptoms of true croup such as barking cough, loss of voice, hoarseness, and difficulty breathing appear.
Syphilis: The sexually transmitted disease manifests itself in its second stage (syphilis II) through flu-like symptoms with swelling of the lymph nodes all over the body.
Chlamydia: An infection with these bacteria is one of the most common sexually transmitted diseases today. Symptoms include swollen lymph nodes in the groin area. If left untreated, the sexually transmitted disease can lead to infertility or blindness.
Tuberculosis: In active tuberculosis, unspecific symptoms such as night sweats, tiredness, loss of appetite, as well as a slight fever and swollen lymph nodes appear.
Actinomycosis: Radiation fungal disease is a chronically progressive infectious disease. It is triggered by bacteria of the genus Actinomyces, which together with other germs (e.g. staphylococci) cause the disease. The bacteria can cause great damage, especially in the face and in the ear, nose and throat area. Here, too, the regional lymph nodes are swollen.
Borreliosis: It is triggered by Borrelia, which is transmitted by tick bites. People develop an initial rash and flu-like symptoms with swollen lymph nodes.
Oral and pharyngeal infections: gingivitis or purulent abscesses in the mouth often cause swollen lymph nodes in the neck and lower jaw.
Cat scratch disease: This mostly harmless infectious disease is caused by a pathogen of the genus Bartonella. The pathogen gets from cats to humans via scratch wounds. First a nodule forms near the wound, then the closest lymph nodes swell. Usually these are the lymph nodes in the neck or armpits.

Rheumatoid Diseases

Rheumatoid arthritis: If the joints are inflamed, the lymph nodes in the affected area can also swell.
Lupus erythematosus: This autoimmune disease often manifests itself initially as general symptoms such as tiredness, fatigue, fever, weight loss and swelling of the lymph nodes.

Cancers

Malignant lymphoma: Lymph gland cancer (malignant lymphoma) usually only occurs in old age. Medically, a distinction is made between Hodgkin and non-Hodgkin lymphomas. Both express themselves as painless, enlarged lymph nodes on the neck, in the armpits and in the groin as well as unspecific complaints such as weight loss, fever and night sweats.
Leukemia: The increase in white blood cells in blood cancer also affects the lymphatic system - swollen lymph nodes, decreased performance, fever and susceptibility to infections are the consequences.
Daughter tumors (metastases): Cancer cells can migrate from their place of origin, for example an organ tumor, get stuck in the nearby lymph nodes and form a daughter tumor there. Doctors then speak of lymph node metastases.

Other causes

Toxoplasmosis: Infected cats in particular transmit the parasite Toxoplasma gondii to humans. Most of the time the disease is symptom-free, but sometimes there is a sore throat, swollen lymph nodes, or tiredness. Toxoplasmosis is dangerous for pregnant women because the pathogen can damage the fetus.
Lymphedema: Mechanical weaknesses in the lymphatic system can also cause the lymph nodes to swell. Then the lymphatic fluid can no longer be transported away sufficiently, so that it accumulates in the tissue - thick legs and swollen lymph nodes, especially in the groin, are the result. Lymphedema can develop after cancer surgery, for example, if many lymph nodes have been removed.

Swollen lymph nodes: when should you see a doctor?

Many diseases are not only expressed by swollen lymph nodes, but also by other symptoms such as fever, runny nose, a general feeling of illness or a sore throat. The cause of the lymph node swelling is often obvious: Mostly it is a harmless infection that goes away on its own or can be treated without any problems.

Even a few days after the inflammation has healed (such as tonsillitis), the lymph nodes may still be swollen.

However, you should definitely see a doctor if:

Lymph nodes are swollen with no evidence of infection.
the lymph node swelling is only on one side (e.g. only in the left armpit, but not in the right).
the palpable or visible swelling has existed for a long time (more than three weeks) and for no apparent reason.
There are other complaints, for example unwanted weight loss, a noticeable drop in performance, fever or night sweats.

Swollen lymph nodes in children

In children, swelling of the lymph nodes is usually not a concern. Especially in the first years of life, the child's lymph nodes are often persistently swollen, because the still young immune system is constantly busy with many, as yet unknown pathogens and foreign substances. This increased activity manifests itself in a swelling of the lymph nodes.

However, if the lymph nodes are still swollen after three to four weeks, you should visit the pediatrician with your offspring. Particular caution is required if the child, in addition to swelling of the lymph nodes, is impaired in performance or growth.

Swollen lymph nodes: what does the doctor do?

The doctor will first take the medical history (anamnesis): For example, he will ask you about recent illnesses - if these are not obvious. Information about other complaints that at first glance have nothing to do with the lymph node swelling can also provide important information. These include, for example, night sweats, unwanted weight loss, fever, loss of performance or cough.

Palpation of the lymph nodes is also particularly important. In doing so, the doctor checks the consistency and surface quality, the ability to move and the sensitivity to pain of the affected lymph nodes. In the case of benign changes, the nodes can be manually delimited from their surroundings and moved. If palpation hurts and a feeling of pressure arises, this indicates an inflammatory but benign infection. Large, pain-free lymph nodes that are firmly attached to their surroundings, on the other hand, are considered a sign of a malignant disease.

If the physical examination does not determine the cause, a blood test will follow. The laboratory values can provide information about inflammation, viral infections (antibodies!) Or leukemia.

The doctor will take a tissue sample from the swollen lymph nodes and send it to the laboratory for analysis (biopsy), especially in the case of one-sided, sudden swelling of the lymph nodes without a clear source of infection. There the sample is examined microscopically for cancer cells.

In order to clarify a suspicion of cancer, the doctor can also examine the patient with imaging tests. Magnetic resonance imaging (MRI, magnetic resonance imaging) and computed tomography (CT) are particularly suitable. With their help it can be determined, for example, whether and which organs are affected and whether the cancer cells have already spread in the body.

In breast cancer, prostate cancer and skin cancer, the sentinel lymph nodes are particularly in focus.In addition to the tumor, they are removed and examined for malignant changes. If they are infected with cancer, the tumor cells have already spread in the body.

Swollen lymph nodes: you can do this yourself

If a lymph node is swollen for several weeks, you should always consult a doctor. Only the medical professional can diagnose the underlying disease and initiate the appropriate treatment.

If the lymph node swelling is harmless, you can do something yourself to alleviate the symptoms. For example, if the lymph nodes in your neck are swollen from a cold or flu, you should keep your neck warm. Cold will not relieve the swelling in this case.

However, a lymph node is often swollen and tender for no apparent reason. The cause can be a local inflammatory reaction, which may even have subsided. In this case you should take care of yourself. Even when you are feeling physically healthy, an infection seems to keep your immune system busy. In order not to spread the bacteria in the event of a bacterial infection and to weaken the body unnecessarily, you should refrain from sport and strenuous activities. Wait until you can no longer feel any swollen lymph nodes and feel completely fit again.

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