Enlarged lymph nodes. Should you see an oncologist or a therapist?

Every third appeal to an oncologist on social networks or on remote consultation portals is formulated something like this: “save, help, I have enlarged lymph nodes.”

As a rule, young people write, usually from 18 to 25 years old, and I don’t remember a case when it eventually turned out that the situation required treatment from an oncologist. Most often, enlarged lymph nodes were caused by a sore tooth, sore throat, conjunctivitis, and so on.

It is clear that fear and fears for one’s health in such cases force one to immediately run to an oncologist.

However, is everything so simple, and is it worth rolling your eyes about any treatment with an enlarged lymph node?

My personal statistics show: if a person comes for a face-to-face consultation, he is already one of those few whose situation was not limited to the banal “it got sick and went away.”

Let's take a closer look at how the lymphatic system works and understand the nature of enlarged lymph nodes.

Fact #2

Lymphatic vessels are not something abstract.

It is worth crossing or ligating them, for example, during surgery on the axillary lymph nodes for breast cancer, and lymphostasis is likely to develop - swelling of the limb, which, again, most likely will not go away.

The most visible to us from the point of view of examination - the so-called peripheral lymph nodes (in the neck, supraclavicular, axillary and inguinal) can increase, and this is in most cases a manifestation of reactive lymphadenopathy - an inflammatory reaction indicating the fight against infection.

Causes

Lymphadenopathy in children occurs as a consequence of various infectious diseases. If we distribute them into groups, then these are:

• bacterial;
• fungal;
• mycobacterial;
• chlamydial;
• viral;
• parasitic.

In addition, long-term use of certain medications can lead to the onset of the disease. Depending on how many lymph nodes are affected by the pathological process, experts classify the following types of lymphadenopathy:

• Localized when we are talking about one lymph node. They occur most often (up to 75%).
• Regional – several lymph nodes are enlarged.
• Generalized – lymph nodes in several non-contiguous areas of the body are affected.

Fact #3

Most often, the cervical and submandibular lymph nodes become inflamed, because in the facial part of the skull there are many open mucous membranes and associated infections.

A sore throat, carious or rotten teeth, and ear and eye bacterial and viral infections are the most common causes of cervical lymphadenopathy. The axillary and inguinal nodes react according to the same principle.

Therefore, if a lymph node is bothering you, first of all you need to go to a therapist, dentist, or ENT doctor.

If the genesis of lymphadenopathy is unclear, the doctor will prescribe an ultrasound, and during this study, attention will be directed mainly not to the size of the lymph node, but to its shape and differentiation of the structure.

Enlarged lymph nodes in a child

Enlarged lymph nodes in a child Enlarged lymph nodes (lymphadenopathy) occurs in children of different ages and is often very worrying for parents. Lymph nodes play an important role in the child’s immune system and determine the body’s ability to resist infection.

They serve as a barrier to pathogenic microorganisms. Normally, in healthy children, separate groups of lymph nodes can be felt, usually in the axillary, groin and cervical region. In children under one year old they are up to 0.5 cm, in preschoolers - up to 0.7 cm. But if the lymph nodes are visible without palpation or there is pain or redness of the skin over them, you should urgently see a doctor.

The increase can be local and generalized. Local – when the lymph nodes of one group are enlarged: cervical, axillary, inguinal, etc. Generalized – if several groups are involved in the process at once.

All causes of lymphadenopathy can be divided into infectious and non-infectious. Local enlargement of lymph nodes is caused by infections, viral or bacterial. In childhood, there is an active development of immunity, which occurs more intensely in children attending kindergarten and more often encountering infections typical for their age. The location of the changes may indicate the area of ​​the inflammatory process. For example, adenoiditis and tonsillitis are inflammation of the lymphatic pharyngeal ring, the first barrier to infection. Cervical lymphadenopathy most often develops in the presence of inflammation in the nasopharynx. The cause of enlarged lymph nodes under the lower jaw may be ordinary caries. Some childhood infections can leave behind a long-term enlargement of the lymph nodes (infectious mononucleosis, scarlet fever, chickenpox, rubella, etc.).

Generalized lymphadenopathy in children is much less common, and an increase in several groups of lymph nodes is observed. The cause may be various tumor processes, infectious or parasitic diseases. In such cases, a comprehensive examination is necessary: ​​a comprehensive clinical blood test, chest x-ray, ultrasound of the lymph nodes, as well as serological tests for infections (chlamydia, mycoplasmosis, toxoplasmosis, Epstein-Barr virus infection, cytomegalovirus and herpetic infections) and parasitic diseases (helminthic infestations , giardiasis, etc.)

What to do?

Do not self-medicate, heat enlarged lymph nodes or put too much pressure on them! Antibiotics should not be given “just in case.” It is necessary to consult a pediatrician, and if local manifestations appear (pain, redness, thickening) - to a surgeon.

After finding out the cause and treating the disease that caused lymphadenopathy, you should not expect an immediate shrinkage of the lymph nodes. This happens gradually, over 2-3 weeks, and provided that the child does not get sick again during this time.

Fact #5

Lymph nodes enlarge during cancer because cancer cells enter the lymphatic vessels draining a certain area, which then settle in the “filters” (lymph nodes) in the form of metastases and begin to grow there.

Such lymph nodes do not shrink after treatment of infectious diseases, but only increase, merging with other lymph nodes into conglomerates, extending beyond the lymph node and fixing it in the surrounding tissues. Such lymph nodes are rarely painful, they are dense, very dense.

Often in cancer, lymph nodes are affected by a “chain” that is clearly visible on palpation. With lymphomas, conglomerates are often visible from the outside. Of course, with such manifestations you need to go to an oncologist and hematologist.

For suspicious nodes, a biopsy will be performed in the absence of other causes. This is either a puncture with a needle and collection of material, or an operation to completely remove the lymph node for histological examination.

Features of the pathology

Considering that there are more than 600 lymph nodes in the human body, we can assume the development of pathology in any organ and system of the body, both in an adult and a child. Most often, in the practice of a hematologist at a medical center, it is necessary to diagnose lymphatic lesions in places such as:

• abdomen;
• mediastinum;
• groin;
• submandibular zone;
• neck;
• armpits.

The presence of pathology of the lymph nodes in any of these areas of the body indicates an existing underlying disease. And, unfortunately, often it can be oncology. According to statistics, in 1% of cases in patients diagnosed with lymphadenopathy, additional examination reveals malignant formations.

Consistency of lymph nodes

Dense lymph nodes, especially if accompanied by redness, increased local temperature, fluctuation, are often detected in infectious diseases.

Dense lymph nodes and without redness are often detected in viral infections and systemic diseases [5].

Dense, hard, immobile lymph nodes are a finding in malignant diseases.

Normally, the lymph nodes are soft, elastic, mobile (easily displaced upon palpation).

Consolidation of the lymph nodes may be associated with fibrosis or hemorrhage into it, immobility and cohesion are possible with the germination of metastases, or inflammation of surrounding tissues (tuberculosis, sarcoidosis).

Enlargement of lymph nodes can be generalized (enlargement or change in 2 or more unrelated groups of lymph nodes). Often generalized lymphadenopathy is accompanied by an enlarged liver and spleen, and a rash may be present. Generalized lymphadenopathy is not always a sign of serious pathology [5].

Localized lymphadenopathy is often found in children (palpation of the cervical, less often inguinal lymph nodes).

Most often, lymphadenopathy is localized and affects the nodes of the neck and head (3:1) [7].

In most cases, lymphadenopathy resolves on its own or after adequate treatment [5]. If lymphadenopathy does not resolve within 3–4 weeks, it is advisable to consider additional testing [5].

Child's age

Lymph nodes are usually not identified/palpated in newborn babies due to their small size and soft consistency.

In young children, cervical, axillary and inguinal lymph nodes can be identified.

In children under 5 years of age, during a routine examination by a pediatrician, palpable lymph nodes are detected in 44% of cases, in children with any diseases - in 64% of cases [2].

The presence of palpable lymph nodes is not always a manifestation of any pathology. And also palpable formations may not be lymph nodes at all, but, for example, a congenital anomaly (cyst, hygroma).

Normally, lymph nodes in children grow until 8-12 years of age, then decrease slightly [3].

Prevention and treatment of lymphadenopathy in Makhachkala

The essence of treatment for lymphadenopathy is to identify and treat the underlying disease. For example, if the pathology of the lymph nodes is caused by a bacterial disease, then a course of antibacterial therapy is prescribed. If the cause of lymphadenopathy is a viral infection, then antiviral treatment is carried out accordingly; in case of oncology, a complex of antitumor measures, etc. When choosing a treatment regimen, the doctor is guided by the individual characteristics of the patient’s body and the results of the examination. Self-medication is strictly prohibited. And the use of folk remedies is possible only in agreement with the attending physician. special measures to prevent lymphadenopathy in children . But the following will help minimize the likelihood of developing lymph node pathology:

• active lifestyle;
• good nutrition;
• increasing immunity;
• outdoor games;
• preventing frequent colds.

Parents are also required to take care of the child’s health, including timely visits to the doctor.

Diagnosis and treatment

The doctor makes the diagnosis based on external symptoms and accompanying complaints of the patient. Most often, the disease affects the glands on both sides. Sometimes the symptoms of the disease practically do not appear, except for inflammation of the salivary glands. Once ill, a small patient may refuse to eat, he may experience dry mouth and inflammation behind the ears.

The child is hospitalized only in case of complications or an epidemic. At home, the patient must be isolated from family members for 10 days and kept in bed.

It is necessary to adhere to a dairy-vegetable diet, grind food to reduce pain when swallowing, eat in small portions and drink plenty of warm teas, decoctions, and fruit drinks. You should avoid sour juices and fatty foods.

Doctors often prescribe:

• antipyretic,
• antihistamine,
• vitamins.

Gargling with a soda solution and dry warm compresses applied to the throat area are indicated. To relieve pain, you can tie a warm scarf around your neck and make a warm oil compress with heated vegetable oil.

In some cases, the doctor prescribes physical therapy, for example, ultraviolet radiation, diathermy. In severe cases, intravenous detoxification therapy with glucose solution is prescribed.

You can get a referral for them and undergo them at the children's clinic or at the SANMEDEXPERT clinic in Moscow Central Administrative District at the Baumanskaya metro station.

Prevention

To avoid mumps, a vaccination is necessary, which is done in any children's clinic according to the vaccination calendar, that is, after a year, often together with the measles and rubella vaccine. However, if a child has a decrease in immunity, for example, with leukemia, then the vaccine is contraindicated. Vaccinations for small allergy sufferers are given with special care. Normally, vaccination should be carried out under the supervision of an allergist.

Localization of lymph nodes

When lymph nodes are enlarged, it is important to determine the cause/source of the changes. Palpation of inguinal or axillary lymph nodes is unlikely to be associated with the disease, cervical - possibly supraclavicular - probably (further assessment and differential diagnosis are required) [2].

Often, enlargement of the supraclavicular lymph nodes on the right is associated with a tumor or infection of the mediastinum, and on the left – with metastases of an abdominal tumor. When palpating the supraclavicular lymph nodes, an additional examination is recommended - CT or MRI of the chest [5]. Read more in the article “Management of lymphadenopathy in children.”

Diagnostics

To establish the true causes of enlarged lymph nodes, you need to undergo a comprehensive diagnostic examination in a clinical setting. First of all, it is necessary to conduct a thorough history taking to establish the cause of the enlarged lymph nodes in the child. Next, a study is carried out to determine the presence of tumor formations, skin lesions, and the presence of inflammatory processes.

In our medical network clinics in Makhachkala, various types of laboratory and instrumental studies are carried out. To identify the causes of lymphadenopathy in children, specialists usually conduct a set of diagnostic examinations, which includes:

• general and biochemical blood tests;
• general urine analysis;
• X-ray of the chest area;
• ultrasound examination of internal organs;
• magnetic resonance imaging (MRI);
• computed tomography (CT);
• lymph node biopsy with histological and cytological analysis.

Lymph node size

Often the exact size of the lymph nodes is difficult to determine by touch. The size largely depends on the specific group of lymph nodes.

In principle, any lymph node, if it is detected by touch, is already considered enlarged. However, some groups of lymph nodes filter lymph from large areas of the body and can be detected even in healthy children [4].

Thus, in children, cervical, occipital, posterior ear, axillary lymph nodes can be palpated - no more than 0.5 cm - cervical, submandibular - no more than 1 cm, inguinal - no more than 1.5 cm. Occipital and posterior ear lymph nodes can more often be detected in small children, cervical and inguinal - in children over 2 years old.

Lymphadenopathy is a condition characterized by an increase in lymph nodes in size and/or quantity and/or a change in their consistency.

According to many observations, the incidence of enlarged lymph nodes depending on age is [4]:

Normal size of lymph nodes

It is believed that lymph nodes should be up to 1 cm in diameter (but definitely not exceed 2 cm [2]), inguinal - up to 1.5 cm, ulnar, behind the ear - up to 0.5 cm [5,6].

These sizes are not strict, especially for children in the first years of life (babies are just encountering different antigens and developing their immunity, more details in the article “Causes of enlarged lymph nodes”).

When assessing lymph nodes, it is also necessary to evaluate their consistency, mobility, shape, density, and changes in the skin over the surface.