Swollen Lymph Nodes: Infection vs. Lymphoma Assessment

This page is for people with swollen lymph nodes (glands) who worry about blood cancer. It covers when swelling is an emergency, why most swollen nodes are not cancer, what makes a node worth checking, and which tests come first.

Most swollen glands are not urgent. A few patterns are.

• Call 911 or go to an emergency department if swelling makes it very hard to breathe or swallow, or breathing has become noisy. The American Cancer Society notes that lymphoma in the chest can press on the windpipe. Do not drive yourself.
• Call 911 or go to an emergency department if the face, neck, upper body or arms are swelling along with trouble breathing, or you see swollen veins on the chest or neck. NCI lists these as signs of superior vena cava syndrome, when the large vein that returns blood from the upper body to the heart is partly blocked. Do not drive yourself.
• Call 911 or go to an emergency department if you have an infection and also confusion, shortness of breath, a fast heartbeat or weak pulse, clammy or sweaty skin, or extreme pain. CDC lists these as signs of sepsis, which is a medical emergency. Do not drive yourself.
• Call your cancer team right away, at any hour, if you have a temperature of 100.4°F (38°C) or higher while having chemotherapy. The CDC calls this a medical emergency, because fever may be the only sign of an infection that can become life-threatening. If you cannot get through quickly, go to an emergency department and say at the desk that you are on chemotherapy. If your own team has given you a different number, ask them which one to use.

The urgency in that list comes from pressure on the airway or the large veins, or from infection. It does not come from the size of the lump.

Lymph nodes are small filters. The American Cancer Society explains that they hold immune cells that fight germs. When there is an infection, inflammation, or cancer, they can get larger. Those near the surface can then be felt, and sometimes seen.

MedlinePlus says infections are the most common cause of swollen lymph nodes. Colds, flu, ear infections, tonsillitis and mono are common examples. Other causes include immune conditions such as HIV or rheumatoid arthritis, and cancers such as leukemia and lymphoma.

The American Cancer Society puts it plainly. Enlarged nodes are a common sign of lymphoma, but they are much more often caused by infection.

MedlinePlus also notes that sore nodes from an infection usually stop hurting within a couple of days. The node itself may take several weeks to shrink back to its normal size.

The feel of a node carries some information, and it is why an exam is not a formality.

• Pain. The American Cancer Society says nodes reacting to an infection are often tender. Nodes from lymphoma are usually not painful. Still, pain alone does not settle it either way.
• Texture and movement. MedlinePlus lists nodes that feel hard, irregular, or fixed in place as a reason to contact a provider.
• Time. MedlinePlus advises contacting a provider if nodes do not get smaller after several weeks, or keep getting larger.
• Other symptoms. Fever, night sweats, or weight loss you cannot explain are also reasons to be seen, according to MedlinePlus.

Size alone is weak evidence. A node that has been the same size for years is different from one that appeared last month and keeps growing. Change over time counts for more than any single measurement. In children, MedlinePlus says a node wider than 1 cm (0.4 inch) is considered enlarged and is worth a check.

Whole-body symptoms shift the picture. The American Cancer Society lists fever and chills, weight loss, tiredness, and drenching night sweats among common lymphoma symptoms, along with enlarged nodes.

Hodgkin lymphoma gives three of these a formal name: B symptoms. NCI defines them as unexplained weight loss of more than 10% of body weight in the 6 months before diagnosis, unexplained fever above 38°C, and drenching night sweats that keep coming back. NCI notes that fever and weight loss matter most of the three for outlook, and that night sweats alone do not worsen it.

The same symptoms with a swollen neck node and a sore throat are much more likely to be an ordinary infection. Your provider weighs the whole picture.

MedlinePlus says a provider starts with an exam and questions about when the swelling began and what else you have noticed. Tests may then include:

• blood tests
• a chest X-ray
• a CT scan of the chest and belly
• a lymph node biopsy

A biopsy is how lymphoma is diagnosed. NCI says the biopsy is preferably excisional, which means removing the whole node. That keeps the node's structure intact for the pathologist. A needle sample is sometimes used first. Ask which kind is planned and why.

For related reading, see a symptom is not a diagnosis, lymphoma, and lymphoma symptoms that were initially overlooked.

• MedlinePlus — Swollen lymph nodes
• American Cancer Society — Signs and Symptoms of Non-Hodgkin Lymphoma
• American Cancer Society — Lymph Nodes and Cancer
• NCI PDQ — Adult Hodgkin Lymphoma Treatment (Health Professional Version)
• NCI PDQ — Cardiopulmonary Syndromes (Patient Version)
• CDC — About Sepsis
• CDC — Fever during chemotherapy