Swollen glands
You have clusters of lymph nodes all over the body, and people often refer to these as lymph glands. Most people have experienced them swelling at the time of a cold or tonsillitis, just under the jawline on either side of the neck.
When you're well, you can't usually feel lymph nodes (although it is possible to feel ones that are close to the surface of the skin!). They swell up in a normal response to infection, which is when you can feel them more prominently in the neck, armpits, or groin. They also sit in the chest and tummy.
There are some occasions when one or more lymph nodes may be concerning, and need to be checked out.
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Why do lymph nodes swell in infection?
A fluid called lymph passes in a network of lymph vessels throughout the body, and this contains infection-fighting white blood cells called lymphocytes. They respond if they detect an infection, leaping into action to build up more lymphocytes and send them out to fight the threat.
While active, the lymph nodes can feel warm, sore, and swollen. Once you've conquered your cold, they should shrink back down and stop hurting.
There's nothing you can do to make them shrink sooner. It might feel soothing to press a cool, wet washcloth over them for a few minutes, or you can take simple pain relievers like acetaminophen or ibuprofen.
Other infections that typically cause swollen glands include HIV and syphilis, just after contracting either one, measles, glandular fever, and even dental abscess.
If not infection, what can it be?
White blood cells like lymphocytes and leukocytes develop in the bone marrow before reaching the bloodstream and being transported around the body. Dysfunction in their development can cause certain white blood cells to grow abnormally or in great number, which can lead to the formation of a blood cancer.
In the case of lymphocytes, this blood cancer is called lymphoma, and with leukocytes, this is leukemia. Both can cause swollen glands.
Swollen glands can occur in other cancers if they have spread to the lymphatic system, such as breast cancer if it's spread to a lymph node in the armpit.
When should I worry?
Firstly, don't panic if you have a swollen gland. While doctors always consider the worst-case scenario, infections are very common, and swollen glands are common with them.
Your doctor will be reassured if there is an obvious trigger or cause for the swollen lymph node. A local skin infection, a mouth ulcer, a cut or graze, cough or cold symptoms – something that can be seen as a reason why the immune system and lymph nodes have become bigger and more active. By comparison, blood cancers and other cancers are rare, but it's best to be informed and know when to get checked out.
You should book an urgent appointment with your doctor if a gland is still swollen after two weeks, and especially if you don't seem to have any particular illness or cause. Infection usually causes lymph nodes to feel painful to touch, but concerning ones are typically not painful. And the gland may continue to enlarge, which doesn't happen with an infection.
Cancer of the blood is likely to bring other symptoms, such as extreme tiredness, night sweats, persistent fevers, unintentional weight loss, and a poor appetite.
For concern about breast cancer, it's good for women to be in the habit of checking for lumps every month, and see their doctor if they notice one. Even without a breast lump, see your doctor for a persistent lump in the armpit.
If you have had unprotected sex or any other reason to suspect HIV, syphilis, other sexually transmitted infections, or hepatitis B or C, you should check in urgently with your local sexual health clinic or doctor for a full check-up and possibly treatment to help reduce the risk of contracting HIV – known as post-exposure prophylaxis (PEP) medication.
What happens next?
Your doctor will ask about your symptoms and examine the lymph node, along with other relevant examinations, such as checking for breast lumps. They are likely to order blood tests.
Depending on the results and level of suspicion, they may request an ultrasound of the lymph node, or they may refer you directly to a specialist team to consider blood cancer like non-Hodgkin's lymphoma. The hematology team can consider relevant scans, and they may take a sample of the lymph fluid with a small needle.
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