Last updated: March 9, 2020
Richard Honaker M.D.
Primary Care Physician
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Pain in your neck could be a sign of an infection. Swollen lymph nodes in the neck could be a sign you have an infection or possibly something more serious.
You have probably noticed that many trips to your local doctor include checking your neck. This is because your doctor is checking if your lymph nodes are swollen. Swollen lymph nodes can be a sign that your immune system is working to fight off an infection, or possibly something more serious.
In fact, when you feel ill you may notice that Lymph nodes will often swell as a reaction to an injury, infection or illness. Actually, when your lymph nodes are not swollen you are unable to feel them. In fact, lymph nodes can only be felt in certain areas of the body where they are located closer to the surface of the skin.
What are Lymph Nodes?
Lymph nodes as small ovals of lymphatic tissue that are found at intervals along the lymphatic vessels. Lymph nodes are part of the body’s lymphatic system which works to help filter out impurities that are in the body’s muscle tissue, outside of the blood stream.
Your Lymphatic System
The lymphatic system includes lymph vessels and lymph nodes. These work together to rid the body of fluid, waste material and viruses and bacteria. When swollen, lymph nodes can be felt on the neck, back of knees, groin, armpit and head.
Similar to the veins that run throughout your body, lymph vessels carry the clear lymph fluid. This fluid flows out from the body’s capillary walls to bathe the cells walls in its fluid. It carries nutrients to the cells such as oxygen and removes impurities and carbon dioxide. This fluid also carries infection-fighting white blood cells called lymphocytes.
The lymph vessels direct the fluid away from the cells and towards the chest. The fluid is directed to a large vessel in the chest where it is collected and drained into a blood vessel in the heart.
There are two main types of lymphocytes:
- B lymphocytes (B cells): These cells make antibodies which are proteins to help protect the body from bacteria and viruses.
- T lymphocytes (T cells): Some of these cells destroy germs or abnormal cells which others boost or the activity of other immune cells.
The Role of Lymph Nodes
As the lymph fluid is drained from around the cells and sent towards the chest it is passed through many lymph nodes.
They are found along the lymphatic vessels similar to beads on a string. Some lymph nodes are located close to the surface of the skin, while others are deep within the body.
The lymph nodes act as a filter to remove any harmful substances in the fluid before it reaches the chest.
The lymph nodes contain immune cells that help to fight and break down infection by destroying the germs in the lymph fluid.
There are about 600 hundred lymph nodes in the body. Lymph fluid is often filtered through nodes several times before it is sent to the chest to be filtered into the bloodstream.
For example, the lymph fluid may start in the toes and be filtered by lymph nodes behind the knee and groin before arriving at the chest.
There are also lymph nodes deep in the body such as around the lungs or bowel, that are used to filter the fluid in that area. The lymph fluid flows slowly through the body, collecting more and more fluid as it moves towards the chest.
Swollen Lymph Nodes
When the lymph nodes detect a problem in the fluid, such as cancer, infection or injury they may swell. In general, lymph nodes more than 1 cm in diameter are considered to be ‘abnormal’. Lymph nodes may also swell due to stress.
The swelling of one of more lymph nodes is called Lymphadenitis. Lymph nodes usually swell due to an infection in another area of the body. Lymph nodes are usually small and firm. As they swell they become enlarged and may feel tender.
Although finding a swollen lymph node can make you fear the worst, often they are just the result of a benign infection. Infection that spread to the lymph nodes are usually caused by bacteria, fungus or an infection.
As the lymph nodes detect these things the groups of nodes will work together to rid the body of the unwanted virus, bacteria or fungus in the lymph fluid.
Swollen Lymph Nodes in the Neck
Lymph nodes usually swell in the area that is infected. Swollen lymph nodes in the neck may indicate an upper respiratory infection such as a cold.
Swollen lymph nodes in the neck may be as small as a pea or as large as a cherry. You may notice pain when chewing, swallowing or moving your head from side to side.
Swollen lymph nodes are a sign that your body is working hard to rid your body of the virus, bacteria or infection that caused the nodes to swell. In rare cases, it can be a sign of something more serious.
Reasons for Swollen Lymph Nodes in the Neck
- Ear infection
- HIV infection
- Sinus infection
- ear infection
- Infected tooth
- Skin infection
- Strep throat
- Rheumatoid arthritis
- Cancer such as lymphoma (where the cancer began in the lymphatic system) or if cancer that originated in other areas moves to the lymphatic system the nodes will swell.
- Antiseizure and antimalarial drugs
- Medication or allergic reactions to medication
- cat scratch fever
- mouth sores
- Sézary syndrome
Swollen lymph nodes is often called lymphadenopathy. In most cases, only one area of lymph nodes will swell at a time. Swollen lymph nodes are often located in the neck, groin, and underarms.
While the main symptom of lymphadenopathy is swollen lymph nodes, infected lymph nodes can produce additional symptoms.
Symptoms of Infected Lymph Nodes:
- Lymph nodes are swollen
- The infected area may be tender to the touch
- Nodes may be soft or matted together
- The skin over the nodes may appear red
- Nodes may become filled with pus
- Fluid may drain from the nodes onto the skin
When more than one area is swollen at a time it is called generalized lymphadenopathy.
Generalized lymphadenopathy can be caused by:
- Strep throat
- Chicken Pox
- Certain medications
- Immune system diseases
- Cancer such as leukemia and lymphoma
Cancer in the Lymph Nodes
There are two scenarios that cause cancer to be found in the lymph nodes. It may have originated in the lymph nodes or it originated in another area and then spread to the lymph nodes. When cancer begins in the lymph nodes it is called Lymphoma. More often, cancer will begin somewhere else and then spread to the lymph nodes.
Cancer can spread to the lymph nodes from other areas of the body. The cancer cells will move away from the tumor and travel to other areas of the body through the bloodstream or lymphatic system.
When the cancer cells travel through the bloodstream they may affect organs in the body. When they travel through the lymph system they often affect the lymph nodes. Fortunately, most cancer cells that break away from the tumor are destroyed by the body. Yet some may be able to reach a new area and form another tumor. When cancer spreads to a new part of the body it is referred to as metastasis.
Diagnosis of Swollen Lymph Nodes in the Neck
In general, the cause of swollen lymph nodes can be easily pinpointed by considering the other symptoms observed.
For example, swollen lymph nodes accompanied by a sore throat can be caused by strep throat. It is when swollen lymph nodes are not accompanied by other symptoms that it can be hard to pinpoint the cause.
If you have lymphadenitis your doctor will likely rely heavily on your medical history and a physical exam to determine the diagnosis. During your exam, you will likely be asked about any other symptoms you are experiencing as well as any recent travel, encounters with animals and any signs of infection near the swollen nodes.
Your doctor may order a blood test to determine if there are any abnormalities in the blood. You may also need to have an imaging test, such as an MRI, CT scan, x-ray or ultrasound.
In some rare cases, you may need a lymph node biopsy. With this test a small amount of cells are removed from the lymph node with a needle and sent for testing for diseases such as cancer.
How to Check Your Lymph Nodes in the Neck
In some cases, your doctor may ask you to check your lymph nodes periodically. This is often true in cases where you have been diagnosed with skin cancer. This is because one of the reasons lymph nodes will swell is because they have cancer cells in them.
- Start at the lymph nodes in front of the ear (1). Use your fingertips to feel the area in a gentle circular motion
- Check your nodes in the order shown in the image above. Always start with the front of the ear and finish just above the collar bone.
- Check both sides of the body to compare for size. A swelling may only be the size of a pea.
- When checking your neck, tilting your head towards the side you are examining can help relax the muscle.
- Press your fingers under the muscle to look for swelling
- When checking above the collarbone first hunch your shoulder and bring your elbows forward to relax your skin.
Treatment of Swollen Lymph Nodes in the Neck
The treatment of swollen lymph nodes depends heavily on the cause. For many infections the lymph nodes have swollen as a reaction to the infection and the swelling will subside as the infection is treated. Your doctor may advise that you take over the counter pain medication to combat the inflammation.
Swollen lymph nodes caused by cancer will not shrink until the cancer has been completely treated. In some cases, your doctor may advise the lymph node be removed. Your doctor will determine the best treatment options for you.
Speak to a Doctor
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*Not her real name.
Disclaimer: This article provides general information and is not intended to diagnose, treat or cure any disease or medical condition. If you require specific advice, please consult one of our medical professionals through the app. However, in case of an emergency, please call 911.
About Richard Honaker M.D.
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