I’ve got this gland in my neck that’s all swollen.  I just noticed it shaving a few days ago and I don’t have any idea how long it’s been there.  What the heck do you think it is?”  Danny, a man in his 30’s had that deer-in-the-headlights look in his eyes.  He was obviously thinking the worst, having Googled the possibilities.

Commonly referred to as “swollen glands,” enlarged lymph nodes can show up as small lumps (from BB sized to a couple inches across) at many locations, including all around the neck, under the arms, at the elbows, in the groin, as well as inside the abdomen and chest.

Lymph nodes are a normal part of our anatomy consisting of groupings of cells that help filter the lymph and produce immune cells to fight infection.  Of course not all lumps are swollen lymph nodes.  Some turn out to be salivary glands, lipomas (benign fatty growths), cysts and a number of other common entities.  So when a new lump is noticed, the first distinction to be made is whether it is a lymph node or one of these other entities.

If the lump is indeed a lymph node, the question is then whether this is a normal reactive lymph node or something more serious.  Reactive lymph nodes are simply lymph nodes that have enlarged due to fighting some infection or inflammation.  For example a child with an ear infection will often have enlarged lymph nodes around that ear, someone with Strep throat will have enlarged nodes under the angle of the jaw, and a person with eczema or similar scalp condition may have enlarged nodes at the base of the skull.  Likewise if someone has an infected finger they may get enlarged lymph nodes in the elbow and axilla (underarm) on that side.  Other conditions such as mononucleosis can enlarge lymph nodes in many locations at once.

But the reason enlarged lymph nodes get the attention they do is that a very small percentage of them can be a red flag alerting us to something much more serious.  Lymphomas, leukemias and other cancers can produce enlarged lymph nodes as well.

So what are the clues that a swollen lymph node is one of these bad guys vs. just a reactive lymph node doing its job?  No one feature is full proof.  But certain locations, such as a swollen node just above your collar bone, are more worrisome than, for example, one in the groin.

The growth trend of the lymph node also matters.  A reactive node tends to enlarge fairly quickly and then starts to shrink after the inciting infection goes away.  On the other hand, a cancerous lymph node almost never shrinks without treatment of the cancer.  So even if a swollen node doesn’t totally go away, if it shrinks considerably that’s a reassuring sign.

As to what they feel like, reactive nodes tend to be smooth, mobile, and sometimes tender whereas a cancerous node is more likely to be very hard, stuck to the underlying tissues and not sore or tender to push on.

Other red flags would be the presence of other symptoms when the enlarged lymph nodes show up.  Symptoms like night sweats, unexplained weight loss, or localized pain near the lymph nodes can be concerning.

So what do you do if you find a lump?  You could reasonably watch it for a while if you don’t have any of the red flag symptoms and feel like it fits with being a reactive lymph node.  But if it persists or continues to grow it would be best to have it checked out.  A physical exam, blood work and sometimes a trial of antibiotics followed by rechecking the node a couple weeks later can be adequate follow up if the node is shrinking.  If not, imaging such as x-ray, ultrasound, MRI or CT scan, and possibly biopsy of the lymph node may be needed.

But keep in mind the odds are very much in your favor if you get a swollen lymph node.  We see hundreds and hundreds, if not thousands of normal reactive lymph nodes for every one bad guy cancerous node we see.  At the same time we don’t want to miss that one bad guy.  So if you’ve got a suspicious lump, get it checked out.