What are the common causes of swollen lymph nodes. How are swollen lymph nodes diagnosed and treated. When should you see a doctor for swollen lymph nodes. What are the symptoms associated with swollen lymph nodes. How can swollen lymph nodes be prevented.

Understanding Lymphadenopathy: An Overview of Swollen Lymph Nodes

Lymphadenopathy, or swollen lymph nodes, is a common medical condition that can be caused by various factors. These small, bean-shaped glands play a crucial role in our immune system, filtering substances and housing lymphocytes that help fight infections. When lymph nodes swell, it often indicates that the body is responding to an infection, inflammation, or other underlying issues.

Swollen lymph nodes can occur in different parts of the body, including the neck, armpits, and groin. While most cases of lymphadenopathy are benign and resolve on their own, some instances may require medical attention. Understanding the causes, symptoms, and treatment options for swollen lymph nodes is essential for proper management and knowing when to seek professional help.

Common Causes of Swollen Lymph Nodes: From Infections to Autoimmune Disorders

Swollen lymph nodes can be attributed to various factors, ranging from minor infections to more serious conditions. Some of the most common causes include:

• Bacterial infections (e.g., strep throat, skin infections)
• Viral infections (e.g., common cold, mononucleosis, HIV)
• Fungal infections
• Autoimmune disorders (e.g., lupus, rheumatoid arthritis)
• Certain medications
• Cancer (e.g., lymphoma, leukemia)

Is there a difference between localized and generalized lymphadenopathy? Indeed, there is. Localized lymphadenopathy affects a specific area of the body and accounts for about 75% of cases, with half of these occurring in the head and neck region. Generalized lymphadenopathy, on the other hand, involves two or more non-contiguous regions and represents about 25% of cases.

Recognizing the Symptoms: When to Be Concerned About Swollen Lymph Nodes

Identifying the symptoms associated with swollen lymph nodes is crucial for determining whether medical attention is necessary. Common signs include:

• Tender, swollen lumps under the skin
• Pain or discomfort in the affected area
• Redness or warmth of the skin over the lymph nodes
• Fever, night sweats, or unexplained weight loss (in some cases)

How can you tell if swollen lymph nodes are serious? While most cases of lymphadenopathy are benign, certain symptoms may indicate a more serious condition. Seek medical attention if you experience:

• Lymph nodes that are hard, fixed, or rapidly growing
• Persistent swelling lasting more than two weeks
• Unexplained fever or weight loss
• Night sweats
• Difficulty breathing or swallowing

Diagnosis and Evaluation: Uncovering the Root Cause of Swollen Lymph Nodes

Diagnosing the underlying cause of swollen lymph nodes typically involves a comprehensive approach. Healthcare providers may use the following methods to evaluate lymphadenopathy:

1. Medical history and physical examination
2. Blood tests to check for infections or other abnormalities
3. Imaging studies (e.g., ultrasound, CT scan, or MRI)
4. Lymph node biopsy (in some cases)

How do doctors determine the cause of swollen lymph nodes? The diagnostic process often begins with a thorough medical history and physical examination. Doctors will ask about recent illnesses, travel history, and any other symptoms you may be experiencing. They will also palpate the affected lymph nodes to assess their size, consistency, and tenderness.

In some cases, additional tests may be necessary to pinpoint the underlying cause. These may include blood tests to check for infections or autoimmune disorders, imaging studies to visualize the lymph nodes and surrounding tissues, or a biopsy to examine the lymph node tissue under a microscope.

Treatment Options: Addressing Swollen Lymph Nodes and Their Underlying Causes

The treatment for swollen lymph nodes depends on the underlying cause. In many cases, especially those related to minor infections, lymphadenopathy will resolve on its own without specific treatment. However, some situations may require medical intervention:

• Bacterial infections: Antibiotics may be prescribed
• Viral infections: Supportive care and symptom management
• Autoimmune disorders: Immunosuppressants or other targeted therapies
• Cancer: Chemotherapy, radiation therapy, or other cancer-specific treatments

Are there any home remedies for swollen lymph nodes? While medical treatment may be necessary for underlying conditions, some home remedies can help alleviate discomfort associated with swollen lymph nodes:

• Applying warm compresses to the affected area
• Resting and getting adequate sleep
• Over-the-counter pain relievers (e.g., ibuprofen or acetaminophen)
• Staying hydrated

Prevention Strategies: Minimizing the Risk of Swollen Lymph Nodes

While it’s not always possible to prevent swollen lymph nodes, certain lifestyle choices and preventive measures can help reduce the risk of developing lymphadenopathy:

• Practicing good hygiene, including regular handwashing
• Maintaining a healthy diet and exercise routine to support immune function
• Avoiding close contact with individuals who have contagious illnesses
• Staying up-to-date on vaccinations
• Managing stress through relaxation techniques or mindfulness practices

Can lifestyle changes help prevent swollen lymph nodes? While not all cases of lymphadenopathy can be prevented, adopting a healthy lifestyle can strengthen your immune system and potentially reduce the frequency of swollen lymph nodes. This includes eating a balanced diet rich in fruits and vegetables, exercising regularly, getting adequate sleep, and managing stress effectively.

Special Considerations: Lymphadenopathy in Children and Older Adults

The approach to swollen lymph nodes may vary depending on the age of the patient. Children and older adults may require special considerations:

Lymphadenopathy in Children

Swollen lymph nodes are common in children and are often related to minor infections. A study by Knight PJ et al. reviewed 239 children who underwent peripheral node biopsies and found that the most common causes were:

1. Reactive hyperplasia of unknown etiology
2. Granulomatous infections
3. Cancer
4. Dermatopathic lymphadenopathy

How should parents approach swollen lymph nodes in children? While most cases of lymphadenopathy in children are benign, parents should monitor their child’s symptoms and consult a pediatrician if the swelling persists for more than two weeks, is accompanied by fever or other concerning symptoms, or if the lymph nodes are rapidly increasing in size.

Lymphadenopathy in Older Adults

In older adults, swollen lymph nodes may be more concerning due to the increased risk of underlying malignancies. However, studies have shown that even in this population, most cases of lymphadenopathy are benign. A Dutch study revealed that out of 2556 patients presenting with unclear lymphadenopathy to their family physicians, only 1.1% were found to have malignant causes.

When should older adults be particularly concerned about swollen lymph nodes? While the risk of malignancy is still relatively low, older adults should be more vigilant about persistent or unexplained lymphadenopathy. They should consult their healthcare provider if swollen lymph nodes are accompanied by symptoms such as unexplained weight loss, night sweats, or persistent fever.

The Role of Imaging in Evaluating Swollen Lymph Nodes

Imaging studies play a crucial role in the evaluation of lymphadenopathy, especially when the cause is not immediately apparent or when malignancy is suspected. Various imaging modalities can be employed, each with its own strengths and limitations:

Ultrasound

Ultrasound is often the first-line imaging technique for evaluating superficial lymphadenopathy. It is non-invasive, does not involve radiation exposure, and can provide real-time imaging of lymph node structure and blood flow.

What can ultrasound reveal about swollen lymph nodes? Ultrasound can help assess the size, shape, and internal architecture of lymph nodes. It can also differentiate between solid and cystic structures and evaluate blood flow patterns, which can be helpful in distinguishing between benign and malignant causes of lymphadenopathy.

Computed Tomography (CT)

CT scans offer detailed cross-sectional images of the body and are particularly useful for evaluating deep-seated lymph nodes or when a more comprehensive assessment of multiple body regions is needed.

When is a CT scan recommended for swollen lymph nodes? CT scans may be ordered when there is suspicion of widespread lymphadenopathy, when evaluating for potential malignancies, or when planning for a biopsy or surgical intervention.

Magnetic Resonance Imaging (MRI)

MRI provides excellent soft tissue contrast and can be valuable in assessing lymph nodes in certain body regions, such as the head and neck or pelvis.

How does MRI compare to other imaging modalities for evaluating lymphadenopathy? MRI offers superior soft tissue contrast compared to CT and can be particularly useful in evaluating lymph nodes in areas where CT image quality may be compromised by artifacts from bone or dental fillings.

Positron Emission Tomography (PET)

PET scans, often combined with CT (PET-CT), use radioactive tracers to visualize metabolic activity in the body. This can be particularly helpful in identifying malignant lymph nodes or evaluating the extent of disease in known cancers.

When is PET-CT used in the evaluation of swollen lymph nodes? PET-CT is typically reserved for cases where malignancy is strongly suspected or has been confirmed, as it can help stage the disease and guide treatment planning.

The Importance of Biopsy in Diagnosing Lymphadenopathy

While imaging studies can provide valuable information about the characteristics of swollen lymph nodes, a biopsy remains the gold standard for definitive diagnosis in many cases. There are several types of biopsies that may be performed:

Fine Needle Aspiration (FNA)

FNA involves using a thin needle to extract cells from the lymph node for microscopic examination. It is minimally invasive and can often be performed in an outpatient setting.

What are the advantages of FNA in evaluating swollen lymph nodes? FNA is quick, relatively painless, and can provide rapid results. It is particularly useful for distinguishing between benign and malignant causes of lymphadenopathy and can often guide further management decisions.

Core Needle Biopsy

A core needle biopsy uses a larger needle to remove a small cylinder of tissue from the lymph node. This provides more tissue for analysis compared to FNA.

When is a core needle biopsy preferred over FNA? Core needle biopsies may be recommended when more tissue is needed for diagnosis, such as in cases where lymphoma is suspected or when previous FNA results were inconclusive.

Excisional Biopsy

An excisional biopsy involves surgically removing an entire lymph node for examination. This provides the most comprehensive analysis but is more invasive than needle biopsies.

In what situations is an excisional biopsy necessary? Excisional biopsies may be performed when needle biopsies are inconclusive, when a larger tissue sample is needed for diagnosis, or when the lymph node needs to be removed for treatment purposes.

How do doctors decide which type of biopsy to perform? The choice of biopsy technique depends on several factors, including the location and size of the lymph node, the suspected underlying cause, and the patient’s overall health status. Your healthcare provider will discuss the most appropriate option based on your individual circumstances.

Emerging Research and Future Directions in Lymphadenopathy Management

As our understanding of the immune system and lymph node biology continues to evolve, new approaches to diagnosing and treating lymphadenopathy are emerging. Some areas of ongoing research include:

Molecular Diagnostics

Advances in molecular testing techniques are improving our ability to identify specific pathogens or genetic markers associated with various causes of lymphadenopathy.

How might molecular diagnostics change the approach to swollen lymph nodes? These techniques could potentially lead to more rapid and accurate diagnoses, allowing for earlier and more targeted treatment interventions.

Immunotherapy

For cases of lymphadenopathy related to cancer, particularly lymphomas, immunotherapy approaches are showing promise in stimulating the body’s own immune system to fight malignant cells.

What potential does immunotherapy hold for treating lymphadenopathy associated with cancer? Immunotherapy could offer new treatment options for patients with lymph node involvement due to cancer, potentially leading to improved outcomes and fewer side effects compared to traditional chemotherapy.

Artificial Intelligence in Imaging

Machine learning algorithms are being developed to assist in the interpretation of imaging studies, potentially improving the accuracy and efficiency of lymph node evaluation.

How might AI impact the diagnosis of swollen lymph nodes? AI-assisted image analysis could help radiologists more accurately identify concerning features in lymph nodes, potentially leading to earlier detection of malignancies and more precise treatment planning.

As research in these areas continues, it is likely that our approach to diagnosing and managing lymphadenopathy will become increasingly sophisticated and personalized. Staying informed about these developments can help both patients and healthcare providers make more informed decisions about lymph node health and related conditions.

Lymphadenopathy – StatPearls – NCBI Bookshelf

Continuing Education Activity

Lymphadenopathy refers to the swelling of lymph nodes which can be secondary to bacterial, viral, or fungal infections, autoimmune disease, and malignancy. This activity outlines the evaluation and treatment of lymphadenopathy and highlights the role of the interprofessional team in evaluating and treating patients with this condition.

Objectives:

• Summarize the etiology of lymphadenopathy.

• Outline the typical presentation in lymphadenopathy.

• Explain the management of lymphadenopathy.

Access free multiple choice questions on this topic.

Introduction

The lymphatic system is a complex component of the immune system involved in filtering substances in the body. Lymphocytes are the integral agents involved in searching for target proteins and travel through lymph nodes, which are diffusely placed throughout the body. Lymphadenopathy is a term that refers to the swelling of lymph nodes. Lymph nodes are small glands that are responsible for filtering fluid from the lymphatic system. They are divided into sections known as follicles, which are subdivided into B zones and T zones, which represent the base location of lymphocytic maturation.

Abnormal proliferation of lymphocytes may be a result of inflammation, infection, or malignancy, and thus, clinicians must perform a detailed history and physical to screen for lymphadenopathy. When inspecting for lymphadenopathy, one should carefully examine all pertinent anatomic regions, including the neck, supraclavicular, axillary, and inguinal regions. In general, the size of a normal lymph node in the adult population should be less than 1 cm; however, there are exceptions to this rule.[1]

Etiology

Lymphadenopathy, while pertinent, may be nonspecific. There are several potential causes of lymphadenopathy, ranging from infectious, autoimmune, malignant, and lymphoproliferative.

There is a wide range of infectious etiologies, including bacterial, fungal, viral, mycobacterial, spirochetal, and protozoal organisms. Autoimmune disorders that may contribute include but are not limited to sarcoidosis, amyloidosis, systemic lupus erythematosus, rheumatoid arthritis, and eosinophilic granulomatosis with polyangiitis. Malignant diseases like lymphoma, leukemia, metastatic cancer, and head and neck cancers are also common causes of lymphadenopathy. Lymphoproliferative disorders such as hemophagocytic lymphohistiocytosis can also manifest with the enlargement of lymph nodes.

Lymphadenopathy can be localized or diffuse. About 75% of most lymphadenopathies are localized, and about 50% of those occur in the head and neck regions. Generalized lymphadenopathy, which involves two or more non-contiguous regions, is reported to occur in 25% of lymphadenopathies.[2]

Elucidating the etiology of lymphadenopathy can be challenging. A thorough history and physical exam are one of the most important steps in determining the underlying cause of lymphadenopathy.

Etiologies can be determined based on lymph node groups. Submental and submandibular lymphadenopathy commonly is infectious in origin, often presenting with viral prodromes. Posterior cervical lymphadenopathy can arise from localized bacterial and viral infections, as well as lymphoma.[2] Axillary lymphadenopathy can also be related to lymphoma or breast malignancy but can be involved by infections such as cat-scratch disease. Lastly, inguinal lymphadenopathy can be impacted by local sexually transmitted infections, lymphoma, and pelvic malignancies.

Epidemiology

A majority of patients with lymphadenopathy will have a benign etiology. Age is an important factor in characterizing the epidemiology of lymphadenopathy, and thus, can be divided into children and adults.

Children more commonly appear to have benign causes of lymphadenopathy. To better understand this, a study completed by Knight PJ et al. reviewed 239 children who underwent a peripheral node biopsy and found that the most common etiology noted was reactive hyperplasia of unknown etiology, followed by granulomatous infections, cancer, and dermatopathic lymphadenopathy. [3]

Adults also appear to have a low prevalence of malignancy. To further characterize this, a study was completed in a family practice setting where only 3% of 249 patients with lymphadenopathy underwent biopsies. Of these patients, no one was found to have a debilitating illness.[4]

A Dutch study also revealed that of 2556 patients that presented with unclear lymphadenopathy to their family physicians, 10% were referred for a biopsy, and only 1.1% were found to be related to malignancy.

These findings are mirrored by two case series completed in family practice departments within the United States that demonstrated that 0 of 80 patients and 3 of 238 patients had malignant causes of lymphadenopathy, respectively.

It is important to remember that endemic regions such as South Africa or India have increased rates of lymphadenopathy due to tuberculosis, parasitic infections, and HIV.[2]

Pathophysiology

Lymph nodes are a part of the reticuloendothelial system, which includes monocytes of the blood, macrophages of the connective tissue, thymus, spleen, bone marrow, bone, mucosa-associated lymphoid tissue of visceral organs, lymphatic vessels, and lymphatic fluid found in interstitial fluid. [1]

Lymphatic fluid moves throughout the lymphatic system, transitioning from the organs to lymphoid capillaries, lymphatic vessels, and finally lymph nodes for foreign antigen filtration. Foreign substances are presented to the lymphoid cells, which lead to cellular proliferation and enlargement. Under microscopy, cellular proliferation in lymphoid follicles may be identified as several mitotic figures.[5] As lymphatic capsules stretch due to increased activity, patients may experience localized tenderness.

The development of B-cells originates from pluripotent stem cells from the bone marrow. B cells that successfully build their immunoglobulin heavy chains migrate to the germinal centers to allow for antibody diversification by somatic hypermutation.[6] B-cell lymphomas are believed to be a result of alternations in somatic hypermutation and chromosomal translocations.

The development of T-cells also begins from pluripotent stem cells, which mature within the thymic cortex. [7] While in the thymic cortex, T cells begin specific rearrangements at the T-cell receptor. It is understood that chromosomal translocations at the level of T-cell receptors lead to T-cell lymphomagenesis.

Lymph nodes follicle necrosis may occur as a result of many different conditions, be it inflammatory, infectious, or malignant. The predominance of neutrophilic infiltrates suggests bacterial infection, while lymphocytic predominance may suggest viral infection. However, clinicians must remember that etiologies may vary; lymphomas, leukemias, tuberculosis, or even systemic lupus may be more appropriate diagnoses in the appropriate clinical context.[8]

Histopathology

Histology of lymph nodes can vary when there are endogenous insults. Histology can provide further information regarding the cause of lymphadenopathy when etiology is not clear during initial history taking, physical examination, and laboratory evaluation.

Below is a list of common causes of lymphadenopathy with associated histological findings:

• Bacterial lymphadenitis: Predominately neutrophilic infiltrate can be found within the sinus and medullary cords. Follicular hyperplasia can be seen as well.[9][10]

• Viral lymphadenopathy: Infiltration by macrophages and lymphoid hyperplasia. Necrosis can be seen in those who are immunocompromised.[11]

• Sarcoidosis: Non-caseating granulomas that replace the normal architecture of the lymph node 

• Non-Hodgkin lymphoma: There is partial or widespread loss of the lymph node by a single cell lineage. Lymphoid cells can either proliferate in a disorderly manner or as those that mimic follicular center structures.

• Hodgkin lymphoma: Can be classified by the histological appearance noted below. These histological types are listed in order of most common to least.[12]

• • Nodular-sclerosing

  • Mixed cellularity

  • Lymphocyte-rich

  • Lymphocyte-depleted

History and Physical

A history and physical must be completed in a systematic form. One must always remember all components of a complete history and physical examination.  

History involves the following:

1. History of Presenting Illness: location, pain – if so intensity, quality, onset, precipitating factors, alleviating factors

2. Review of Systems: This should include a system-based review of all organ systems, including constitutional systems (fever, chills, night sweats, changes in weight, fatigue).

3. Past Medical History: It is imperative to know the patient’s previous medical history, as this could clue into the reason for lymphadenopathy (i.e., HIV/AIDs, remote history of non-Hodgkin’s lymphoma)

4. Medications: Some medications can cause reversible lymphadenopathy (i.e., cephalosporins, phenytoin [13]) 

5. Social History: It is vital to know living conditions, chemical exposures, use of alcohol, tobacco, recreational drugs, pets, animal exposures, recent travel

6. Sexual History: It is pertinent to know the number of sexual partners, sexually active with males, females, or both; use of protection, history of sexually transmitted infections, and partners with known sexually transmitted infections

7.  Surgical History: Inquire about which surgeries and when they occurred, how soon the lymphadenopathy occurred (i.e., post-operative lymphadenopathy)

8. Family History: It is imperative to know if a family history exists of cancer

Physical examination involves the following:

1. Vital signs: Temperature, Blood pressure, heart rate, respiratory rate, oxygen saturation are all of significance to help determine if the patient is hemodynamically stable. This can help differentiate sepsis from benign conditions.

2. A head-to-toe exam must to conducted including inspection of the head, ears, nose, throat, and thyroid gland. Auscultation of lungs, heart, and palpation for splenomegaly and hepatomegaly. A thorough inspection should be done of the skin, palpating when necessary, looking for rashes, lesions, nodules.

3. When palpating lymphadenopathy, one must keep in mind location, size, firmness, and pain.

• Location:

  • Anterior cervical lymph nodes are superior and inferior to the sternocleidomastoid muscle. Posterior cervical lymph nodes are posterior to the sternocleidomastoid muscle.

  • One should also inspect for supraclavicular, axillary, and inguinal lymphadenopathy bilaterally.

  • Local lymphadenopathy suggests a more localized disease as compared to widespread lymphadenopathy.[1]

• Size:

  • Cervical lymph nodes and axillary nodes are atypical if > 1 cm, as compared to supraclavicular > 0.5 cm, and inguinal nodes >1.5 cm.

• Firmness:

  • Generally, if a lymph node is readily mobile, it is less concerning for a malignant condition.

• Pain:

  • Pain can be a sign of inflammation, an acute reaction to an infection, and is less concerning for a malignant process.

Evaluation

Listed below is a diagnostic approach that may help clinicians evaluate lymphadenopathy:

1. Laboratory evaluation: blood chemistries including complete blood count with differential, complete metabolic panel, lactate dehydrogenase, fungal serologies (histoplasmosis, blastomycosis, coccidioidomycosis, cryptococcosis), laboratory evaluation of Syphilis, HIV, CMV, EBV, HSV, HBV, QuantiFERON for tuberculosis.

2. Imaging: Computed Tomography (CT) of the chest, abdomen, and pelvis can be used to further substantiate the location of lymphadenopathy, pattern, and size. This can also guide a biopsy if needed.[14]

3. Lymph node biopsy: The need for a lymph node biopsy depends on the etiology of lymphadenopathy. An excisional node biopsy is the gold standard for diagnosis.[15]

Treatment / Management

Treatment differs depending on the etiology of lymphadenopathy. Simply put, the following generalizations can be made:

1. Malignant: Surgery +/- radiation therapy +/- chemotherapy.

2. Autoimmune: Immune therapy, systemic glucocorticoids.

3. Infectious: Antibiotic therapy, antiviral therapy, or antifungal therapy.

4. Medication: Discontinuation of medication with re-evaluation is necessary.

Differential Diagnosis

The variability in causes of lymphadenopathy can often present diagnostic challenges to clinicians. To reduce confusion and to improve diagnostic accuracy, it is important to obtain a thorough history and physical, create a set of differentials, and organize them in accordance with their presentation.

Causes of lymphadenopathy include but are not limited to:[2]

• Malignant: If the history and physical examination are consistent, lymphadenopathy may be concerning for diagnoses like metastatic breast cancer, Kaposi sarcoma, leukemias, lymphomas, metastatic disease (i.e., gastric cancer), malignant disorders of the skin.

• Autoimmune: Several conditions that are characterized by a highly active immune system may result in lymph node abnormalities, including dermatomyositis, Kawasaki disease, rheumatoid arthritis, sarcoidosis, Sjogren syndrome, Still disease, systemic lupus erythematosus

• Infectious: Many different infections can contribute to benign changes in the lymph nodes. Health care providers may consider several different subcategories of infection, including bacterial, viral, and other:

  • Bacterial: brucellosis, cat-scratch disease, bacterial pharyngitis, syphilis, tuberculosis, tularemia, typhoid fever

  • Viral: cytomegalovirus, hepatitis, herpes simplex, HIV, mononucleosis, rubella, viral pharyngitis. [16]

  • Other: bubonic plague, blastomycosis, coccidioidomycosis, cryptococcosis, histoplasmosis, toxoplasmosis

• Medications: Often, medical therapies may incite the benign growths of lymph nodes. These therapies include but are not limited to allopurinol, atenolol, captopril, carbamazepine, cephalosporins, gold, hydralazine, penicillin, phenytoin, primidone, pyrimethamine, quinidine, sulfonamides, and sulindac.[2]

The aforementioned causes may be subdivided into a mnemonic “MAIM,” which may help as a useful memory tool for recall of the vast amount of differentials that may contribute to lymphadenopathy. These differentials lead to changes in lymph node size and/or consistency and require further investigation with history, physical examination, and diagnostic testing.

Staging

Staging is a process in oncology that allows health care providers to determine the extent of disease burden from its primary locations.

It should be known that malignant lymphadenopathy can occur from both primary lymphomas or from metastatic cancer.

Most, but not all, cancers use the tumor, node, and metastasis (TNM) staging system. A tumor refers to the primary involvement by the neoplasm and the depth of involvement. Node describes the local lymph nodes that are involved by the disease process, and metastasis defines distant sites of involvement.

The staging of non-Hodgkin and Hodgkin lymphoma is based on the Lugano classification, which is based on the Ann Arbor system.[17]

• Stage I: Lymphoma found in 1 lymph node or in only one lymphoid organ

• Stage II: Lymphoma is found in 2 or more groups of lymph nodes on the ipsilateral side of the diaphragm

• Stage II: Lymphoma involvement bilaterally in reference to the diaphragm

• Stage IV: Lymphoma has metastasized to one organ beyond the lymphatic system

Prognosis

Generally, lymph node enlargement in younger populations (for example, children) tends to be benign and usually related to infection. There are exceptions to the rule, particularly if the patient’s history and physical are concerning for chronic infection, malignancy, or autoimmune conditions. Other risk factors that may be poor prognostic indicators include but are not limited to advanced age, length of duration of lymphadenopathy (> 4 weeks is concerning), generalized lymphadenopathy, male sex, lack of resolution of node size, and systemic signs (such as fever, night sweats, weight loss, hepatosplenomegaly).[18]

Complications

While lymphadenopathy itself may not lend itself to complications, unaddressed lymphadenopathy may lead to worsening progression of an underlying condition, the most concerning of which is sepsis or metastatic cancer. For lymphadenopathy related to autoimmune disorders, progressive autoimmune disease may lead to cancer or dysfunctional immunity, which may lead to significant morbidity and mortality.

Deterrence and Patient Education

Patient education remains critical in mitigating concerning lymphadenopathy. Abating interactions with modifiable risk factors such as alcohol, environmental toxins, recreational drugs, and/or tobacco may significantly reduce the risks of malignant lymphadenopathy. Immunizations and safe sex practices may help reduce the risk of infectious lymphadenopathy.

Enhancing Healthcare Team Outcomes

Health care providers like nurses, nurse practitioners, physician assistants, and physicians all need to be cognizant of the significance of lymphadenopathy. Most cases of lymphadenopathy are nonspecific, and thus, the provider caring for a patient needs to be aware of these signs in addition to advising patients to monitor for any abnormal growths or any inconsistencies in regional lymph node sites.

Review Questions

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• Comment on this article.

Figure

Bilateral hilar lymphadenopathy. Image courtesy S Bhimji MD

References

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Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A. Peripheral lymphadenopathy: approach and diagnostic tools. Iran J Med Sci. 2014 Mar;39(2 Suppl):158-70. [PMC free article: PMC3993046] [PubMed: 24753638]

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Ferrer R. Lymphadenopathy: differential diagnosis and evaluation. Am Fam Physician. 1998 Oct 15;58(6):1313-20. [PubMed: 9803196]

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Knight PJ, Mulne AF, Vassy LE. When is lymph node biopsy indicated in children with enlarged peripheral nodes? Pediatrics. 1982 Apr;69(4):391-6. [PubMed: 7070884]

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Williamson HA. Lymphadenopathy in a family practice: a descriptive study of 249 cases. J Fam Pract. 1985 May;20(5):449-52. [PubMed: 3989485]

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Mesin L, Ersching J, Victora GD. Germinal Center B Cell Dynamics. Immunity. 2016 Sep 20;45(3):471-482. [PMC free article: PMC5123673] [PubMed: 27653600]

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Kumar BV, Connors TJ, Farber DL. Human T Cell Development, Localization, and Function throughout Life. Immunity. 2018 Feb 20;48(2):202-213. [PMC free article: PMC5826622] [PubMed: 29466753]

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Strickler JG, Warnke RA, Weiss LM. Necrosis in lymph nodes. Pathol Annu. 1987;22 Pt 2:253-82. [PubMed: 3317224]

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Elmore SA. Histopathology of the lymph nodes. Toxicol Pathol. 2006;34(5):425-54. [PMC free article: PMC1892634] [PubMed: 17067938]

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Eberle FC, Mani H, Jaffe ES. Histopathology of Hodgkin’s lymphoma. Cancer J. 2009 Mar-Apr;15(2):129-37. [PubMed: 19390308]

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Johns ME, Moscinski LC, Sokol L. Phenytoin-associated lymphoadenopathy mimicking a peripheral T-cell lymphoma. Mediterr J Hematol Infect Dis. 2010 Sep 07;2(2):e2010028. [PMC free article: PMC3033141] [PubMed: 21415974]

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Sumi M, Ohki M, Nakamura T. Comparison of sonography and CT for differentiating benign from malignant cervical lymph nodes in patients with squamous cell carcinoma of the head and neck. AJR Am J Roentgenol. 2001 Apr;176(4):1019-24. [PubMed: 11264102]

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Weiss LM, O’Malley D. Benign lymphadenopathies. Mod Pathol. 2013 Jan;26 Suppl 1:S88-96. [PubMed: 23281438]

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Gaddey HL, Riegel AM. Unexplained Lymphadenopathy: Evaluation and Differential Diagnosis. Am Fam Physician. 2016 Dec 01;94(11):896-903. [PubMed: 27929264]

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Chau I, Kelleher MT, Cunningham D, Norman AR, Wotherspoon A, Trott P, Rhys-Evans P, Querci Della Rovere G, Brown G, Allen M, Waters JS, Haque S, Murray T, Bishop L. Rapid access multidisciplinary lymph node diagnostic clinic: analysis of 550 patients. Br J Cancer. 2003 Feb 10;88(3):354-61. [PMC free article: PMC2747551] [PubMed: 12569376]

Disclosure: Ruby Maini declares no relevant financial relationships with ineligible companies.

Disclosure: Shivaraj Nagalli declares no relevant financial relationships with ineligible companies.

Neck Swelling on One Side Symptoms, Causes & Common Questions

Cancer

A swelling on one side of the neck is frightening because it may signal a cancerous process. In general, any growth is the result of cells dividing and growing uncontrollably. Sometimes there

is a genetic mutation in DNA or a specific protein, or failure in an important checkpoint that results in this unchecked growth. These abnormal cells accumulate to form a noticeable lump that can be either benign or malignant (spread throughout the body).

• Lymphatics: The lymphatic system is susceptible to cancer. Cancers of this system are called lymphomas and there are many different types. Lymphomas often occur in the lymph nodes of the neck and can grow very rapidly, causing massive swelling and associated symptoms of fatigue, night sweats, and unintentional weight loss.
• Other: The other organs of the neck are also susceptible to the development of cancer. Anything from the nasal cavity to the larynx can develop cancer, especially in individuals who smoke or abuse alcohol.

12 conditions of neck swelling on one side

This list does not constitute medical advice and may not accurately represent what you have.

Viral throat infection

A sore throat is most often caused by the same viruses that cause influenza and the common cold. The illness spreads when an infected person coughs or sneezes, and then someone else inhales the airborne virus or touches a surface where it has landed.

Those most at risk for viral sore throat are children, smokers, those who work indoors with others, and anyone with a weakened immune system.

Symptoms include throat irritation; pain when swallowing or talking; red, swollen tonsils; fever; body aches; and cold-like symptoms of cough, sneezing, and runny nose.

If symptoms do not clear up within 24 hours – especially in children – a medical provider should be seen. A persistent sore throat can be a symptom of serious illness such as mononucleosis, measles, chickenpox, or croup.

Diagnosis is made through physical examination and throat swab.

Treatment involves rest, fluids, and over-the-counter pain relievers. Do not give aspirin to children. Antibiotics only work against bacteria and cannot help against a viral illness.

The best prevention is frequent and thorough handwashing.

Tooth abscess (infection)

A tooth abscess is a collection of infected material (pus) in the center of a tooth. It is due to a bacterial infection.

You should seek dental care within 24 hours. The diagnosis is made based on your history, an exam, and an x-ray of the mouth. If the abscess is affecting your breathing, it’s considered a medical emergency and you should seek emergency care. Treatment involves incision and drainage of the abscess in addition to antibiotics.

Rarity: Uncommon

Top Symptoms: severe jaw or tooth pain, swollen jaw, jaw stiffness, tooth pain that gets worse with hot, cold, or sweet beverages, warm and red jaw swelling

Symptoms that always occur with tooth abscess (infection): severe jaw or tooth pain

Urgency: Primary care doctor

Skin abscess

A skin abscess is a large pocket of pus that has formed just beneath the skin. It is caused by bacteria getting under the skin, usually through a small cut or scratch, and beginning to multiply. The body fights the invasion with white blood cells, which kill some of the infected tissue but form pus within the cavity that remains.

Symptoms include a large, red, swollen, painful lump of pus anywhere on the body beneath the skin. There may be fever, chills, and body aches from the infection.

If not treated, there is the risk of an abscess enlarging, spreading, and causing serious illness.

Diagnosis is made through physical examination.

A small abscess may heal on its own, through the body’s immune system. But some will need to be drained or lanced in a medical provider’s office so that the pus can be cleaned out. Antibiotics are usually prescribed.

Keeping the skin clean, and using only clean clothes and towels, will help to make sure that the abscess does not recur.

Retropharyngeal abscess

Retropharyngeal abscess is a collection of pus in the tissues in the back of the throat. It is a potentially life-threatening medical condition.

This is a medical emergency. Please seek out urgent care at your closest Emergency Department today. Diagnosis is done with imaging. Treatment is immediate surgical drainage and antibiotics.

Overactive thyroid

Overactive thyroid, or hyperthyroidism, means that the thyroid gland in the neck produces an excess of the hormone thyroxine and causes a metabolic imbalance.

Hyperthyroidism can be caused by autoimmune disorders such as Graves’ disease; by benign growths in the thyroid; or by inflammation of the gland, called thyroiditis.

The condition may run in families. Women seem to be more commonly affected than men.

Hyperthyroidism causes very high metabolism with sudden and unexplained weight loss, rapid and irregular heartbeat, sweating, nervousness, and anxiety.

Goiter, or swelling of the thyroid gland, may appear at the base of the neck. The eyeballs can protrude and become irritated, a condition called Graves’ ophthalmopathy.

If not treated, hyperthyroidism can lead to serious heart rhythm abnormalities and osteoporosis. An endocrinologist can diagnose the condition through a physical examination and simple blood test.

Treatment is done with anti-thyroid medications and sometimes radioactive iodine. Surgery to remove part of the thyroid gland may be done. The condition usually responds well to treatment and monitoring, and to improved diet, exercise, and stress reduction.

Non-specific neck pain

Non-specific neck pain means there was no definite injury or incident to account for the cause of the pain. If it lasts longer than three months with no resolution, it is considered chronic.

Diagnosis is made through physical examination and sometimes through imaging, primarily to rule out causes such as fracture or arthritis.

Neck pain often goes away on its own, only to return again for no apparent reason. However, a medical provider can offer some solutions to ease the symptoms and improve quality of life.

Treatment involves physical therapy, with exercises to improve stretching and encourage strengthening; applying a heating pad or a cold pack; and over-the-counter pain relievers such as ibuprofen. Other treatments may include traction; therapeutic massage; chiropractic manipulation of the neck and the rest of the spine; and electrotherapy, which helps to stimulate production of the body’s natural painkillers.

Alternate therapies such as acupuncture, laser therapy, and even psychological counseling may be tried. Simple lifestyle improvements in diet, exercise, and stress management are sometimes very helpful.

Neck sprain

Neck sprain, sometimes called “whiplash,” means that the ligaments – the tough, fibrous bands that connect bones together – in the neck have been torn or overstretched.

It is caused by a sudden impact that causes the head to whip back and forth very suddenly, most commonly from an automobile accident or riding a fast amusement park ride. A sports injury may force the neck to overstretch, spraining the ligaments.

Symptoms include pain and stiffness in the neck, shoulders, and upper back; dizziness; ringing in the ears; and sometimes spots of numbness in the hands and arms.

It is important to see a medical provider about these symptoms, to rule out any damage to the spinal cord. Paralysis, difficulty walking, or loss of control over bladder and bowels indicate a medical emergency. Take the patient to the emergency room or call 9-1-1.

Diagnosis is made through physical examination, tests of reflexes, and sometimes x-ray, CT scan, or MRI.

Treatment includes rest and over-the-counter nonsteroidal anti-inflammatory drugs to ease pain and reduce inflammation. Muscle relaxants may be prescribed.

Mumps

Mumps or “the mumps” is a viral infection for which most people have been vaccinated when they were a child. Though in rare cases, even vaccinated people can still get sick. Symptoms of the are swelling of the parotid gland (this gland produces your spit and is located in the cheek), fever, face pain and a sore throat.

Since this infection is caused by a virus, treatment with antibiotics is not helpful. It usually resolves on its own. You can seek advice over the phone or in a retail clinic to have other infections ruled out and get symptomatic treatment. If you are pregnant and possibly exposed to mumps, you need to call your doctor.

Ludwig’s angina

Ludwig angina is a bacterial infection of the floor of the mouth and occurs beneath the tongue.

You should visit an emergency room immediately. This requires immediate antibiotic treatment and, in some cases, surgery.

Head and neck cancer

There are five main types of head and neck cancer, which are all named according to the part of the body where they develop: laryngeal (voice box), nasal cavity and sinus, nasopharyngeal (air passage way behind the nose), oral (mouth), and salivary gland cancers. Most of these cancers are squamous cell carcinomas (SCCs), meaning they begin in the flat (squamous) cells that make up the thin surface layer of the structures in the head and neck.

You should visit your primary care physician who will coordinate your care with a cancer specialist (oncologist) for further testing. It is impossible to definitively diagnosis head and neck cancers without lab testing and biopsy. Treatment is likely to include surgery and chemotherapy.

Rarity: Rare

Top Symptoms: loss of appetite, unintentional weight loss, hoarse voice, neck bump, ear canal pain

Urgency: Primary care doctor

Enlarged lymph nodes in the neck

Enlarged lymph nodes occur when the node becomes larger as it fills with inflammatory cells. This often is a result of an infection but can occur without a known cause.

You should discuss with a health care provider whether or not your lymph node needs to be checked. Enlarged lymph nodes will usually shrink on their own. To speed up the process, try applying a warm, wet compress to the affected area.

Rarity: Common

Top Symptoms: neck bump, movable neck lump

Symptoms that always occur with enlarged lymph nodes in the neck: neck bump

Symptoms that never occur with enlarged lymph nodes in the neck:unintentional weight loss, fever, hard neck lump

Urgency: Phone call or in-person visit

Branchial cleft anomaly

A branchial cleft anomaly (abnormality) is a mass of unusual tissues within the neck. These tissues may form fluid-filled pockets called cysts, or they may form passages (called fistulas) that drain to an opening in the skin.

You should visit your primary care physician who will perform a thorough physical exam. Branchial cleft anomalies are usually treated with surgery, and it is important to check for any infection.

Acute thyroiditis

Acute thyroiditis is a rare inflammation of the thyroid gland caused by an infection, radiation, medication, or trauma.

You should seek immediate medical care at an ER. This is possibly a medical emergency and requires immediate diagnosis (thyroid function tests, blood tests, and imaging) and treatment (antibiotics, supportive care, stopping causative drugs).

Rarity: Ultra rare

Top Symptoms: sore throat, fever, being severely ill, hoarse voice, pain in the front of the neck

Symptoms that always occur with acute thyroiditis: pain in the front of the neck

Urgency: Hospital emergency room

Questions your doctor may ask about neck swelling on one side

• If you touch the swollen area, is there pain?
• Do food or drinks get stuck when you swallow?
• Any fever today or during the last week?
• Did you recently injure your neck?

Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.

Facial lymphedema

Head and neck lymphedema is a very common late treatment side effect for head and neck cancer. It is a chronic disease with potentially severe consequences for quality of life. Unfortunately, knowledge of the condition is poor and clinical studies are rare. Here we present an overview of the current clinical understanding of the condition and how it can be managed.

Want to know more about how your experience compares to other patients? Check: “Is my head and neck lymphedema “normal”?”

Contents [hide]
1 Part 1. Clinical features of head and neck lymphedema
1.1 what is lymphedema?
1.2 What is head and neck lymphedema and how does it happen?
1.3 What are the symptoms of head and neck lymphedema?
1.4 How is head and neck lymphedema diagnosed?
1.5 Risk factors for head and neck lymphedema after cancer treatment
1.6 Prevalence of head and neck lymphedema after cancer treatment
2 Part 2: Prevention and treatment of secondary head and neck lymphedema
2. 1 Prevention and self-regulation of head and neck lymphedema after cancer treatment
2.2 Professional management of head and neck lymphedema after cancer treatment
2.2.1 gold standard treatment
2.2.2 Surgical options
2.2.3 Pharmaceuticals and supplements
3 comments or questions?
4 references
Part 1: clinical features of head and neck lymphedema
what is lymphedema?

Lymphedema is a chronic condition of swelling caused by damage to the lymphatic system (“secondary lymphedema”) or malformation of the lymphatic system (“primary lymphedema”). A disruption in the normal function of the lymphatic system in an area of ​​the body results in insufficient clearance of the lymphatic fluid (lymph) from that area. As the blood transports oxygen and nutrients to the cells of the body and collects waste products for excretion, 80% of the fluid returns to the bloodstream while 20% enters the lymphatic system as lymph, the colorless liquid that makes up the bulk. Eventually the lymph returns to the bloodstream in the heart.

More than just a fluid collection system, the lymphatic system is an essential component of the immune system, transporting immune cells around the body. Consequently, the blockage of lymphatic flow causes fluid buildup as well as other deleterious changes, including localized immune depression. Lymphedema is usually seen in the extremities (arms and legs) but is also very common in people treated for head and neck cancer. Learn more about lymphedema here.

what is head and neck lymphedema and how is it caused?

Secondary lymphedema of the head and neck usually results from damage to the local lymphatic system during cancer biopsy or treatment (see Figure 1 for an illustration of some of the lymph nodes and vessels of the head and neck). Removal of lymph nodes during cancer biopsy or tumor resection is the main cause of secondary lymphedema in patients with head and neck cancer. This is a direct consequence of the essential role of the lymph nodes in collecting lymphatic fluid from small lymphatic vessels and draining it into larger vessels leading to the heart.

Radiation therapy can also cause damage to any remaining lymph nodes and lymph vessels located in the radiation field, another potential cause of lymphedema. Unfortunately, the large number of nodes in the head and neck area makes radiation-induced damage more difficult to avoid. Stimulation of the normal lymphatic flow in the head and neck leads to a buildup of lymphatic fluid and then a chronic and progressive swelling that can affect various areas of the head, neck and face.

Lymph glands and vessels-of-the-head-and-neck Figure 1. Superficial lymph glands (nodes) and lymphatic vessels of the head and neck (Ref. 1).
As with arm or leg, head and neck lymphedema, lymphedema should be caught and treated early to relieve symptoms and prevent or delay the progression of the disease.

Uncontrolled edema causes additional damage by overstressing the remaining normal lymphatic vessels, and may also initiate a cascade of deleterious events, including localized inflammation, immune system impairment, and eventually hardening of the edema (which is termed “non-punctate lymphedema”) , further exacerbating the problem.

Hardening is the result of compositional changes occurring in tissue, including fibrosis (scarring), connective tissue proliferation, and fat (and to a lesser extent muscle and bone) accumulation, possibly the result of altered stem cell behavior. This advanced stage of the disease is less responsive to typical treatments and may require surgery (see below).

what are the symptoms of head and neck lymphedema?

The main symptom of head and neck lymphedema is swelling, usually developing 2-6 months after cancer treatment. In the early stages of swelling, head and neck lymphedema can be difficult to observe. Head and neck lymphedema can develop internally in the larynx and pharynx (which are the various structures that make up the mouth and throat), or externally in the neck and face, or a combination of both, depending on which lymphatic channels are obstructed.

More rarely, the tumor may progress to the point where it creates serious functional problems such as difficulty breathing and swallowing, as well as obvious problems with body image and associated social output arising from deformity of the neck and face (art. 2). Overall, head and neck lymphedema has the potential to seriously impair the quality of life of patients. To see how your symptoms compare to a group of 1,202 head and neck cancer patients at the M.D. Anderson Cancer Center (MDACC) in Texas, check out our post: “Is my head and neck lymphedema ‘normal’?“.

Symptoms of mild to moderate lymphedema of the head and neck may include:

Visible swelling under the chin, in the neck, or in the face, including the eyes and lips.
Feeling of tightness or limited movement in these areas, including the jaw or shoulders.
Symptoms of moderate to severe lymphedema of the head and neck may include:

Severe swelling of the face and neck
Swelling feels hard and hard to the touch
Visual or auditory impairment
Difficulty breathing, swallowing, eating, or speaking
Nasal congestion, chronic ear pain
How is head and neck lymphedema diagnosed?

Lymphoscintigraphy or other imaging modalities involving injections of contrast agents to visualize lymphatic fluid flow pathology may lead to a definitive diagnosis of lymphedema, but this is usually diagnosed by mild means. The presence of lymphedema is usually assessed based on observations, the results of the physical examination, the patient’s symptoms, and a review of the patient’s history. Alternative causes of the tumor need to be identified. Accordingly, the early stages of the disease can be particularly difficult to diagnose.

The patient’s subjective findings (such as feeling “tight” or “heavy”) are often the earliest indications, while objective measurements of volume change may be more difficult to obtain. This is especially true for early internal lymphedema and early external lymphedema in areas such as the chin, where there is no symmetrical counterpart that can be compared (as opposed to swelling on one side of the face that can be compared to the other unaffected side).

External lymphedema is often classified into one of four common weights. However, standardization is lacking, and this scale appears to be imperfectly suited for capturing the stage of head and neck lymphedema (Model Number/Ref. 3).

Modification of the Foldy scale for categorizing extrinsic lymphedema does a good job of capturing the range of soft tissue changes seen with progression of untreated head and neck lymphedema (see Table 1), although further validation of the scale is warranted (see Table 1). 4).

Lymphedema Feldi score modified for head and neck Lymphedema Table 1: Modified Feldi score for head and neck clients (ref. 5). This is beyond the time that normal acute post-treatment edema is usually seen.

External lymphedema is identified by visible swelling of the face or neck, and can be best quantified using a “composite facial score” consisting of seven measurements, as well as a “composite neck score” consisting of 3 measurements (model number / Ref. 4) . Measurements are needed to establish baselines, monitor changes, and improve tracking.

In contrast to internal edema, swelling of the mucous membrane and soft tissues of the pharynx and larynx is visible. Internal lymphedema is more difficult to quantify. An endoscopy or examination mirror by an experienced practitioner can be used to measure 11 internal anatomical sites and two Patterson scale sites (art. 5).

risk factors for head and neck lymphedema after cancer treatment

Fundamentally, the risk of lymphedema increases as a function of lymphatic damage. Perhaps the best predictor of likelihood is the number of lymph nodes that were removed during surgery; the more nodes removed, the more likely it is to develop head and neck lymphedema. Studies on head and neck lymphedema show that the total dose of radiotherapy as well as the number of days of radiotherapy also increase the risk of developing lymphedema (Ref. 6).

In addition to the number of lymph nodes removed, additional factors may change your chances of developing head and neck lymphedema. A study of arm lymphedema secondary to breast cancer shows that the chance of lymphedema increases for patients who:

Received chemotherapy before or after surgery (ref. 7),
Have a high Body Mass Index (BMI) of
Have genetic factors associated with lymphedema
Report about lower general health indicators (see 7)

Frequently asked questions about lymphedema associated with breast cancer treatment

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This information answers frequently asked questions about lymphedema associated with breast cancer treatment.

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What is lymphedema?

Click to display an interactive image.

Lymphedema is swelling that develops when the lymphatic vessels in a location in your body can no longer drain all of the lymph fluid away from that area. In this case, lymphatic fluid can accumulate and cause swelling.

Lymphedema may develop in the arm, hand, fingers, breast, or trunk on the side of the operation (i.e., where the lymph nodes were removed).

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What is my risk of developing lymphedema?

The risk of developing lymphedema depends on how the lymph nodes were removed (see Figure 1). Two types of surgery can be done to remove lymph nodes: sentinel lymph node biopsy and axillary lymph node removal.

A sentinel lymph node biopsy in the armpit removes one to more lymph nodes to check for cancer cells. The risk of developing lymphedema after sentinel lymph node biopsy is low. It is estimated that no more than 7 out of every 100 people who have a sentinel lymph node biopsy will develop lymphedema.

During axillary lymph node removal, more lymph nodes are removed in the armpit. This is done in order to remove additional lymph nodes that may contain cancer cells. After removal of the axillary lymph nodes, the risk of developing lymphedema is higher than after biopsy of the sentinel lymph node. About 15 to 25 out of every 100 people who have axillary lymph nodes removed can develop lymphedema.

Figure 1 Lymphedema risk assessment

The risk of developing lymphedema can also be increased if the lymphatic system is damaged. This damage can be caused by:

• radiotherapy of the armpit affected by the treatment;
• infection or serious injury (such as a serious burn) to the treated arm, hand, fingers, or breast after surgery;
• tumor growth in or near the armpit on the side that underwent surgery;
• overweight in the diagnosis of breast cancer;
• Gaining or losing more than 10 pounds (4. 5 kg) in a month after surgery.

It is impossible to predict exactly which patients will develop lymphedema.

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What can I do to reduce my risk of developing lymphedema?

Doing the following may help reduce your risk of developing lymphedema.

• Maintain a healthy body weight or try to reach it in safe ways.
• Carry something heavy on your untreated arm or both arms until you regain strength on the treated side.
• Exercise and stretch your muscles regularly. Discuss with your doctor or nurse about which exercises are right for you.
  • When resuming exercise and daily activities, be sure to do so slowly and gradually. If you feel uncomfortable, stop and take a break. Exercise shouldn’t hurt.
• In the event of a cut or scratch on the arm or hand on the side affected by the treatment:
  1. Wash the area with soap and water.
  2. Apply an antibacterial ointment such as Bacitracin® or Neosporin®.
  3. Apply a bandage, such as Band-Aid®.
• In the event of a burn on the arm or hand on the side affected by the treatment:
  1. Apply a cold compress to the affected area or place it under cool tap water for about 10 minutes.
  2. Wash the area with soap and water.
  3. Apply a bandage, such as Band-Aid.
• If you notice any signs of infection (such as redness, swelling, warmer than normal skin, or tenderness), call your healthcare provider.

If your axillary lymph nodes were removed:

• Ask your health care staff to take blood samples, give injections (shots), give intravenous (IV) lines, and measure blood pressure in your untreated arm.
  • In some situations, if blood cannot be drawn from an unaffected arm, the affected arm can be used. The health care provider can tell you about them.
  • If it is not possible to inject into the unaffected arm, gluteal muscle, thigh, or abdomen (abdomen), injection into the affected arm can be given.
  • If blood pressure cannot be measured on the untreated arm, the affected arm may be used.
  • If lymph nodes have been removed on both sides, talk to your healthcare provider about which arm is safe to use.
• Watch out for sunburn. Use sunscreen with an SPF of at least 30. Apply it as often as possible.
• Use insect repellant to prevent insect bites.
• Use lotion or cream daily to protect the skin of the affected arm and hand.
• Do not trim the cuticle on the treated arm. Instead, gently push it back with a cuticle stick.
• Wear protective gloves when doing yard or garden work, washing dishes, or using strong detergents or wire cloths.
• Wear a thimble while sewing.
• Be careful when shaving the underarm area of ​​the affected arm. It might be better to use an electric razor. If you get a cut while shaving, treat it by following the instructions above.
• Do not apply heating pads or hot compresses to the affected arm, shoulder, or chest.
• Do not wear tight-fitting or heavy jewelry, or clothing with tight elastic bands that leave marks. All of these can cause swelling.

If you have had a sentinel lymph node biopsy:

• On the arm affected by the treatment, you can take blood for analysis, make injections, put intravenous drips and measure blood pressure. However, ask medical staff to do this on the unaffected arm if possible.
• If you start noticing any signs of lymphedema, always use your untreated arm. If this is not possible, discuss with your healthcare provider which hand is safest to use.

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How long does it take for lymphedema to develop?

Lymphedema can develop immediately after surgery or months or even years later.

Slight swelling after surgery is normal. This swelling may last up to 6 weeks, but it is temporary and will gradually disappear.

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What are the signs of lymphedema?

• Feeling of heaviness, pain or aches
• Feeling of skin tightness
• Reduced Flexibility
• Edema
• Changes in the skin, such as tightness or pitting (when a pressure mark is left on the skin)

If you have swelling, you may notice the following:

• veins on the hand of the affected arm are less visible than on the other hand;
• rings on the finger(s) of the affected hand are tight or do not fit;
• the sleeve of the shirt on the treated side is tighter than usual.

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What should I do if I think I have lymphedema?

Call your healthcare provider if you notice any signs of lymphedema.

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How to treat lymphedema?

Treatment for lymphedema can be simple or intensive. A rehabilitation therapist or physical therapist who specializes in lymphedema can help you find the best program for you.

Treatment includes 4 main points:

• Skin care. The recommendations above are examples of how you can take care of your skin.
• Compression . Compression helps drain lymphatic fluid from the swollen area. Compression can be provided by elastic (stretch) garments, tight elastic compression bandages, and other inelastic (non-stretch) compression garments that are often worn at night. Your lymphologist will discuss with you the best options for you.
• Physical exercise . An exercise program can help you get rid of the swelling. Perform the program slowly and carefully so that the muscles get used to it gradually.
• Manual lymphatic drainage . Manual lymphatic drainage (MLD) is a gentle massage of the lymphatic system that can help drain lymphatic fluid from a swollen area. If you have questions about MLD or massage, please consult your lymphologist.

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Can I take any medication to reduce swelling?

No. There are currently no approved drugs to treat lymphedema.

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Will the swelling go away?

Edema may decrease, stabilize, or gradually increase over time. Following a program to treat edema will help control it.

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When is it safe to start your daily activities and exercises?

You can slowly and gradually return to your usual way of life. Your lymphologist may recommend that you wear a compression garment or bandage.

We encourage you to keep doing what you love. If you have questions about returning to your normal lifestyle or lymphedema, talk to your health care provider or lymphologist.

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Support Services

National Lymphedema Network
The National Lymphedema Network provides educational materials and community referrals.
www.lymphnet.org
415-908-3681

American Cancer Society (ACS)
ACS provides information about the diagnosis and treatment of lymphedema.
www.cancer.org
800-227-2345

National Cancer Institute (NCI)
The NCI provides information on the diagnosis and treatment of lymphedema.
www.cancer.gov
800-4-CANCER (800-422-6237)

Step Up, Speak Out Program
The Step Up, Speak Out Program provides information and educational materials about lymphedema.
www.stepup-speakout.org

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