Swollen glands

A lymph node is a small filter set along the course of the lymph, with immune cells living inside it. When an infection appears nearby the node gets to work, swells and becomes noticeable: that is exactly what it is supposed to do. So "I have felt a little lump on my neck" most often means the body is dealing with something, not that something dreadful has happened. But not always, and the whole value of this page lies in showing how the two differ.

Where glands can be felt, and what counts as ordinary

They can be felt where they lie close to the surface: at the sides of the neck and under the jaw, behind the ears and at the back of the head, in the armpits, in the groins and, occasionally, above the collar bone and near the elbow. Nodes in the chest and abdomen cannot be found by hand: they show up only on scans.

Some nodes can be felt in completely healthy people. Small mobile lumps in the neck and groin are an ordinary finding, especially in children: a child's immune system works hard, and almost every child has small nodes in the neck. In an adult, a groin node of up to two centimetres is also often old and harmless. And it happens that, after a long-forgotten infection, a small firmish lump stays where it is for years and never changes again.

What matters more than size is how it behaves: whether it appeared this week or has always been there, whether it is growing or staying the same, whether it is one node or many.

The reactive node: what it is like and how long it lasts

A node is called reactive when it has enlarged in response to an infection nearby. You recognise it by the whole set of features:

• it appeared quickly, over a day or two, soon after a sore throat, a cold, an ear infection, a bad tooth or a break in the skin;
• it is tender when pressed, and sometimes sore on its own;
• it is soft or rubbery, not stony;
• it is mobile: it shifts under the fingers and is not stuck to the skin;
• the skin over it may be slightly red and warm;
• it gets noticeably smaller within two to three weeks.

The timing is worth being precise about, because this is where people frighten themselves for nothing. A reactive node starts to go down within two to three weeks, but it takes far longer to disappear altogether: a small residual lump may still be felt for months, and that is normal. What is worrying is not that the node is still there, but that after a month it has not become smaller, or is still growing.

Nodes enlarge in the area that "serves" the sore spot: with tonsillitis or a dental problem, under the jaw and at the sides of the neck; with an infection on the arm, in the armpit; with a wound on the leg or a sexually transmitted infection, in the groin. If a node has grown where nothing nearby was sore and there was no wound or inflammation, that alone is a reason to be seen.

What raises suspicion, and why painlessness is not reassuring

Let me say it plainly, because it is the commonest mistake people make: "it does not hurt, so it is nothing" is the argument the wrong way round. Pain is how inflammation announces itself, which is to say the ordinary reactive story. A node in which something serious is happening usually grows without hurting, and so it fails to worry anyone for a long time. That logic is exactly why people come late. Painlessness is not reassuring; it raises suspicion.

Have the node looked at without delay if:

• it feels hard;
• it is fixed: it does not shift, as though it were anchored deep down or to the skin;
• it is painless;
• it is growing: clearly bigger over a few weeks;
• it is more than two centimetres across, about the size of a grape or larger;
• it has lasted longer than a month without shrinking;
• nodes are enlarged in several parts of the body at once;
• alongside the node there are drenching night sweats (you have to change the bedding), a temperature with no clear cause, weight loss you cannot account for, persistent itching of the skin, or unusual tiredness;
• the skin over it has changed, or the node has broken through the skin or gone soft in the middle.

Three situations where nothing is waited out

The list above works as a set: the more points it ticks, the less reason there is to watch and wait. But there are three cases where one feature is enough on its own.

A node above the collar bone, or just below it. This spot always deserves attention, whatever its size, whether it moves and whether it hurts. Lymph reaches it from the chest and the abdomen, so an enlarged node here means the answer is to be looked for outside the neck.

A hard node on the neck of a smoker over forty is a reason for cancer vigilance, not a "chill". Such a node can be the first and only visible sign of a cancer of the voice box, throat, mouth or tongue, particularly if there is hoarseness alongside it, a sore throat on one side only, earache, a mouth ulcer that will not heal or difficulty swallowing. An examination is needed within days, and that applies to people who used to smoke as well.

A node in the armpit with no wound or inflammation on that arm, and all the more so if there is a lump in the breast or the skin or nipple has changed. This applies to women and to men.

Why glands swell

There are many causes, and in most of them the outlook is good, but the whole range is worth knowing.

• Ordinary infections: viral illnesses of the throat and nose, tonsillitis, an ear infection, a bad tooth, a wound or a boil on the skin. These are the overwhelming majority of cases.
• Infectious mononucleosis, a very common cause of large nodes in teenagers and young adults. The neck nodes are big, with a severe sore throat, a temperature and weeks of exhausting fatigue alongside; sometimes the spleen enlarges, which is why contact sport and heavy exertion are off during that period.
• Tuberculosis of the lymph nodes. The neck nodes grow over months, barely hurt, mat together into a firm block and may soften and break through the skin. Commoner in people who have come from areas where tuberculosis is frequent, and in those who have been in contact with a case.
• Cat scratch disease. A single node near the scratch or bite, appearing one to three weeks later, sometimes tender and lasting a long time. Mention the cat: without that detail the cause cannot be guessed.
• Toxoplasmosis: neck nodes and tiredness, caught from the cat litter tray and from undercooked meat. It matters particularly in pregnancy.
• HIV infection, one of the causes in which nodes are enlarged in several areas at once and stay enlarged. With that picture an HIV test is part of the routine work-up.
• Medicines. Some anti-epileptic drugs, gout medicines and certain antibiotics cause nodes to enlarge, sometimes with a rash and a temperature; bring the list of what you take. Vaccination belongs here too: a node on the side of the injection lasts a few weeks and is an expected reaction.
• Lymphoma, leukaemia and secondary deposits from other cancers: rare, but precisely the reasons the list above exists.

Is it a gland or something else?

The neck, armpit and groin hold more than lymph nodes, and the confusion is common. A few pointers that will help you describe it better:

• A thyroid nodule or a goitre sits on the front of the neck and moves upwards when you swallow.
• A salivary gland: a swelling under the jaw or in front of the ear that swells and hurts while eating, especially with anything sour.
• A lipoma: soft, doughy, rolls easily under the fingers, grows over years. A skin cyst: round, smooth, often with a tiny pore in the centre.
• A groin hernia appears on standing and on straining, and goes down when you lie flat.
• An abscess or an inflamed hair follicle in the armpit or groin: hot, red, sharply painful.

Working all this out with your own fingers is not possible even roughly, and it does not need to be: there is a separate page on this site about lumps under the skin, and at an appointment a doctor separates them in a minute. Your job is simpler — to notice and describe whether the lump moves when you swallow, whether it changes with meals, whether it only appears when you stand.

What the doctor does

They will ask about recent infections, teeth, wounds, cats, travel, contact with tuberculosis, medicines and vaccinations, and about temperature, sweating and weight. Then they will feel not only the node you found but every group of nodes, and examine the throat, mouth and skin and, if needed, the abdomen for the liver and spleen.

After that it depends: a full blood count, inflammatory markers, tests for mononucleosis, tuberculosis, toxoplasmosis and HIV, an ultrasound scan of the node, a chest X-ray. If the picture does not clear up or the signs are worrying, the node itself is examined: cells are taken from it or, more reliably where lymphoma is suspected, one whole node is removed for analysis. Being sent for a biopsy does not mean the doctor has found something bad; it is the way to stop guessing. And one more thing: antibiotics do not work on viruses, so a course "just in case" for a node of unclear origin does not help and does steal time.

What you can do yourself, and what not to do

While the cause is clear and it is an ordinary infection, simple things help: rest, enough to drink and, if it is sore, one of the usual over-the-counter painkillers such as paracetamol or ibuprofen, at the dose on the packet and taking your other conditions into account. Aspirin is not given to children or teenagers.

And here is what not to do:

• do not apply heat, compresses or rubbing: warmth increases inflammation and helps infection spread;
• do not massage it, squeeze it or try to press it out;
• do not feel it ten times a day: constant pressure irritates the tissues, and you cannot tell by touch whether it has grown anyway. Better to photograph it once a week beside a coin or a ruler;
• do not take antibiotics that were not prescribed;
• do not diagnose yourself from pictures online, and do not put the visit off because the node does not hurt.

What is useful is to write down the date you noticed it and note what happened shortly before: a cold, a dental appointment, a trip abroad, a scratch from the cat, a new medicine. Those small details are, more often than not, the answer.

Online consultation

A node cannot be felt through a screen, but most of the work here is done by the conversation: where it is, when it appeared, what came before, whether it is growing, whether it hurts, whether there is fever, sweating and weight loss. An Oladoctor doctor will go through that with you, look at photographs, and say whether this looks like an ordinary response to an infection or whether an examination is needed — and if it is, within what time and with whom. They will tell you which tests are worth doing straight away, explain results and ultrasound reports you already have, check your medicines and help you prepare for the visit. And if what you describe falls into the list of warning signs — a node above the collar bone, hard and painless, night sweats and weight loss — you will be told plainly, and nobody will suggest waiting.

This material is for information only and does not replace medical advice.