Swollen Glands, Good or Bad?
When we get sick, we often notice sore lumps in our neck. These are the lymph glands, or more accurately the "lymph nodes". They are important organs in your body, which produce white blood cells to fight infection. When you are sick, or injured, the lymph nodes work harder to produce more white blood cells, so they get larger. This is a good thing, because you need to have larger white blood cell "factories" at a time when you need more white blood cells!
If you look carefully, almost all sick children will have lymph nodes in the neck area, and often other areas, such as armpits, groin, and several other places. The place depends on the site of the infection. For example, we often see several pea-sized lymph nodes either behind or in front of the ear with a swimmer's ear infection. Often lymph nodes will stay large for months, so they will be noticeable even when the child (or adult) is not sick.
When should we worry about large lymph nodes?
Sometimes the lymph nodes themselves get infected. This is called "lymphadenitis", and is usually caused by common germs such as Staph and Strep. Sometimes, lymphadenitis is caused by more exotic germs such as cat scratch disease (from cats) or brucellosis (from rabbits) or others. Most of these can be treated with the same antibiotics that kill Staph and Strep, so we usually start with a common antibiotic such as cephalexin or trimethoprim-sulfa, to treat lymphadenitis.
The signs of lymph node infection include: persisting fevers, nodes that keep getting larger, very painful nodes, or nodes that are red or draining pus. Most lymph nodes are less than three-quarters of an inch across when they are healthy, so larger than that for more than a few days, or any of the above signs, should suggest a visit to the doctor.
How common is lymph node cancer?
Cancer in the lymph nodes can originate in the nodes (lymphoma) or can start anywhere else and spread to the lymph nodes. Fortunately, both lymphoma and metastatic (spreading) cancer are rare in children. If an enlarged lymph node does not improve after two courses of antibiotics, it is recommended that the node be removed for a biopsy. The vast majority of these biopsies show cat scratch or some other infection, but rarely will detect a lymphoma. Then the child would be referred to an oncologist for treatment. Signs of lymphoma include nodes that keep getting larger, usually not painful, weight loss, and lethargy.
How often would a child have to get a biopsy of his lymph nodes?
Fortunately, almost never! Even though we commonly see 3/4 inch and larger nodes with a sore throat or even a cold, they usually cool off quickly when the infection is over. After a week, if a node is still larger than 3/4 inch, you should call the doctor. Be sure to tell the doctor if your child has been scratched by a cat or kitten, since this would increase the chance of it being cat scratch disease. Most of the time our hard-working lymph nodes return to a more normal size of 1/2 inch or less, once their work is done.