causes, symptoms, diagnosis and treatment

Infections, autoimmune diseases or cancers can be accompanied by an increase in the size of the lymph nodes called lymphadenopathy. How does it manifest? What does it reveal? How is the diagnosis made?

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Behind the term adenopathy hides a long list of potential causes of various natures, ranging from simple infection by an adenovirus to the presence of a tumour. In all cases, the swelling of the lymph nodes testifies to an immune reaction to an attack.

What is it about ?

The term lymphadenopathy means “an abnormal increase in the size of the lymph nodes”, says Professor France Roblot, infectious disease specialist at the Poitiers University Hospital. These nodes, which belong to the lymphatic system and are distributed throughout the body, filter the lymphatic fluid and trigger the production of lymphocytes in the presence of pathogens. In this, they are the first line of defense of the immune system. Some are superficial and can be felt (occipital lymph nodes – behind the neck -, cervical, axillary, inguinal, etc.). Others are lodged deeper in the body (thoracic and abdominal lymph nodes, etc.), the increase in their size is only visible on medical imaging.

“In the event of aggression – whatever the nature – of an organ in the territory of a group of ganglia, these are stimulated and react by a proliferation of cells which generates an increase in their volume.continues Professor Roblot. We speak of lymphadenopathy when the size of a node exceeds 1 cm”.

The different types of lymphadenopathy

Adenopathy can concern a single group of ganglia, it is then said to be localized “and reveals a problem of loco-regional originsays Professor Roblot. An increase in the size of the nodes located at the level of the groin can suggest, for example, a problem in the external genitalia or in the lower limbs. Lymphadenopathy located in the cervical region suggests, for its part, an anomaly in the ENT sphere”.

Another type of adenopathy, that described as diffuse, that is to say which concerns several lymph node groups at the same time. It evokes, in this case, a more general cause which is not limited to the territories of the abnormally voluminous lymph nodes.

What are the causes of lymphadenopathy?

There are many reasons that can explain the swelling of the lymph nodes. We will cover the most common ones.

When lymphadenopathy is localized, it is often the result of a local infection of viral, bacterial or parasitic origin. “This is for example the case with a wound with staphylococcus, cat-scratch disease”, illustrates the infectiologist. Among the causes of localized lymphadenopathy are also viral infections of the airways or certain sexually transmitted infections such as herpes simplex or syphilis.

More rarely, localized adenopathy can also be due to the existence of cancer. Thus, pulmonary neoplasms are frequently accompanied by swelling of the lymph nodes located under the clavicle, breast tumors can metastasize to the axillary lymph nodes, ENT cancers are likely to induce cervical lymphadenopathy, etc.

When lymphadenopathy is diffuse, it may indicate a viral infection. “Diseases such as measles and rubella in children, infectious mononucleosis or primary HIV infection are accompanied by an increase in the size of several lymph node groups”observe le Pr Roblot.

The same is true in the presence of autoimmune diseases such as lupus erythematosus, rheumatoid arthritis or dermatomyositis. Finally, among the causal pathologies, we can mention Hodgkin’s disease and other lymphomas, and sarcoidosis. Note that many drugs can cause polyadenopathy, like some antibiotics or antiepileptics.

Before looking for the cause, it is advisable to make sure that it is indeed a lymphadenopathy. Swelling of the lymph nodes can indeed be confused with other similar phenomena, such as a lipoma, a cyst, hyperthyroidism, etc.

Once the other causes have been eliminated, the clinical examination consists of observing the symptoms. “The number of lymph node territories involved, their location and their appearance are very telling.explains France Roblot. If the lymphadenopathy is inflammatory, red, mobile, painful, it points to an infectious cause, all the more so if there is an entry point, such as a wound. We will think more of cancer when the adenopathy is hard, fixed to the underlying tissues, painless and not very inflammatory”.

The practitioner also endeavors, during his examination, to look for associated signs: Thus, an eruption of pimples evokes an infectious cause, profuse sweating or a large spleen suggest lymphoma, lung damage pleads for sarcoidosis, an alteration in general condition, sudden weight loss or intense fatigue may suggest cancer…

What examinations in case of lymphadenopathy?

Depending on the context, examinations complement the first observations. “The basic biological assessment includes the count of the blood formula, the search for liver enzymes and antibodies against the pathogens possibly involved.explains Professor Roblot.

A scanner is sometimes prescribed to inspect the presence of deep adenopathies, inaccessible to palpation. This imaging examination has its place in particular in the slightest doubt of a cause of tumoral origin. Doctors now rely on the PET-Scan, which makes it possible to count abnormal lymph nodes, identify their location and locate the most accessible to guide a possible biopsy at a later date.

“It may be necessary to perform a cytopuncture, i.e. a needle samplecontinues Professor Roblot. This makes it possible to see, when an infectious cause is suspected, whether the lymph node contains pus”. In the presence of a swollen lymph node for a month without a cause being identified, or when there is a strong suspicion of lymphoma or tumor, a biopsy is performed surgically. The sample taken is then sent to several laboratories for analysis: anatomo-pathology, bacteriology, hematology laboratory, etc.

What treatments for lymphadenopathy?

“Lymphadenopathy is not treated, it is a marker revealing an infection, an autoimmune disease, a tumor or a hematological pathologysums up Professor France Roblot. The treatment put in place can only be that of the cause. We treat the disease, not the adenopathy”. The range of possible treatments is therefore very wide, from antibiotics in the event of a bacterial infection to chemotherapy in the presence of cancer. “In most cases, fortunately, the adenopathies are consecutive to a viral infection and return to order spontaneously “reassures Professor Roblot.

Who to consult?

First, the general practitioner. “If it is a simple lymphadenopathy, with an obvious cause, the attending physician treats it alonenotes Professor Roblot. On the other hand, he turns to specialists when, after a debriefing assessment, there is no clear orientation or when the general practitioner has exhausted his diagnostic and therapeutic resources. The attending physicians are very cautious when they lack guidance: if the situation does not evolve favorably after a month at most, they invite their patients to refer them to a specialist.. Depending on the context, patients can then consult an internist, a hematologist, an oncologist or an infectiologist.

Lymphadenopathy being an immune reaction to an attack, this attack should be prevented to avoid an increase in the volume of the lymph nodes. It is therefore impossible to provide specific advice in terms of prevention as the causes can be numerous. In general, the eviction of risky practices and the adoption of a healthy lifestyle (varied and balanced diet, regular practice of physical activity).

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