Nodal disease is a broad term for any condition that affects the lymph nodes, causing them to become enlarged or abnormal. These small, bean-shaped glands are part of the lymphatic system, a network of vessels and organs running throughout the body. The lymphatic system carries a clear fluid called lymph, which contains white blood cells that help defend the body against germs and infections.
Functioning as biological filters, lymph nodes trap and destroy foreign particles like bacteria and viruses. They are located in clusters in areas like the neck, armpits, and groin. When the body is fighting an infection, these nodes can swell as they work to clear harmful substances. This enlargement, medically known as lymphadenopathy, is a signal that the immune system has been activated.
Underlying Causes of Nodal Disease
Infections
The most frequent reason for swollen lymph nodes is an infection. Viral infections are a common trigger. For example, upper respiratory infections like the common cold or viral illnesses such as mononucleosis can lead to noticeable swelling, particularly in the lymph nodes of the neck.
Bacterial infections also cause nodal disease. Strep throat often results in tender, swollen nodes in the neck. Skin infections, like cellulitis or an abscess, can cause the lymph nodes nearest to the affected area to enlarge. Less common infections like cat-scratch disease or tuberculosis can also be the underlying cause.
Cancers
Nodal disease can also be a sign of cancer. This occurs in two primary ways: the cancer starts within the lymph nodes, or it spreads to them from another part of the body. Cancers that originate in the lymphatic system are called lymphomas, with the main types being Hodgkin lymphoma and non-Hodgkin lymphoma. In these conditions, lymphocytes grow and multiply uncontrollably within the nodes.
More commonly, cancer spreads to the lymph nodes from a primary tumor located elsewhere in the body, a process known as metastasis. Cancer cells can break away from the original tumor, enter the lymphatic vessels, and become trapped in the downstream lymph nodes. For instance, breast cancer often spreads to the axillary (armpit) lymph nodes, while lung cancer may spread to nodes in the chest.
Inflammatory and Autoimmune Conditions
Systemic inflammatory conditions can provoke a reaction in the lymph nodes, causing them to swell. In autoimmune diseases, the body’s immune system mistakenly attacks its own tissues, leading to chronic inflammation that can affect the lymph nodes. Conditions like rheumatoid arthritis and lupus can cause generalized lymphadenopathy, where multiple lymph node groups throughout the body become enlarged. Sarcoidosis, a condition characterized by the formation of inflammatory cells in various organs, can also lead to their enlargement.
Signs and Symptoms
The primary sign of nodal disease is the enlargement of the lymph nodes, which can be felt as lumps under the skin. These are found on the sides of the neck, under the jaw, in the armpits, or in the groin. The characteristics of these swollen nodes can provide clues to the underlying cause. Nodes that are tender or painful to the touch suggest an infection, as the rapid swelling stretches the node’s capsule.
In contrast, nodes that are painless may be more concerning for other causes. The consistency of the node is also telling; nodes related to infections are soft and movable, whereas nodes that feel hard, rubbery, or fixed in place can be associated with more serious conditions. The size is also a factor, with nodes larger than a pea or grape warranting attention.
Beyond localized signs, nodal disease can be accompanied by systemic symptoms. The presence of “B symptoms” is significant and includes unexplained fevers that can come and go, drenching night sweats that soak through clothing, and unintentional weight loss of more than 10% of body weight over six months. Persistent fatigue is another common systemic symptom that can occur with various causes of nodal disease.
Diagnostic Process
Diagnosing the cause of nodal disease begins with a medical history and a physical examination. A healthcare provider will ask about the duration of the swelling, associated symptoms, and potential exposures to infections. During the physical exam, the provider will feel the lymph nodes to assess their characteristics and check for other signs of illness, such as a sore throat or skin infection.
If the initial evaluation doesn’t point to a clear cause, blood tests are the next step. A complete blood count (CBC) can reveal signs of infection or abnormalities that might suggest a blood-related cancer like leukemia. Specific blood tests can also look for antibodies to viruses like Epstein-Barr or for markers of inflammation in the body.
Imaging studies are used to get a better look at the lymph nodes and surrounding structures. An ultrasound can help determine the size of the nodes and their internal structure. A computed tomography (CT) scan provides detailed images that can reveal enlarged nodes deep within the chest or abdomen. For suspected cancer, a positron emission tomography (PET) scan is used to detect areas of high metabolic activity, which is characteristic of cancer cells.
The definitive way to determine the cause of persistent or suspicious lymph node enlargement is a biopsy. This procedure involves taking a tissue sample from the node for examination under a microscope. A fine-needle aspiration uses a thin needle to withdraw cells, while a core needle biopsy removes a small cylinder of tissue. An excisional biopsy, where the entire lymph node is surgically removed, may be necessary for an accurate diagnosis.
Treatment Approaches
Treatment for nodal disease depends on its underlying cause. When the swelling is due to a bacterial infection, such as strep throat or a skin infection, antibiotics are the standard treatment. For nodal disease caused by common viral infections like the cold or mononucleosis, treatment is supportive, focusing on rest, hydration, and managing symptoms as the body’s immune system clears the virus.
If the nodal disease is caused by cancer, treatment is tailored to the specific type and stage of the cancer. For lymphomas, treatment may involve chemotherapy, radiation therapy, immunotherapy, or targeted therapy. When cancer has spread to the lymph nodes from another part of the body, treatment will focus on the primary cancer and may include surgery to remove the affected nodes, followed by chemotherapy or radiation.
In cases where nodal disease is a manifestation of an autoimmune condition like rheumatoid arthritis or lupus, the focus of treatment is on managing the underlying disease. This involves medications that suppress or modulate the immune system’s activity. Corticosteroids may be used to reduce inflammation throughout the body, including in the lymph nodes. Other immunosuppressant drugs might be prescribed to control the autoimmune response.