Did you know there are about 200 lymph nodes throughout the neck? They are your head and neck’s defence mechanism against infection, trauma and even cancer and frequently enlarge when your body is fighting these diseases. The commonest sites in the neck are just below the angle of the jaw bone and further down at the nape of the neck. Lymph nodes that are greater than about 1 cm that persist for more than 2 weeks need further investigation, although reassuringly most of these will be harmless (reactive).
The commonest causes include:
- Acute (short lived) infections include: viral or bacterial upper respiratory tract infections including tonsillitis and glandular fever
- Chronic (long standing) infections include: Tuberculosis, atypical mycobacteria (mainly in children), HIV and associated infections. Other infections like toxoplasmosis or bartonella which in these cases can be transmitted from cats.
- Generalised rheumatological disorders with multiple symptoms in other parts of the body including the joints and blood vessels: sarcoidosis and autoimmune conditions like systemic lupus erythematosus.
The most important condition to exclude however is cancer. Almost all cancerous growths in the head and neck spread via the neck lymph nodes. When this happens the lymph nodes that contain tumour cells are called metastases. Common “primary” sites (sites of origin) for metastases in the head and neck include the mouth, tonsils, base of tongue, sinuses, voice box (larynx), thyroid and salivary glands.
Skin cancers of the head and neck, such as squamous carcinoma or malignant melanoma may also metastasise to the neck lymph nodes. Lymph node metastases that appear low in the neck can originate from other areas in the body such as breast, lung or bowel.
The commonest type of cancer in younger people are lymphomas or leukaemia. These cancers originate within the lymph nodes themselves or from blood or bone marrow cells.
Because of this vast differential diagnosis, it is important to be seen by an ENT consultant with experience in head and neck surgery. It is important that a full examination of the head and neck, including endoscopic examination of the interior of the nose, tongue, the upper swallowing apparatus and the voice box (or larynx) is performed to check the common sites from which tumours may originate.