# Swollen Lymph Nodes (Lymphadenopathy) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class BS01 - condition scope only, no dose · Lymphadenopathy - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK513250/ · No dose - referral pathway, no medicine given in primary care · Lymphadenopathy - StatPearls - NCBI Bookshelf - disease-level clinical article (lymphadenopathy-full.txt) - Verified date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care - Lymphadenopathy - StatPearls - NCBI Bookshelf - disease-level clinical article (lymphadenopathy-full.txt) ## Treatment metadata - No drug therapy in primary care (Referral & Advice) ## Complete treatment card ```text SWOLLEN LYMPH NODES (LYMPHADENOPATHY) Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class BS01 - condition scope only, no dose · Lymphadenopathy - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK513250/ · No dose - referral pathway, no medicine given in primary care · Lymphadenopathy - StatPearls - NCBI Bookshelf - disease-level clinical article (lymphadenopathy-full.txt) Review status: REVIEWED against 2 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - Swelling past 3 weeks counts as chronic; under 2 weeks or beyond a year is usually benign - Fever, chills, sweating at night, losing weight and tiredness alarm when nodes are widespread [chills · fatigue · fever · night sweats · weight loss] - The same complaints are unremarkable alongside neck nodes with flu or strep - Pain may come from inflammation, perforation, or bleeding into a necrotic malignant node [bleeding · necrosis] - Whether a node hurts does not reliably separate cancer from benign disease SIGNS - what you find (9) - Generalised means nodes in 2 or more separate, non-touching regions - Firm rubbery nodes lean towards lymphoma, softer ones towards infection, stony hard ones towards cancer - Shotty nodes are small scattered lumps like shot pellets, usual in a child with a viral illness - Matted nodes, clustered and apparently fused, favour malignancy without proving it - A right supraclavicular node drains the mediastinum, lungs and oesophagus - Submandibular nodes take drainage from tongue, lips, mouth and conjunctiva - Posterior cervical nodes reflect the scalp, neck and skin of the limbs - Axillary nodes cover the arm, chest wall and breast - Inguinal nodes serve the genitals, perineum, buttock, lower abdominal wall and lower anal canal TESTS (12) - For unexplained widespread nodes, start with a full blood count plus manual differential and mononucleosis serology - White cell count and differential point towards bacterial, viral or fungal causes - ESR measures inflammation but settles nothing on its own - EBV serology confirms glandular fever behind regional nodes - Bartonella henselae serology identifies cat-scratch disease - Second-line panel: PPD, RPR, chest x-ray, ANA, hepatitis B surface antigen and HIV - Chest x-ray can expose tuberculosis, pulmonary sarcoidosis or a lung tumour - Colour Doppler tells long-standing nodes from newly active ones by their vessel pattern - On ultrasound, a low long-to-short axis ratio signals lymphoma or metastatic cancer - Tuberculosis heads the causes of both regional and widespread nodes outside industrialised countries - Unexplained local nodes carrying no malignancy risk can be watched for 3 to 4 weeks - Where results stay unclear, biopsy the most abnormal node IF NOT THIS - what else fits (12) - Mononucleosis - HIV infection - Tuberculosis - Typhoid fever - Syphilis - Cat scratch disease - Drug reaction, among them allopurinol, carbamazepine, phenytoin and hydralazine - Acute leukaemia - Hodgkin lymphoma - Non-Hodgkin lymphoma - Sarcoidosis - Systemic lupus erythematosus Source StatPearls "Lymphadenopathy" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE) [1st line] Adult Swollen glands are usually reactive to a nearby infection and settle with treatment of the cause. GP treats presumed bacterial lymphadenitis and gives analgesia, but refers if a node is hard, fixed, painless, persistent, or accompanied by systemic symptoms suggestive of lymphoma or TB. - Refer, with advice Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why Swollen glands are usually reactive to a nearby infection and settle with treatment of the cause. GP treats presumed bacterial lymphadenitis and gives analgesia, but refers if a node is hard, fixed, painless, persistent, or accompanied by systemic symptoms suggestive of lymphoma or TB. Caution No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to. A supraclavicular node is almost always a sign of an underlying chest or abdominal malignancy. Review the medication list before working a node up - allopurinol, atenolol, captopril, carbamazepine, cephalosporins, gold, hydralazine, penicillin, phenytoin, primidone, quinidine, sulfonamides and sulindac all cause lymphadenopathy. Where there is any risk of malignancy or serious illness, go straight to biopsy rather than observing. Node texture guides the differential: firm rubbery nodes suggest lymphoma, soft nodes infection or inflammation, and hard stony nodes cancer, most often metastatic. Pain, or its absence, does not reliably separate a malignant node from a benign one. Nodes clustered and matted together strongly indicate significant pathology. Size thresholds differ by site - in an adult, an epitrochlear node above 0.5 cm is already pathological. Adenopathy lasting more than three weeks counts as chronic. RED FLAG - A node larger than 2 cm persisting beyond 4 to 6 weeks, a hard or immobile node, painless enlargement, generalised (multi-site) lymphadenopathy, or fever, night sweats or weight loss alongside the node. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)