LYMPHADENOPATHY

Enlarged lymph glands may be an important indicator of haematological disease but they are not uncommon in reaction to infection or inflammation. Reactive nodes usually expand rapidly and are painful, whereas those due to haematological disease are more frequently painless. Localised nodes should elicit a search for a source of inflammation in the appropriate drainage area: the scalp, ear, mouth, face or teeth for the neck; the breast for the axilla; and the perineum or external genitalia for inguinal nodes. Generalised lymphadenopathy may be secondary to infection, connective tissue disease or extensive skin disease but is more likely to signify underlying haematological malignancy. Weight loss and drenching night sweats which may require a change of night clothes are associated with haematological malignancies, particularly lymphoma.

Initial investigations in lymphadenopathy should include an FBC (to detect neutrophilia in infection or evidence of haematological disease), an ESR and a chest X-ray (to detect mediastinal lymphadenopathy). If the findings suggest malignancy, a formal cutting needle or excision biopsy of a representative node is indicated to confirm a histological diagnosis .