From the Guidelines
Enlarged cervical lymph nodes are most commonly caused by infections, autoimmune conditions, or malignancies, and a thorough evaluation is necessary to determine the underlying cause and guide treatment. The causes of enlarged cervical lymph nodes can be broadly categorized into infectious, autoimmune, and malignant etiologies. Infectious causes include viral upper respiratory infections, strep throat, mononucleosis, and dental infections, as well as tuberculosis, HIV, and cat scratch disease 1. Autoimmune conditions like rheumatoid arthritis and lupus can also trigger lymph node enlargement as part of the body's inflammatory response. Malignancies, including lymphoma, leukemia, and metastatic cancers from the head and neck region, are important but less common causes that require prompt evaluation, as seen in Hodgkin's lymphoma, where most patients initially present with enlarged cervical lymph nodes 1. Some key points to consider when evaluating enlarged cervical lymph nodes include:
- Duration of symptoms (acute vs. chronic)
- Associated symptoms (fever, weight loss, night sweats)
- Node characteristics (size, tenderness, mobility)
- Patient risk factors Nodes larger than 1 cm, those that are hard, fixed, or painless, or those persisting beyond 2-4 weeks warrant further investigation, which may include blood tests, imaging studies like ultrasound or CT scan, and sometimes a biopsy for definitive diagnosis 1. Treatment depends on the underlying cause, ranging from observation for viral infections to antibiotics for bacterial infections or specific therapies for autoimmune or malignant conditions, and in the case of Hodgkin's lymphoma, may involve combined chemoradiotherapy consisting of two cycles of ABVD (doxorubicin/bleomycin/vinblastine/dacarbazine) for patients with early favorable disease 1.
From the Research
Causes of Enlarged Cervical Lymph Nodes
- Infectious mononucleosis, caused by primary Epstein-Barr virus (EBV) infection, can lead to cervical lymph node enlargement, as well as sore throat, fatigue, and fever 2
- Autoimmune diseases, such as rheumatoid arthritis and systemic lupus erythematosus, can also cause enlarged cervical lymph nodes due to the immune system's abnormal response 3, 4, 5
- Infections, including tuberculosis, can increase the risk of enlarged cervical lymph nodes in individuals with autoimmune diseases like systemic lupus erythematosus 6
- Lymphoma, a type of cancer, can also cause enlarged cervical lymph nodes, and individuals with rheumatoid arthritis have a greater risk of developing lymphoma 4